편측안면경련 환자에서 미세혈관감압술후 초래된 지연성 안면신경마비
Delayed Facial Palsy Following Microvascular Decompression in Hemifacial Spasm Patients
소속 상세정보
김범태/Bum Tae Kim
황선철/장재칠/신원한/최순관/변박장/Sun Chul Hwang/Jae Chil Chang/Won Han Shin/Soon Kwan Choi/Bark Jang Byun
KMID : 0359819990280091332
Abstract
결론
편측안면경련에 대한 미세혈관감압술후 합병증으로서 초래된 지연성 안면신경마비의 발생
빈도는 약 8.3%정도로서 그 시기는 수술후 6일∼11일 사이에 발생했다. 발생기전은 확실하
지는 않으나 안면신경기시부의 과도한 조작, Teflon에 의한 진행성 신경부종 등으로 생각되
며, 예후는 양호하였다.
#초록#
Objective : Microvascular decompression(MVD) for hemifacial spasm(HFS) is we11
established. However delayed postoperative facial palsy has not been substantially
reported. The authors reviewed patients with HFS who underwent MVD in our
institution to evaluate the post-operative courses with special attention to the
development of delayed facial palsy.
Methods : Records of 144 cases(137 patients) from 1988 to 1997 were reviewed of
these patients. 12(83%) developed delayed facial palsy. Follow-ups via chart and phone
records were available for 10 of 12 patients.
Results : Reviews of these 12 cases demonstrated that 3 men, 9 women of with
average age of 53(range 45-60) had delayed facial palsy. Among them. 2 had repeated
operation. The preoperative duration ol symptoms averaged 12 years(range 1-30) and 4
patients had mild preoperative weakness. All wens improved their HFS within 7 days
after MVD.
Offending vessels were anterior inferior cerebellar artery(AICA) in 7. Five of these
were meatal branches and 2 were sandwich typo compressions. One case was combined
compression of AICA and posterior inferiors cerebellar artery. Three to 7 pieces of
Teflon felt were necessary for the decompression of offender. The onset of weakness
occurred invariably between postoperative day 6 and 11. Two cases had associated
complications. The one was hearing loss and the other was meningitis accompanied by
cerebrospinal fluid otorrhea. Ten cases received steroids following the onset of their
facial palsies. Duration of follow up of 10 cases was 21months(3months-5years). Three
cases showed complete recovery at 4, 8 and 12 weeks, respectively. Four patients have
improved to House Grade Ⅱ at 5 weeks and remaining three showed continuing
improvement until last follow-up.
Conclusions : Delayed facial palsy following MVD in HFS patients is not uncommon,
being 8.3% in our series. It occurs consistently 1-2 weeks postoperatively. Possible
causes include facial nerve exit zone injury with Teflon felt or delayed facial nerve
edema. Spontaneous recovery usually occur within several weeks.
키워드
Microvascular decompression; Hemifacial spasm; Delayed facial palsy;
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