Na Boo Suk, Cho Jin Whan, Park Kwan, Kwon Soonwook, Kim Ye Sel, Kim Ji Sun, Youn Jinyoung
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Neuroscience Center, Samsung Medical Center, Seoul, Korea.
J Clin Neurol. 2018 Jul;14(3):303-309. doi: 10.3988/jcn.2018.14.3.303. Epub 2018 Apr 27.
Hemifacial spasm (HFS) is mostly caused by the compression of the facial nerve by cerebral vessels, but the significance of spasm severity remains unclear. We investigated the clinical significance of spasm severity in patients with HFS who underwent microvascular decompression (MVD).
We enrolled 636 patients with HFS who underwent MVD between May 2010 and December 2013 at Samsung Medical Center (SMC), Seoul, Korea. Subjects were divided into two groups based on spasm severity: severe (SMC grade 3 or 4) and mild (SMC grade 1 or 2). We compared demographic, clinical, and surgical data between these two groups.
The severe-spasm group was older and had a longer disease duration at the time of MVD compared to the mild-spasm group. Additionally, hypertension and diabetes mellitus were more common in the severe-spasm group than in the mild-spasm group. Regarding surgical findings, there were more patients with multiple offending vessels and more-severe indentations in the severe-spasm group than in the mild-spasm group. Even though the surgical outcomes did not differ, the incidence of delayed facial palsy after MVD was higher in the severe-spasm group than in the mild-spasm group. Logistic regression analysis showed that severe-spasm was correlated with longer disease duration, hypertension, severe indentation, multiple offending vessels, and delayed facial palsy after MVD.
Spasm severity does not predict surgical outcomes, but it can be used as a marker of pathologic compression in MVD for HFS, and be considered as a predictor of delayed facial palsy after MVD.
面肌痉挛（HFS）大多由脑血管对面神经的压迫所致，但痉挛严重程度的意义仍不明确。我们研究了接受微血管减压术（MVD）的HFS患者中痉挛严重程度的临床意义。
我们纳入了2010年5月至2013年12月在韩国首尔三星医疗中心（SMC）接受MVD的636例HFS患者。根据痉挛严重程度将受试者分为两组：重度（SMC 3级或4级）和轻度（SMC 1级或2级）。我们比较了这两组患者的人口统计学、临床和手术数据。
与轻度痉挛组相比，重度痉挛组患者年龄更大，MVD时病程更长。此外，重度痉挛组高血压和糖尿病的发生率高于轻度痉挛组。关于手术发现，重度痉挛组中存在多条责任血管的患者更多，压迹更严重。尽管手术结果无差异，但重度痉挛组MVD后迟发性面神经麻痹的发生率高于轻度痉挛组。逻辑回归分析显示，重度痉挛与病程较长、高血压、严重压迹、多条责任血管以及MVD后迟发性面神经麻痹相关。
痉挛严重程度不能预测手术结果，但它可作为HFS患者MVD中病理压迫的一个指标，并可被视为MVD后迟发性面神经麻痹的一个预测因素。
