青少年时期发病的特发性面肌痉挛(附16例分析)

Adolescent-onset idiopathic hemifacial spasm: analysis of 16 cases

目的探讨青少年时期发病的特发性面肌痉挛的临床特点、病因及显微血管减压术的疗效。方法回顾性分析2001年3月￣2007年7月采用显微手术治疗的1221例面肌痉挛病例,其中16例(1.3%;男4例,女12例)发病年龄≤18岁。结果16例中发现面神经出脑干区有典型责任动脉压迫14例,岩骨骨嵴压迫1例,无血管压迫但蛛网膜增厚1例。术后即刻治愈率75.0%(12例),有效率100%。平均随访22.9个月,延迟治愈2例(12.5%),总治愈14例(87.5%),总有效率100%,无复发病例。术后发生并发症2例(12.5%),包括中度面瘫、听力下降1例,听力下降伴耳鸣1例;随访期间均好转。结论青少年时期发病的特发性面肌痉挛临床表现均典型,多较成年致病者症状轻。性别、桥小脑角蛛网膜增厚黏连、颅后窝容积小等,可能是此类病人的重要患病因素。动脉性血管压迫仍然是其主要病因,显微血管减压术疗效佳,但术后面、听神经并发症发生率高于成年发病者。

Objective To study the clinical features, risk factors and microvascular decompression for adolescent-onset idiopathic hemifacial spasm. Methods Clinical data of 1 221 patients who underwent microvascular decompression for idiopathic hemifacial spasm performed from March 2001 to July 2007 were retrospective analyzed. Among them 16 （1.3%） were adolescent-onset patients （less than 18 years old）. Results The typical compression of offending arteries was observed in 14 patients, compression of the petrous bone crest in 1, and no compression but arachnoid thickening in 1. The immediate efficacy rate was 100%, and cure rate was 75% （12 cases）. The cure rate, efficacy rate and delayed cure rate during follow-up period with mean duration of 22.9 months were 87.5% （14 cases）, 100%, and 12.5% （2 cases） respectively. There was no recurrence. The postoperative complication rate was 12.5% （2 cases）, including transient moderate facial palsy accompanied by hearing loss in 1 case, and transient hearing loss accompanied by tinnitus in 1. Conclusion Clinical manifestations of adolescent-onset idiopathic hemifacial spasm are all typical, but milder than those in adult-onset patients. The sex, thickening and adhesion of ＋ arachnoid membrane in cerebellopontine angle, and small volume of posterior cranial fossa may be important risk factors for adolescent-onset patients. The arterial compression is the main cause of spasm. Microvascular decompression is effective for these patients, but the postoperative complications of Ⅶ, Ⅷ cranial nerves are more common than adult-onset patients.