The value of abnormal muscle response monitoring during microvascular decomprssion surgery for hemifacial spasm

Objective Abnormal muscle response (AMR) to the electrical stimulation of a branch of facial nerve is a specific electrophysiological feature of primary hemifacial spasm (HFS) . Although the correlation between intraoperative AMR findings and postoperative results in patients with HFS were investigated before,

Influence of distal portion compression of facial nerve in hemifacial spasm surgery

Objective To study influence of distal portion compression of facial nerve in hemifacial spasm surgery. Methods 120 hemifacial spasm patients were undergone lateral spread response monitoring during microvascular decompression surgery. 39 patients’LSR remained after decompression of the root exit zone of the facial nerve.

Advances in microvascular decompression for hemifacial spasm

Primary hemifacial spasm(HFS) is a disorder that causes frequent involuntary contractions in the muscles on one side of the face, due to a blood vessel compressing the nerve at its root exit zone(REZ) from the brainstem. Numerous prospective and retrospective case series have confirmed the efficacy of microvascular decompression(MVD) of the facial nerve in patients with HFS. However, while MVD is effective, there are still significant postoperative complications. In this paper, recent technological advances related to MVD(such as lateral spread response,brainstem auditory evokes potential, three dimensional time of flight magnetic resonance angiography, intraoperative neuroendoscopy) are reviewed for the purposes of improving MVD treatment efficacy and reducing postoperative complications.

THE PROPERTIES AND LONGITUDINAL EXPERIENCE OF CHINESE TYPE A BOTULINUM TOXIN FOR THE TREATMENT OF FOCAL DYSTONIA AND HEMIFACIAL SPASM

Objective.To introduce the properties of Chinese type A botulinum toxin(CBTXA,made by Lanzhou Institute of Biological Products),and its long?term effect for focal dystonia and hemifacial spasm.Method.The purity and recovery of crude and crystalline toxin were tested.Long?term data from305patients with hemifacial spasm(HFS),blepharospasm(BS)and cervical dystonia(CD)were evalu-ated and subgroups of patients received CBTXA injections between1994and2000in at least six sepa-rate treatment sessions,with follow up for2～8years.The therapeutic results of the last session CBTXA injections were analyzed in comparison with the first session.Result.CBTXA purity was high[(2.55～2.60)×10 7 LD50/mgPr ,A260/A280≤0.55,high molecular substance accounted for99.2%of total proteins].Long term treatment with CBTXA in patients with focal dystonia and HFS was not associated with any decline in benefit,and efficacy may improve slightly with repeat treatments.CBTXA is an excellent long-term treatment of HFS,BS and CD.Conclusion.We conclude that Chinese type A botulinum toxin is of botulinum toxin therapy quality standard according to results obtained from the basic study and long?term clinical applications.The re?injection of CBTXA significantly improves the quality of life of most patients and is a safe,effective and comparatively economical treatment for patients with focal dystonia and HFS.

EXPRESSION OF CALCITONIN GENE-RELATED PEPTIDE IN FACIAL NERVE OF HEMIFACIAL SPASM

Objective To study the immunoreactivity of Calcitonin gene-related peptide (CGRP) in the facial nerve when Hemifacial Spasm is occurring. Methods The electrophysiological technique was used to explore abnormal muscle response (AMR) which was characteristic of Hemifacial Spasm.The animal models of Hemifacial Spasm in New Zealand white rabbits were established by compressing the main trunk of artificial demyelinated facial nerve with the temporal superficial artery. At 6 weeks after surgery, the facial nerves were taken from the experimental group and control one, the immunohistochemistry for CGRP using polyclonal antibody with ABC kit was performed in the facial nerves; at the same time, the observation for the facial nerves of light and transmission electron microscope was performed. Results The facial nerve demyelinated and the axons retrogressively changed, CGRP immunoreactive positive fibers were significantly detected in experimental groups; whereas this phenomenon was not found in control group. Conclusion CGRP can nutrien the injured facial nerve and plays an important role in the pathogenesis of Hemifacial Spasm.

