非典型性面肌痉挛（附36例报告）

Atypical hemifacial spasm （ Report of 36 Cases）

目的探讨非典型性面肌痉挛的发病机制和手术治疗方法。方法回顾性分析2005年7月到2010年7月采用显微血管减压术治疗的36例面肌痉挛病例，临床表现均为非典型性发作。结果32例患者术后面肌痉挛立即消失，4例患者术后痉挛减轻但未消失，随访5个月时完全消失。随访12—72个月，平均42个月，延迟治愈者4例（11％），无复发病例。术后发生并发症6例（17％），包括中度面瘫、听力下降3例，听力下降伴耳鸣3例；随访期间均好转。结论非典型性面肌痉挛患者神经受血管压迫位置一般位于面神经出脑干区的远侧端，采用显微血管减压术可获良效，但术后发生面瘫、听力障碍的概率升高。术中责任血管的准确识别、实时脑干听觉诱发电位监测、避免颅神经和细小血管的损伤，有助于提高疗效、减少并发症的发生。

Objective To study the pathogenesis and surgical treatment of atypical hemifacial spasm. Methods The clinical data of 36 patients who underwent microvascular decompressions （MVD） for atypical hemifacial spasm（HFS） from July 2005 to July 2010 were retrospectively analyzed. Results The HFS disappeared immediately after MVD in 32 patients. The postoperative spasm was weaker in 4 patients and the residual spasm was disappeared within 5 months. There was no reoccurrence of spasm during follow - up period. The postoperative complications included ： transient moderate facial paralysis accompanied with hearing dysfunction in 3 cases, and transient hearing dysfunction accompanied with tinnitus in 3. Conclusions Atypical hemifacial spasm is caused by vessels on the posterior rostral side of facial nerve. The effectiveness could be predicted after MVD. But the rates of facial paralysis and/or hearing loss are relatively higher. The rates of complications could be reduced significantly by correct identification of offending vessels, fewer disturbance to cranial nerves, avoiding the injury to the penetrating vessels, and intraooerative brain stem auditory evoked potential monitoring during.