Maroon J C
Arch Neurol. 1978 Aug;35(8):481-3. doi: 10.1001/archneur.1978.00500320001001.
A review of the literature as well as recent surgical observations indicate that hemifacial spasm may be caused by normal or pathological vascular structures that cross-compress the facial nerve. The critical area of compression is invariably found at the brain stem exit zone of the seventh cranial nerve. In this area the central glial investment of the facial nerve changes to peripheral or schwannian myelin. It is suspected that this anatomical junction zone may be of pathophysiologic significance when directly compressed or irritated. A retromastoid craniectomy and vascular decompression operation is highly successful in relieving hemifacial spasm while at the same time preserving facial nerve function. This is in contrast to most commonly used destructive operations for hemifacial spasm. Microsurgical techniques, however, must be employed or high morbidity and mortality may occur from the retromastoid approach.
文献综述以及近期的手术观察表明，半面痉挛可能由横跨并压迫面神经的正常或病理性血管结构所引起。压迫的关键区域总是位于第七颅神经的脑干出口区。在该区域，面神经的中央神经胶质包被转变为外周或施万氏髓鞘。据推测，当该解剖交界区受到直接压迫或刺激时，可能具有病理生理学意义。乳突后颅骨切除术和血管减压手术在缓解半面痉挛的同时又能保留面神经功能，成功率很高。这与最常用的半面痉挛破坏性手术形成对比。然而，必须采用显微外科技术，否则乳突后入路可能会导致高发病率和死亡率。