Efficacy of Carbamazepine Combined with Botulinum Toxin A in the Treatment of Blepharospasm and Hemifacial Spasm

Purpose:To observe the efficacy of the combined treatment of carbamazepine and botulinum toxin A for blepharospasm and hemifacial spasm. Methods:Fifty-eight patients with either blepharospasm or hemifacial spasm were randomly divided into treatment and control groups. In the treatment group, 30 patients were administered with local intramuscular injections of botulinum toxin A and oral carbamazepine 100 mg/time,3 times/day for 60 days. Twenty-eight subjects in the control group under-went local intramuscular injections of botulinum toxin A only. Results:After combined treatment, the complete remission rate was 90%, which was significantly higher than that of the of the control group (67.9% , P<0.05,χ2 =4.733). However, no statistical significance was noted regarding the duration of therapeutic effects between the treatment group (range 14～40 weeks; 19.2 weeks on average) and control group (range 12～36 weeks; 18 weeks on average). Conclusion:The combined therapy of carbamazepine and topical injections of botulinum toxin A had increased efficacy in the treatment of blepharospasm or hemifacial spasm, but had no significant effect in terms of the duration of the therapeutic effect.

Complications of microvascular decompression in hemifacial spasm treatment Retrospective analysis of 156 cases

BACKGROUND： Microvascular decompression has become a well-accepted, safe method in the treatment of hemifacial spasms. However, postoperative complications exist and influence the prognosis of the disease. OBJECTIVE： This study aimed to analyze, by case review, the characteristics and regularity of microvascular decompression complications in the treatment of hemifacial spasm. DESIGN： Retrospective analysis. SETTING： Beijing General Group Hospital of the Chinese People＇s Armed Police Forces. PARTICIPANTS： A total of 156 patients with hemifacial spasm were admitted to the Department of Neurosurgery, Beijing General Group Hospital of the Chinese People＇s Armed Police Forces from June 2004 to June 2006 and recruited for this study. The patients, 57 males and 99 females, averaged 46 years of age （range 17-68-years old）. All suffered from facial innervated muscular paroxysmal and recurrent contraction, which could not be controlled by consciousness. Electromyogram demonstrated waves of fibrillation and fasciculation. Prior to admission, all patients had received other treatments. Written informed consents for treatment were obtained from all patients. This protocol was approved by the Hospital＇s Ethics Committee. METHODS： After anesthesia, a cranial bone pore was drilled below the connection of the lateral sinus and sigmoid sinus. Dura mater was dissected at the ＂⊥＂ shape and held in the air. Under microscopy, the flocculus cerebelli was lifted slightly up for convenient observation of the cerebellopontine angle. The mucous membrane was sharply separated. Corresponding vessels were identified at the root of the facial nerves and subsequently liberated and disassociated from the root exit zone. Suitably sized Teflon cotton was placed between the corresponding vessels and brain stem. MAIN OUTCOME MEASURES： Complications of microvascular decompression. RESULTS： All 156 patients participated in the final analysis. （1） Postoperatively, 66 （42%） patients presented with obvious headache or dizziness, 5 （3%） with severe headache, 43 （28%） with nausea or vomiting for 12 hours to 3 days, and 19 （12%） with aseptic meningitis and a body temperature of 37.5-40 ℃ Patients, who suffered from headache and fever, were cured after 2-5 lumbar punctures. （2） Postoperatively, 19 （8%） patients suffered from short-term dysaudia and tinnitus on the affected side, 9 （6%） from mild hemifacial spasms, and 2 （1%） from ambiopia. All patients were cured after treatment with a neurotrophic drug. （3） Postoperatively, 4 （2%） patients suffered from cerebrospinal fluid incision leakage and 2 （1%） from cerebrospinal rhinorrhea. The cerebrospinal fluid incision was tightly sutured. One case of cerebrospinal rhinorrhea was cured after mastoid process repair, and the other one recovered spontaneously. CONCLUSION： Experimental results have indicated that low intracranial pressure is the main complication of microvascular decompression in patients with hemifacial spasms, and no permanent neuro-functional impairment was found.

