Acevedo-González Juan Carlos, Taub-Krivoy Alex, Sierra-Peña Julian Alfonso, Lizarazo Julian Geronimo
Neurosurgeon Specialized in Functional Neurosurgery and Stereotaxic Surgery, Pain, and Spasticity Management, Full Professor at the Faculty of Medicine, Pontifical Javeriana University, San Ignacio University Hospital, Bogotá, Colombia.
Coordinator of the Research Group in Neurosurgery, Pontifical Javeriana University, Bogotá, Colombia.
World Neurosurg X. 2024 Sep 28;25:100406. doi: 10.1016/j.wnsx.2024.100406. eCollection 2025 Jan.
Primary Hemifacial Spasm (PHFS) significantly impacts quality of life, necessitating effective treatment like microvascular decompression of the facial nerve. This study aims to identify prognostic factors related to surgical treatment to enhance outcomes and minimize complications. A systematic review of literature from the past five years was conducted.
Following PRISMA guidelines, we systematically searched databases like PubMed, Embase, Scopus, Ovid, EBSCO, and Cochrane using keywords such as 'Hemifacial spasm,' 'Microvascular decompression,' 'Neurovascular conflict,' and 'Surgical techniques.' The search spanned January 2018 to November 2023. The 'Rayyan' program facilitated data compilation. Each author reviewed abstracts, applying inclusion criteria like systematic reviews, clinical trials, observational studies, and case series, while excluding theoretical or non-English articles.
Of 26 selected articles, those solely addressing PHFS treatment with botulinum toxin and lacking surgical procedure data were excluded. Thus, our analysis focused on 16 articles, including meta-analyses, systematic reviews, clinical trials, and observational studies.
Microvascular decompression at the cerebellar pontine angle is the mainstay treatment for hemifacial spasm. Despite limited statistically significant prognostic factors in the literature, overarching recommendations aim to improve outcomes, minimize complications, and prevent recurrences. Key considerations include surgeon expertise, precise techniques, thorough nerve exploration, identifying the conflict's cause, and intraoperative monitoring.
PHFS significantly impacts patients' lives, necessitating timely surgical intervention if initial treatments fail. While statistically significant prognostic factors may be lacking, this study highlights crucial considerations for successful treatment.
原发性面肌痉挛（PHFS）严重影响生活质量，需要进行有效的治疗，如面神经微血管减压术。本研究旨在确定与手术治疗相关的预后因素，以提高治疗效果并减少并发症。我们对过去五年的文献进行了系统综述。
遵循PRISMA指南，我们使用“面肌痉挛”、“微血管减压术”、“神经血管冲突”和“手术技术”等关键词，在PubMed、Embase、Scopus、Ovid、EBSCO和Cochrane等数据库中进行系统检索。检索时间跨度为2018年1月至2023年11月。“Rayyan”程序协助进行数据整理。每位作者对摘要进行评审，应用系统评价、临床试验、观察性研究和病例系列等纳入标准，同时排除理论性或非英文文章。
在26篇入选文章中，那些仅涉及肉毒杆菌毒素治疗PHFS且缺乏手术操作数据的文章被排除。因此，我们的分析聚焦于16篇文章，包括荟萃分析、系统评价、临床试验和观察性研究。
小脑脑桥角微血管减压术是面肌痉挛的主要治疗方法。尽管文献中具有统计学意义的预后因素有限，但总体建议旨在改善治疗效果、减少并发症并预防复发。关键考虑因素包括外科医生的专业技能、精确的技术、彻底的神经探查、确定冲突原因以及术中监测。
PHFS严重影响患者生活，如果初始治疗失败，需要及时进行手术干预。虽然可能缺乏具有统计学意义的预后因素，但本研究强调了成功治疗的关键考虑因素。
