Tangdu Hospital microvascular decompression cure involuntary tics "hemifacial spasm"

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One side of the face of involuntary convulsions, and convulsions were paroxysmal, irregular, varying degrees, susceptible to emotional influ


One side of the face of involuntary convulsions, and convulsions were paroxysmal, irregular, varying degrees, susceptible to emotional influence, emotional tension, anxiety, it will increase. This is the hemifacial spasm. Often occur in the elderly, and the majority of female patients, to the patient's life and social problems.

The medication is not good for hemifacial spasm, microvascular decompression can be used to cure. This method is the only method that can completely cure hemifacial spasm. Here is an example of microvascular decompression for hemifacial spasm cases, surgery of Tangdu Hospital of The Fourth Military Medical University Department of Neurosurgery director Wang Xuelian function. For hemifacial spasm patients and their families for reference.

Records of patients admitted to the first course of hemifacial spasm

Patients with Yang, female, 46 years old, a native of Shaanxi, the main cause of the left facial recurrent paroxysmal involuntary twitching of more than one year in 2013-03-11 hospital.

Case characteristics: the main clinical manifestations were spontaneous involuntary twitching of the left side.

The initial diagnosis of hemifacial spasm: (left)

Diagnostic basis: 1, young women, aged 46 years, the course of more than 1 years. The main clinical manifestations and the left corner of the left corner of the eye muscles repeatedly involuntary twitching, paroxysmal, frequent seizures, no obvious pain; 2, check the body is visible on the left eye and left mouth involuntary slight twitch, at the same time, paroxysmal. The left eye fissure is narrower than the right side. No obvious positive sign was found in the remaining nervous system. According to the typical clinical manifestations, consider hemifacial spasm.

Differential diagnosis: 1. Focal motor epilepsy. Although there are limitations of hemifacial spasm, but the twitch range is larger, more spread to the head and neck, limbs, facial instrument limitations are rare. EEG can have epileptic wave, such as sharp wave, spike wave, spike slow wave, etc.. 2, the habit of hemifacial spasm. It is common in children and young adults, and it can be controlled by bilateral eyelids. 3, chorea. There is more bilateral hemifacial spasm, but involuntary movement, often accompanied by the trunk and limbs. Other clinical manifestations of this disease are presented in view of rheumatic and hereditary chorea.

The treatment plan: 1, improve hematuria stool, liver and kidney function, blood glucose, blood lipids, electrolytes, coagulation test, electrocardiogram, chest X-ray, perfect echocardiography, cranial MRI examination; 2, if there is no contraindication to surgery, elective.

Patient physician Wang Xuelian recorded before operation

The general condition of the patient is good, clear consciousness, mental state is good, sleep good diet. Check with. Patients did not complain of special discomfort. After admission, the head MRI scan showed that the left side of the auditory nerve vascular ride, no significant abnormalities in the plain brain parenchyma. Liver and kidney function, coagulation function, electrolyte, blood glucose were normal. No obvious abnormality of ECG and chest X-ray examination. There was no absolute contraindication for preoperative examination.

Chief physician Wang Xuelian rounds, a detailed view of patient instructions: patients are generally in good condition, according to the examination of typical clinical manifestations and radiological diagnosis of left definite hemifacial spasm. There was no obvious contraindication of surgery before operation, and the operation of facial nerve decompression was performed. The operation of possible risks and complications, such as detailed communication to patients and their families, such as patients and their families to understand and agree to surgical treatment, willing to take the risk of surgery, elective surgery, active preparation. Ordered to perform,

The doctors have patients with hemifacial spasm Yang disease preoperative discussion

Location: undergraduate office.

Participants: Gao Guodong, director, deputy director of the physician, Dr. Wang Jing, chief physician, chief resident of the hospital, Dr. Li Nan, all residents, doctors and graduate students, such as.