Fire needle combined with filiform needle therapy for hemifacial spasm： a case report

Objective： Hemifacial spasm （HFS） is characterized by involuntary unilateral contractions of the muscles, usually starting around the eyes before progressing inferiorly to the cheek, mouth, and neck. Here we described the use of fire needle combined with filiform needle for a patient with HFS on the left face. Methods： The fire needle was inserted into the points of Du meridian and the first lateral line of bladder meridian, combined with the points of the Ashi points around the left eye, Guanyuan （CV 4）, Qihai （CV 6）, Xiawan （CV 10）, Zhongwan （CV 12）, Tianshu （ST 25）, Guilai （ST 29） and Daheng （SP 15）. The filiform needle was used to acupuncture the points located on the left side of face including Cuanzhu （BL 2）, Tongziliao （GB 1）, Yangbai （GB 14）, Fengchi （GB 20）, Sizhukong （TE 23） and Sibai （ST 2）. Results： The patient received the combined therapy of fire needle and filiform needle for 9 times in 5 weeks. After that, the symptoms of dull sensation in the left facial area and the twitching of the muscles of the left eye were improved remarkably. Conclusions： The fire needle combined with filiform needle therapy has the potential to cure HFS.

Treatment of 86 Cases of Facial Spasm by Acupuncture and Pressure on Otopoints

The combined method of acupuncture with pressure on otopoints (the combination group) was used to treat 86 patients with facial spasm; and simple acupuncture and simple pressure on otopoints were respectively applied in the other two groups of patients as controls. The total effective rates of the combination group, the acupuncture group and the pressure on otopoints group were 95.4%, 92.1% and 62.5% respectively; and the cure rates were 38.4%, 15.8% and 5% respectively. The differences in results of the three groups show statistically marked significance, indicating that the therapeutic effectiveness of the combined method of acupuncture with pressure on otopoints is better than the other two therapeutic methods.

神经电生理监测下MVD术对面肌痉挛患者临床疗效及并发症的影响

目的:探究神经电生理监测下微血管减压(MVD)术对面肌痉挛(HFS)患者的临床治疗效果以及并发症的影响。方法:选取2016年5月—2021年6月郑州大学第五附属医院收治的78例HFS患者作为研究对象,按随机数表法分为对照组(39例)与监测组(39例)。两组患者均给予MVD术进行治疗,监测组患者在实施MVD术中进行神经电生理监测。观察监测组患者面神经侧方扩散反应(LSR)情况以及脑干听觉诱发电位(BAEP)中的V波情况,比较两组患者术后临床治疗效果以及术后并发症发生情况。结果:通过对监测组患者在MVD术中进行神经电生理监测发现,其中有5例患者LSR波形消失是在进行桥小脑角探测检查时,32例患者是在进行神经减压时消失,其余2例患者直至MVD手术结束LSR波形仍然可见。术后1 d,监测组患者治疗总有效率较对照组更高,差异有统计学意义(P<0.05);监测组患者并发症总发生率较对照组更低,差异有统计学意义(χ^(2)=22.675,P<0.05)。结论:HFS患者在神经电生理监测下实施MVD术进行治疗,临床治疗效果较为显著,同时,患者的并发症发生情况较少,比临床治疗HFS患者时单独采用MVD术进行治疗的方式更具优势,值得临床借鉴参考。

