Lemoine Émile, Obaid Sami, Létourneau-Guillon Laurent, Bouthillier Alain
Divisions of Neurosurgery, University of Montreal Health Center (CHUM), Montreal, Quebec, Canada.
Divisions of Radiology,, University of Montreal Health Center (CHUM), Montreal, Quebec, Canada.
J Neurosurg Case Lessons. 2021 Apr 26;1(17):CASE2138. doi: 10.3171/CASE2138.
Facial palsy is a rare, unexpected complication of temporal lobectomy (TL) for intractable epilepsy. Even without direct manipulation, the facial nerve fibers may be at risk of injury during supratentorial surgery, including TL.
The authors presented two cases of facial palsy after unremarkable TL. In the first case, the palsy appeared in a delayed fashion and completely resolved within weeks. In the second case, facial nerve dysfunction was observed immediately after surgery, followed by progressive recovery over 2 years. The second patient had a dehiscence of the roof of the petrous bone overlying the geniculate ganglion, which put the facial nerve at risk of bipolar coagulation thermal injury.
Two major mechanisms could explain the loss of facial nerve function after TL: surgery-related indirect inflammation of the nerve resulting in herpesvirus reactivation and delayed dysfunction (Bell's palsy) or indirect thermal damage to the geniculate ganglion through a dehiscent petrous roof.
面瘫是颞叶切除术（TL）治疗顽固性癫痫罕见的意外并发症。即使没有直接操作，在包括TL在内的幕上手术过程中，面神经纤维也可能有受伤风险。
作者报告了2例颞叶切除术后无异常但出现面瘫的病例。第一例中，面瘫呈延迟性出现，并在数周内完全恢复。第二例中，术后立即观察到面神经功能障碍，随后在2年内逐渐恢复。第二例患者膝状神经节上方的岩骨顶部有裂隙，这使面神经有受到双极电凝热损伤的风险。
两种主要机制可以解释颞叶切除术后面神经功能丧失的原因：与手术相关的神经间接炎症导致疱疹病毒再激活和延迟性功能障碍（贝尔面瘫），或通过岩骨顶部裂隙对膝状神经节造成间接热损伤。
