Liu Jiang, Yuan Yue, Fang Ying, Zhang Li, Xu Xiao-Li, Liu Hong-Ju, Zhang Zhe, Yu Yan-Bing
Departments of 1 Neurosurgery and.
International Medicine, China-Japan Friendship Hospital, Beijing, China.
J Neurosurg. 2016 Feb;124(2):397-402. doi: 10.3171/2015.3.JNS142501. Epub 2015 Sep 4.
Typical hemifacial spasm (HFS) commonly initiates from the orbicularis oculi muscle to the orbicularis oris muscle. Atypical HFS (AHFS) is different from typical HFS, in which the spasm of muscular orbicularis oris is the primary presenting symptom. The objective of this study was to analyze the sites of compression and the effectiveness of microvascular decompression (MVD) for AHFS.
The authors retrospectively analyzed the clinical data for 12 consecutive patients who underwent MVD for AHFS between July 2008 and July 2013.
Postoperatively, complete remission of facial spasm was found in 10 of the 12 patients, which gradually disappeared after 2 months in 2 patients. No recurrence of spasm was observed during follow-up. Immediate postoperative facial paralysis accompanied by hearing loss occurred in 1 patient and temporary hearing loss with tinnitus in 2. All 3 patients with complications had gradual improvement during the follow-up period.
The authors conclude that most cases of AHFS were caused by neurovascular compression on the posterior/rostral side of the facial nerve distal to the root entry zones. MVD is a safe treatment for AHFS, but the incidence of postoperative complications, such as facial paralysis and decrease in hearing, remains high.
典型的面肌痉挛（HFS）通常从眼轮匝肌开始，向口轮匝肌发展。非典型面肌痉挛（AHFS）与典型面肌痉挛不同，其主要表现症状是口轮匝肌痉挛。本研究的目的是分析AHFS的压迫部位及微血管减压术（MVD）的疗效。
作者回顾性分析了2008年7月至2013年7月期间连续12例行MVD治疗AHFS患者的临床资料。
术后，12例患者中有10例面部痉挛完全缓解，2例患者在2个月后逐渐消失。随访期间未观察到痉挛复发。1例患者术后立即出现面瘫伴听力丧失，2例出现暂时性听力丧失伴耳鸣。所有3例有并发症的患者在随访期间均逐渐好转。
作者得出结论，大多数AHFS病例是由面神经根部进入区远端后侧/嘴侧的神经血管压迫引起的。MVD是治疗AHFS的一种安全方法，但术后并发症如面瘫和听力下降的发生率仍然很高。
