Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany.
Department of Neurosurgery, Cairo University, Cairo, Egypt.
Acta Neurochir (Wien). 2020 Jan;162(1):211-219. doi: 10.1007/s00701-019-04119-5. Epub 2019 Nov 21.
Hemifacial spasm is usually caused by arterial compression at the root exit zone of the facial nerve. However, other etiologies have been reported. The aim of this study was to analyze the frequency of other causes of hemifacial spasm.
Our prospectively maintained hemifacial spasm database containing all patients who underwent microvascular decompression (MVD) for hemifacial spasm from 2002 to 2018 was reviewed. All offending structures were identified and recorded by the surgeon at the time of surgery. Additionally, the operative videos were analyzed retrospectively.
MVD was performed in 353 patients. Arterial compression was the main cause of hemifacial spasm in 341 (96.9%) patients. Combined venous-arterial compression was seen in 7 (2.0%) patients. In one patient, the compression was from a large vein. In two patients, no compression was found. One patient who suffered from Bell's palsy many years previously had severe synkinesis and the other had facial tics. In two patients, the spasm was caused due to strangulation of the facial nerve by arachnoid bands. Long-term follow-up of more than 18 months was available in 249 patients with total resolution or near total resolution of spasms in 89.96% of patients.
In most patients with hemifacial spasm, arterial vessels are involved in compressing the facial nerve. Purely venous compression is rarely encountered. We report for the very first time arachnoid bands strangulating the nerve as a cause for hemifacial spasm without involvement of any vessel.
面肌痉挛通常由面神经神经根出口区动脉压迫引起。然而，也有其他病因的报道。本研究旨在分析面肌痉挛的其他病因的频率。
我们回顾性分析了 2002 年至 2018 年间所有因面肌痉挛接受微血管减压术（MVD）的患者的前瞻性维持的面肌痉挛数据库。手术时由外科医生确定并记录所有致病结构。此外，还对手术录像进行了回顾性分析。
对 353 例患者进行了 MVD。动脉压迫是 341 例（96.9%）患者面肌痉挛的主要原因。7 例（2.0%）患者存在动静脉联合压迫。1 例患者的压迫来自大静脉，2 例患者未发现压迫。1 例患者曾患有多年前的贝尔麻痹，有严重的联带运动，另 1 例患者有面部抽搐。2 例患者的痉挛是由于蛛网膜带缠绕面神经引起的。249 例患者的长期随访时间超过 18 个月，89.96%的患者痉挛完全或几乎完全缓解。
在大多数面肌痉挛患者中，动脉血管参与压迫面神经。很少遇到单纯静脉压迫。我们首次报告了蛛网膜带缠绕神经而不涉及任何血管引起面肌痉挛的病例。
