Nagata S, Matsushima T, Fujii K, Fukui M, Kuromatsu C
Department of Neurosurgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Surg Neurol. 1992 Sep;38(3):204-9. doi: 10.1016/0090-3019(92)90170-r.
The authors report eight cases of so-called symptomatic hemifacial spasm. They had gross pathological lesions such as a tumor (one epidermoid, one neurinoma, and two meningiomas), vascular malformation (one medullary venous malformation and two arteriovenous malformations), and aneurysm. In all four cases with a tumor, no artery compressed the facial nerve at the root exit zone. In three of the four cases, the hemifacial spasm disappeared after removal of the tumor in contact with the facial nerve. Compression or encasement of the facial nerve by the tumor was the pathogenesis of the hemifacial spasm in these three cases. The remaining case with tumor (tentorial meningioma) did not have a mass or vessel that directly compressed the facial nerve at the root exit zone. However, the hemifacial spasm disappeared after the removal of the tumor. In a case with a medullary venous malformation with arterial component, an engorged draining vein compressed the root exit zone of the facial nerve. In the remaining three vascular cases--two cases of arteriovenous malformation and a case of saccular aneurysm--enlarged feeding arteries and an aneurysm directly compressed the root exit zone of the facial nerve. Not only arterial or venous but also mass compression can cause hemifacial spasm in some symptomatic cases. Surgical decompression of the facial nerve from the causative organic lesion is the primary choice of treatment.
作者报告了8例所谓的症状性半面痉挛病例。他们存在肉眼可见的病理病变，如肿瘤（1例表皮样囊肿、1例神经鞘瘤和2例脑膜瘤）、血管畸形（1例髓静脉畸形和2例动静脉畸形）以及动脉瘤。在所有4例有肿瘤的病例中，在面神经根部出口区没有动脉压迫面神经。在4例中的3例中，与面神经接触的肿瘤切除后，半面痉挛消失。在这3例中，肿瘤对面神经的压迫或包绕是半面痉挛的发病机制。其余有肿瘤的病例（小脑幕脑膜瘤）在面神经根部出口区没有直接压迫面神经的肿块或血管。然而，肿瘤切除后半面痉挛消失。在1例伴有动脉成分的髓静脉畸形病例中，一条扩张的引流静脉压迫了面神经根部出口区。在其余3例血管性病例中——2例动静脉畸形和1例囊状动脉瘤——增粗的供血动脉和动脉瘤直接压迫了面神经根部出口区。在一些症状性病例中，不仅动脉或静脉，而且肿块压迫也可导致半面痉挛。从引起病变的器质性病变对面神经进行手术减压是主要的治疗选择。