Moderator: Wang Xuelian, deputy director of physicians

Case report: Li Jiaming, (report records omitted), before the general condition of the patient is on the left side of the face of patients before, in addition to involuntary twitching, no special discomfort. There was no absolute contraindication of surgery.

Dr. Wang Jing: Patients with more than one year, the main clinical manifestations were repeatedly paroxysmal involuntary left facial spasm, no pain, with hemifacial spasm. Check the body to see the left corner of the eye and the left side of the tongue involuntary twitching, frequent attacks, simultaneous occurrence of paroxysmal. Cranial MRI showed that the left side of the auditory nerve to the region of the blood vessels to ride across the intracranial space occupying. After admission to improve the inspection, no absolute contraindication. Surgical indications, surgical treatment.

Director Wang Xuelian: according to the medical history, physical examination and imaging examination, the diagnosis of hemifacial spasm with clear surgical indications, surgical. Hemifacial spasm caused mainly by vascular compression of the nerve may also be caused by nerve adhesion, according to the intraoperative findings seen for vascular decompression or facial nerve neurolysis, alleviate the condition. Actively improve preoperative preparation, blood preparation. Review of blood, such as neutrophils is still low, may be appropriate to give Ruibai treatment leukogenic risk, reduce postoperative infection. Before the operation to patients and their families account for risk and complications that may exist in the patients and their family members fully understand and agree to surgery, scheduled for surgical treatment, signed the consent form and consent to a blood transfusion.

Director Gao Guodong: now clear of patients with hemifacial spasm patients, positive surgical treatment will, surgical treatment can be. The operation was performed by the left suboccipital retrosigmoid approach, which was easy to reveal the anatomical structure of the left cerebellopontine angle region. The location of the operation is deep, and there are important neurovascular structures in the region. The operation is difficult, the chance of injury is great, and it is possible to injure the important nerve vessels. Such as the injury of vascular hemorrhage, may appear difficult to stop bleeding or bleeding after severe cerebral infarction caused by serious complications. Therefore, the operation can not be forced surgery, the need to pay attention to protect the vascular nerves, careful operation to avoid injury. In addition, when the facial nerve long pressed, even if the operation to remove the blood vessels, the symptoms may not immediately ease, the need to explain to patients and their families.

Comprehensive opinion: hemifacial spasm patients with clear diagnosis, surgical indications, surgical treatment can be. But the operation is difficult, the risk is big, need to be careful to operate, as far as possible to avoid the damage of important nerves, blood vessels. Preoperative assessment; 1, operation by left suboccipital retrosigmoid surgery in the preoperative marker marker; 2, patient, clear diagnosis of hemifacial spasm, underwent facial nerve vascular decompression, surgical exploration with nature, the specific operation mode according to the situation in operation; 3, in general. Good nutrition; 4, heart lung liver and other important organs function had no obvious abnormalities; 5, no other system diseases and infection: 6, has completed the preparation before surgery, surgical consent, consent to a blood transfusion, anesthesia consent signed; 7, evaluation of anesthesia (ASA grade 2), without anesthesia special requirements; 8, pay attention to protect blood vessels and nerves in the surgery, not reluctantly surgery, observe the vital signs of patients pay attention to postoperative, timely review of head CT, to observe the postoperative situation, found problems in a timely manner; 9, surgical resection Mouth cleanliness: I class incision (clean surgery): 10, the operation time is expected to exceed 3 hours, preoperative antibiotic prophylaxis.

Surgery chief physician Wang Xuelian and the anesthesiologist preoperative checking record

With the spirit, rest, no discomfort, check with. By positive preoperative preparation, the examination has been improved. After the preoperative discussion, the facial nerve vascular decompression. The anesthesiologist has seen patients, anesthesia accidents and complications may occur in the families of patients that. Patient physician Wang Xuelian see the patient, medical accidents and complications and explain to patients and their families during and after surgery may occur, patients' families understand that. Patients and their families agreed to surgical treatment, has been signed on the consent of the surgery and anesthesia consent. Operation orders have been under the supervision of the doctor's orders.

