山梨医科大学雑誌　第1巻4号　115-122(1986)

＜原著＞半側顔面痙攣の手術成績を左右する因子の臨床的検討

永関慶重，掘越　徹，宮沢伸彦，
松川　隆，八木下勉，深町　彰，
貫井英明

抄　録：半側顔面痙攣に対する神経血管減圧術はその高い治癒率から現在その治療法はほぼ確立された。しかし未だに手術効果の不完全な例も有り，これについて検討した報告例はまだ見あたらない。今回我々は半側顔面痙攣に対して行った神経血管減圧術例40例の追跡調査を行い手術効果の不完全な例に注目し，手術成績を左右する因子を把握する目的で種々な観点から検討を行った。検討した因子は既往歴，年齢，罹病期間，術前のfacial nerve blockの有無，術前，術中及び術後聴性脳幹反応の比較，圧迫血管の種類，及び術後合併症の7項目とした。手術結果は追跡調査結果より4型に分類された。顔面痙攣の残存した例は40例中9例で，術前の程度と比較すると1例が完全に再発したのみで残りの8例の残存度は術前の半分以下で平均32%であった。これらの顔面痙攣が残存した例と消失した31例とを7つの因子について比較検討した結果，年齢が60歳以上の16例中顔面痙攣が残存した例は7例であり，統計学的有意差を認めた(P<0.05)。また，年齢が60歳以上で尚かつ罹病期間が6年以上の12例中6例に残存を認め P<0.025で明かな有意差を認めた。他の5つの因子については明かな有意差が認められなかった。以上より顔面痙攣に対する神経血管減圧術の効果は，手術年齢及び罹病期間に左右され，これは顔面痙攣患者の手術時期の一つの目安となり，血管が神経を圧迫する時間的あるいは血管の器質的関係，更に神経の可塑性によると考えられた。

キイワード　半側顔面痙攣，神経血管減圧術



An Analysis of Clinical Factors Affecting Results of Microvascular Decompression to Hemifacial Spasm

Yoshishige Nagaseki, Tohru Horikoshi, Nobuhiko Miyazawa,
Takashi Matsukawa, Tsutomu Yagishita, Akira Fukamachi
and Hideaki Nukui

To evaluate factors influencing the effects of the microvascular decompression for hemifacial spasm, we conducted follow-up and retrospective studies. The follow-up period ranged from one month to two years (mean 13.8 months). In forty patients, 40 microvascular decompressions were carried out. The effects on the hemifacial spasms were classified clinically and electromyographically into 4 types. In 31 cases, 20 spasms were completely abolished after operation and the effect was maintained (Type 1). The other 11 spasms (Type 2) were partially subsided postoperatively and disappeared from 3 to 90 days (mean 40 days). In 9 cases, hemifacial spasms were noted during the follow-up sudy. Although 2 spasms were completely abolished after operation, they recurred partially or completely in the early postoperative period (Type 3). In the remaining 7 cases, spasms were observed both after operation and during follow-up (Type 4). Based on these results, we retrospectively examined 7 items (past history, age, duration of disease, whether treated by facial nerve block or not, latency of ABR, kinds of compressed vessel, and postoperative complications). Residual spasms were in 7 patients of 16 patients over 60-years-old and in 2 of 24 patients under 60-years-old (p<0.05). Furthermore, residual spasms were seen in 6 of 12 patients over 60-years old whose duration of disease was over 6 years (p<0.025). No significant shifts were noted in the other 5 items. From these results, we conclude that age and the duration of disease influence the effects of microvascular decompression. These 2 factors appear to play important roles in vessel compression, which may be related to the genesis of facial nerve injury.

Key words: hemifacial spasm, microvascular decompression



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