Objective To study the causes of ineffectiveness of microvascular decompression (MVD) and need for reoperation in the treatment of hemifacial spasm (HFS). Methods Reoperative MVD was performed in 15 HFS patients undergoing previous ineffective MVD. In the patients, the main causes of ineffectiveness included mis-judgment of compressing vessels (5 cases), improper insertion of decompressing grafts (8 cases), improper selection of grafts (1 case) and small grafts (1 case). Results Symptoms of HFS disappeared immediately after reoperative MVD in 14 patients and the symptoms of HFS improved significantly in 1 patient which delayed for 1 month. No recurrence of HFS was found during the follow-up of 1.0~3.0 years (with a mean of 2.5 years). Conclusion MVD is an effective treatment for HFS. Exposing root exit Zone (REZ) during operation, accurately identifying the offending vessels, fully decompressing of REZ, as well as the size of graft and location of graft placed, are the important factors influencing surgical efficacy.%目的 探讨显微血管减压术治疗面肌痉挛无效并需再次手术的原因.方法 对15例经显微血管减压术治疗无效的面肌痉挛患者进行再次手术,发现责任血管判断失误致主要压迫血管遗漏5例；减压棉片插入位置不当,血管襟未离开面神经根部8例；减压材料选择及操作方法错误1例；责任血管粗大弯曲,而减压棉片过小致血管复位1例.结果 经第2次手术后14例患者症状立即消失,1例面部仍抽搐,在术后1个月消失.第2次术后所有患者经1～3年随访(平均2.5年),无一例症状复发.结论微血管减压术是面肌痉挛的首选治疗方法,面神经脑干区(REZ)的显露,准确判断责任血管,面神经REZ的充分减压,以及垫棉的大小和放置的位置等,是影响手术疗效的重要因素.
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