Seaman Scott C, Noeller Jennifer, Nourski Kirill, Hitchon Patrick W
Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States.
Surg Neurol Int. 2020 May 16;11:110. doi: 10.25259/SNI_95_2020. eCollection 2020.
Hemifacial spasm (HS) is a muscular disorder frequently exacerbated by arterial compression amenable to surgical intervention through microvascular decompression (MVD). Recurrence is a known cause and warrants investigation.
A 65-year-old woman presented with the left HS of 7 years duration. Her symptoms were initially well controlled with botulinum toxin injections. However, these injections eventually lost their effectiveness, necessitating MVD. At surgery, the anterior inferior cerebellar artery was indenting the facial nerve at its root entry zone. This was carefully dissected away, and several Teflon (polytetrafluoroethylene) felt pledgets were used for decompression. Postoperatively, the patient reported great improvement of her symptoms for 3 months. Gradually her spasms returned, intermittently at first, until finally they became persistent 6 months postoperatively. An MRI was obtained showing elevation and posterior displacement of the VII-VIII complex by the pledgets. After failing to improve, the patient opted for reoperation 10 months after initial MVD. At surgery, the Teflon pledgets were displacing the VII-III nerves posteriorly and superiorly. The Teflon pledgets were dissected free, and the nerve dis-impacted. On her postoperative visit 1 year later, she is spasm free, subjectively, and objectively.
This case illustrates the value of re-imaging recurrent HS, and re-exploration with a favorable rkesult.
面肌痉挛（HS）是一种肌肉疾病，常因动脉压迫而加重，可通过微血管减压术（MVD）进行手术干预。复发是一个已知原因，值得研究。
一名65岁女性，患有持续7年的左侧面肌痉挛。她的症状最初通过注射肉毒杆菌毒素得到很好的控制。然而，这些注射最终失去了效果，需要进行微血管减压术。手术中，小脑下前动脉在面神经根部入口区压迫面神经。小心地将其分离，并使用几块特氟龙（聚四氟乙烯）棉片进行减压。术后，患者报告症状在3个月内有很大改善。逐渐地，她的痉挛又复发了，起初是间歇性的，直到术后6个月最终变得持续。进行了磁共振成像（MRI）检查，显示棉片导致VII - VIII神经复合体抬高和向后移位。在症状没有改善后，患者在初次微血管减压术后10个月选择再次手术。手术中，特氟龙棉片将VII - III神经向后上方移位。将特氟龙棉片分离，解除神经压迫。在术后1年的随访中，她主观和客观上均无痉挛。
本病例说明了对面肌痉挛复发进行再次成像以及再次探查并取得良好结果的价值。
