Lovely T J, Getch C C, Jannetta P J
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Surg Neurol. 1998 Nov;50(5):449-52. doi: 10.1016/s0090-3019(97)00314-5.
Retromastoid craniectomy and microvascular decompression of cranial nerve VII for hemifacial spasm is a well accepted and effective treatment. Risks of the operation relate to the surgical approach in general and to the seventh nerve in particular. Delayed facial weakness is an unusual and little-described complication of the procedure. The purpose of this review is to describe this complication and the characteristics of the patients so affected.
Between 1972 and 1996, 985 patients have undergone microvascular decompression for hemifacial spasm. During this time, 28 patients (2.8%) undergoing decompression of the facial nerve and 1 patient undergoing decompression of the cochlear nerve for tinnitus developed delayed facial palsy.
The weakness was at least a House Grade III or worse and was complete in 11 of the patients. The time to occurrence averaged 12 days, with a tight range of 7 to 16 days. There were no factors such as duration of symptoms, intraoperative findings, or preoperative botulinum injections that were predictive of this postoperative weakness. In all patients there was almost complete recovery (House Grade I or II).
Delayed facial weakness after MVD of CN VII can occur in up to 3% of cases. The onset of weakness after operation is consistent in its timing, occurring on average 12 days after the procedure. Although the etiology of this complication is uncertain, the palsy spontaneously resolves with a good or excellent outcome.
乳突后颅骨切除术及面神经微血管减压术治疗面肌痉挛是一种广泛认可且有效的治疗方法。该手术风险一般与手术入路相关，尤其与第七神经有关。迟发性面神经麻痹是该手术一种罕见且描述较少的并发症。本综述的目的是描述这种并发症以及受其影响患者（的情况）特征。
1972年至1996年间，985例患者接受了面肌痉挛微血管减压术。在此期间，28例（2.8%）接受面神经减压术的患者以及1例接受耳蜗神经减压术治疗耳鸣的患者出现了迟发性面神经麻痹。
面神经麻痹程度至少为House III级或更严重，11例患者完全麻痹。发病时间平均为12天，范围在7至16天之间。症状持续时间、术中发现或术前肉毒杆菌注射等因素均无法预测这种术后麻痹。所有患者几乎完全恢复（House I级或II级）。
面神经微血管减压术后迟发性面神经麻痹发生率可达3%。术后麻痹发作时间一致，平均在手术后12天出现。尽管这种并发症的病因尚不确定，但麻痹可自发缓解，预后良好或极佳。