On the day of surgery for patients with hemifacial spasm were recorded: chief physician Wang Xuelian date: 2013-03-14

Patients with vascular decompression today, operation time: 16:05, back ward time: 18:15. The preoperative diagnosis of hemifacial spasm (left), anesthesia methods: general anesthesia, intraoperative anesthesia satisfaction, smooth operation process, the responsible vessels found during the operation, careful separation and implant felt gasket. There was no normal organ injury, hemostasis was complete, and the expected effect was achieved. The name and quantity of the indwelling catheter: a epidural drainage tube. Intraoperative blood loss: About 200ml, blood volume: No, fluid volume: 1600ml.

The recovery of postoperative patients with hemifacial spasm records

The first day after the surgery, patients recovery from general anesthesia, conscious, mental state. Call can be able to answer the question correctly. The patient had no obvious headache, and complained of dizziness, nausea and so on. Dry dressing head fixed, no bleeding, head of epidural drainage, postoperative blood routine examination showed yesterday, the white blood cell and neutrophil counts more than normal, normal. Active electrolyte, blood glucose monitoring, etc.. No significant abnormal bleeding was observed in the left cerebellopontine angle area of the head CT, and a small amount of subdural hematoma was found in the left occipital region.

Chief physician Wang Xuelian rounds, a detailed view of patient instructions: Patients with stable condition after surgery, the day before the general conditions can still continue to give hemostasis, nutritional support, nerve nutrition and supportive treatment. Attention to bed rest, proper elevation of the head. Patients may appear vertigo, vomiting and other symptoms in the short term, pay attention to observation and symptomatic treatment. Patients with a small amount of subdural hematoma after surgery may be caused by the release of cerebrospinal fluid when the operation is too fast decompression, the need for close observation, attention to review. Turn to the general ward to continue treatment. As requested, the concept of condition changes.

Second days after operation, patients in good general condition, conscious, good mental state, stable vital signs, no fixed head dry dressing, exudation, head of drainage, with no headache, nausea and other discomfort. Postoperative patients did not feel the left facial tic. This review of blood white cells and neutrophils,

Chief physician Wang Xuelian rounds after instructions: Patients with good general condition, eating liquid diet patients, pay attention to rest in bed, following the concept of condition changes.

Third days after operation, patients in good general condition, conscious, mental state is good. At present, eating liquid diet, good night sleep. There was no obvious dizziness, headache and other discomfort, and a slight pain in the incision. No nausea and vomiting. The left facial spasm did not occur again. Review of normal electrolytes, white blood cell and neutrophil counts were normal. The head dressing was dry and fixed without exudation. Yesterday to this morning, there was no drainage of epidural drainage, and the drainage of epidural drainage was performed. The incision was close to each other, and healed well. Routine dressing change.

Chief physician Wang Xuelian rounds after instructions: patients in good condition, continue to support treatment, patients should strengthen nutrition, before bed, and then gradually get out of bed.

When the discharge of patients with hemifacial spasm records

The general condition of the patient is good, conscious, good mental state, stable vital signs, normal body temperature, diet and sleep, urine normal. At present, patients can get out of bed activity, no special discomfort. Postoperative left facial tics did not occur again. Dry dressing head fixed, no leakage, can be.

Wang Xuelian, chief physician rounds: indicating patients in good general condition of wound healing, now stitches, can go through the discharge.

[interpretation] surgery of Tangdu Hospital of The Fourth Military Medical University by microvascular decompression for hemifacial spasm. Microvascular decompression is not only minimally invasive, but also very safe, less complications, no damage to the facial nerve tissue, facial nerve integrity and functional protection. Tangdu Hospital constantly improve the technology and surgical skills, so that the incidence of surgical complications to a minimum. Has cured numerous patients with hemifacial spasm, let them get rid of the pain, healthy life.

Source: four medical network encephalopathy



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