Tugend Margaret, Joncas Colby T, Lee Veronica, Simmons Grace B, Sekula Raymond F
Department of Neurological Surgery, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York , New York , USA.
Neurosurgery. 2024 Nov 26;97(1):16-27. doi: 10.1227/neu.0000000000003290.
Hemifacial spasm (HFS) is a rare movement disorder characterized by brisk, irregular, involuntary, and unilateral contraction of the facial musculature. This systematic review aims to synthesize the existing literature and compare the use of 2 microvascular decompression (MVD) techniques-transposition and interposition-used in the treatment of HFS.
A retrospective systematic review of randomized controlled trials, meta-analyses, case-control studies, and case series examining transposition and/or interposition during MVD for HFS was performed using PubMed, Embase, and Scopus databases. Data extracted included study objective and size, surgical method, demographic information, operative technique notes, number and location of offending vessels, complications, follow-up duration, rate of spasm freedom at last follow-up, and additional outcomes. Cohorts of at least 20 patients with HFS treated with MVD reported in studies explicitly mentioning surgical techniques were included.
PubMed, Embase, and Scopus database searches yielded 1300 records, of which 528 were duplicates. Sixty-two studies reporting 68 cohorts met inclusion criteria, including 5 on transposition, 51 on interposition, and 6 using both techniques. Interposition was used in 18 627 cases, and transposition was used in 810 cases. Spasm freedom at final follow-up was similar between transposition and interposition (90.4% vs 89.6%). Complication rates were similar between techniques, with the largest difference being higher rates of temporary facial nerve weakness/palsy among the transposition series (9.52%) than the interposition series (6.03%).
Both transposition and interposition are safe and effective techniques for MVD in patients with HFS. Available literature to date does not provide conclusive evidence that 1 method is superior to the other in safety or efficacy although there are specific instances that favor the use of interposition. A prospective trial would be required to delineate the true differences between these techniques.
半面痉挛（HFS）是一种罕见的运动障碍，其特征为面部肌肉快速、不规则、不自主的单侧收缩。本系统评价旨在综合现有文献，比较用于治疗HFS的两种微血管减压（MVD）技术——移位术和置入术的应用情况。
使用PubMed、Embase和Scopus数据库，对检查MVD治疗HFS期间移位术和/或置入术的随机对照试验、荟萃分析、病例对照研究和病例系列进行回顾性系统评价。提取的数据包括研究目的和规模、手术方法、人口统计学信息、手术技术记录、责任血管的数量和位置、并发症、随访时间、最后随访时痉挛缓解率以及其他结果。纳入明确提及手术技术的研究中至少20例接受MVD治疗的HFS患者队列。
PubMed、Embase和Scopus数据库检索共获得1300条记录，其中528条为重复记录。62项报告68个队列的研究符合纳入标准，包括5项关于移位术的研究、51项关于置入术的研究以及6项同时使用两种技术的研究。置入术应用于18627例，移位术应用于810例。移位术和置入术在最后随访时的痉挛缓解率相似（90.4%对89.6%）。两种技术的并发症发生率相似，最大差异是移位术组（9.52%）的暂时性面神经无力/麻痹发生率高于置入术组（6.03%）。
对于HFS患者，移位术和置入术都是安全有效的MVD技术。尽管有特定情况支持使用置入术，但目前的文献没有提供确凿证据表明一种方法在安全性或有效性上优于另一种方法。需要进行前瞻性试验来明确这些技术之间的真正差异。
