Miller Larry E, Miller Valerie M
Miller Scientific Consulting, Inc., Arden, NC 28704, USA.
Br J Neurosurg. 2012 Aug;26(4):438-44. doi: 10.3109/02688697.2011.641613. Epub 2011 Dec 15.
Hemifacial spasm (HFS) is caused by vascular compression of the VII cranial nerve at its root exit zone from the brainstem. Microvascular decompression (MVD) is the only treatment option that offers the prospect of a definitive cure for HFS. We conducted the first systematic review on the safety and effectiveness of MVD for the treatment of HFS.
English-language studies on MVD for HFS published from 2000 to present were retrieved and summarized. The primary outcomes of interest were treatment success, recurrence rate and adverse events including mortality, stroke, cerebrospinal fluid leak, facial palsy (permanent and transient) and hearing deficit (permanent and transient).
Twenty-two papers representing 5685 patients treated with MVD for HFS were included in this review. Complete resolution of symptoms following MVD was reported in 91.1% of patients over a median 2.9-year follow-up period. HFS symptoms recurred in 2.4% of patients and 1.2% underwent repeat MVD during the follow-up period. Transient complications included facial palsy (9.5%), hearing deficit (3.2%) and cerebrospinal fluid leak (1.4%). Permanent complications included hearing deficit (2.3%), facial palsy (0.9%), stroke (< 0.1%) and death (< 0.1%).
MVD successfully relieves HFS in approximately 9 of 10 patients with low rates of symptom recurrence. Complications of this surgery are uncommon and generally transient.
面肌痉挛（HFS）是由位于脑干的第七颅神经根部出口区受到血管压迫所致。微血管减压术（MVD）是唯一有望根治面肌痉挛的治疗选择。我们首次对面肌痉挛微血管减压术的安全性和有效性进行了系统评价。
检索并总结了2000年至今发表的关于面肌痉挛微血管减压术的英文研究。主要关注的结果指标为治疗成功率、复发率及不良事件，包括死亡率、中风、脑脊液漏、面神经麻痹（永久性和暂时性）以及听力减退（永久性和暂时性）。
本评价纳入了22篇论文，共5685例接受面肌痉挛微血管减压术治疗的患者。在中位2.9年的随访期内，91.1%的患者微血管减压术后症状完全缓解。随访期间，2.4%的患者面肌痉挛症状复发，1.2%的患者接受了再次微血管减压术。暂时性并发症包括面神经麻痹（9.5%）、听力减退（3.2%）和脑脊液漏（1.4%）。永久性并发症包括听力减退（2.3%）、面神经麻痹（0.9%）、中风（<0.1%）和死亡（<0.1%）。
微血管减压术能使约十分之九的患者成功缓解面肌痉挛，症状复发率低。该手术的并发症并不常见，且一般为暂时性。
