Lee Hyun-Seok, Park Kwan
Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea.
Department of Neurosurgery, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
Life (Basel). 2023 Oct 7;13(10):2021. doi: 10.3390/life13102021.
(1) Background: In cases of hemifacial spasm (HFS), there are various patterns related to the vascular compression of the facial nerve, including a very rare form that is seen when the offending vessel penetrates the facial nerve. However, there have been few reports in the literature regarding the associated surgical techniques and postoperative prognosis. (2) Methods: A retrospective review was conducted of 4755 patients who underwent microvascular decompression (MVD) surgery from April 1997 to June 2023. In total, 8 out of the 4755 patients (0.2%) exhibited a penetrating offending vessel; the medical and surgical records of these 8 patients were then analyzed. Surgery was then attempted to maximally decompress the penetrating offender. (3) Results: Seven out of the eight patients (87.5%) were spasm-free immediately after surgery, and one had only 10% residual spasm compared to their preoperative condition. That patient was also spasm-free one year later. Postoperative facial palsy occurred in one patient (12.5%) who was assessed as grade II in the House-Brackmann grading system. In another patient, the resection of a small facial nerve bundle did not result in facial palsy. There were no cases of hearing loss or other complications. (4) Conclusions: Decompressing the penetrating offender did not increase the incidence of facial palsy, and the prognosis for hemifacial spasms was good. Therefore, when a penetrating pattern was encountered during MVD surgery, decompression between the penetrating offender and the facial nerve may offer good results.
(1) 背景：在半面痉挛（HFS）病例中，存在多种与面神经血管压迫相关的模式，包括一种非常罕见的形式，即致病血管穿透面神经时所见的情况。然而，文献中关于相关手术技术和术后预后的报道很少。(2) 方法：对1997年4月至2023年6月期间接受微血管减压（MVD）手术的4755例患者进行回顾性研究。在4755例患者中，共有8例（0.2%）出现致病血管穿透；然后对这8例患者的医疗和手术记录进行分析。随后尝试进行手术，以最大程度地减压穿透性致病血管。(3) 结果：8例患者中有7例（87.5%）术后立即无痉挛，1例与术前相比仅有10%的残余痉挛。该患者在一年后也无痉挛。1例患者（12.5%）出现术后面神经麻痹，在House-Brackmann分级系统中评定为Ⅱ级。在另一例患者中，切除一小束面神经未导致面神经麻痹。没有听力丧失或其他并发症的病例。(4) 结论：减压穿透性致病血管并未增加面神经麻痹的发生率，半面痉挛的预后良好。因此，当在MVD手术中遇到穿透模式时，在穿透性致病血管与面神经之间进行减压可能会取得良好效果。