磁共振成像评价颅神经血管压迫综合征研究进展

颅神经血管压迫综合征常见的表现有三叉神经痛(trigeminal neuralgia,TN)、面肌痉挛(hemifacial spasm,HFS)等,卡马西平和奥卡西平是长期治疗的首选药物,而微血管减压术(microvacular decompression,MVD)是难治性患者的一线手术,是解除血管压迫神经的有效方式。术前磁共振成像可以观察受累神经的解剖结构、责任血管的来源及状态,显示血管与神经的走行关系。使用特定的磁共振序列作为颅神经血管压迫综合征诊断检查的一部分,可以检测可能的神经血管接触并排除继发原因,同时神经血管接触的证明可用于促进手术决策。本文基于磁共振成像对颅神经血管压迫综合征相关病理机制、临床表现、解剖基础及高分辨率磁共振成像序列和多模态交互式磁共振成像技术研究进展进行综述,旨在为临床诊治提供影像学依据,为患者减轻病痛,减少术中并发症发生,改善患者预后。

面肌痉挛患者显微血管减压术后复发危险因素分析

目的通过分析面肌痉挛(HFS)患者行显微血管减压术(MVD)后复发的相关因素,进一步建立HFS患者MVD术后预测模型。方法选取2015年1月至2021年12月于河北医科大学第二医院神经外科行MVD的HFS患者267例,将MVD后未复发的患者与复发的患者的临床资料进行比较,应用Logistic回归分析研究MVD后HFS复发的危险因素,通过R软件来绘制列线图、校准曲线和受试着工作特征(ROC)曲线图。结果本组患者中,复发的患者有58例,未复发的患者有209例,复发率为21.72%;年龄、异常肌反应(AMR)消失与否、责任血管数量、病程是影响HFS患者MVD术后复发的危险因素;回归分析显示≤55岁、异常肌反应未消失、责任血管2根及以上以及病程5年以上是HFS患者MVD术后复发的独立危险因素;列线图、校准曲线和ROC曲线显示评估HFS患者MVD术后复发风险预测模型具有良好的校准度和区分度。结论年龄≤55岁,病程≥5年,术中AMR未消失,责任血管2根及以上是HFS患者MVD术后复发的危险指标。

多模式神经电生理监测在面肌痉挛MVD中的应用

目的探讨多模式神经电生理监测在面肌痉挛(HFS)显微血管减压术(MVD)中的应用效果。方法回顾性分析2020年12月至2022年3月MVD治疗的80例HFS的临床资料。术中应用异常肌电反应(AMR)、面神经运动诱发电位(FMEP)及自由肌电图(EMG)监测指导手术。结果术后1周治愈55例,明显缓解15例,部分缓解7例,无效3例;术后半年治愈57例,明显缓解10例,部分缓解9例,无效4例。术后1周治疗有效率为96.3%,术后半年治疗有效率为95.0%。术中AMR消失70例,存在10例;术中AMR消失病人术后1周(74.3%)、术后半年(78.6%)治愈率明显高于术中AMR存在的病人(分别为30.0%、20.0%;P<0.05)。80例术中均稳定引出FMEP,其中72例FMEP无变化;6例出现一过性波幅降低和(或)潜伏期延长,暂停手术操作后恢复;2例出现波幅降低且暂停手术操作无改善,术后出现面瘫。80例在分离和探查面神经REZ时均出现EMG不同程度的反应,其中一过性反应71例;持续出现的面神经爆发肌电图反应9例,暂停手术操作后缓解。结论术中AMR+FMEP+EMG多模式电生理监测技术对MVD判断责任血管、提高治愈率、保护面神经功能及避免并发症具有重要作用。

不同切口显微血管减压术治疗面肌痉挛的效果

目的分析不同切口显微血管减压术(MVD)治疗面肌痉挛(HFS)的效果。方法回顾性收集2019年6月至2023年11月周口市中心医院收治的97例HFS患者为研究对象,按照不同治疗方案分为两组,其中竖切口组(49例)接受竖切口MVD,横切口组(48例)接受耳后横切口MVD,观察两组手术基础指标、面部美观满意度、并发症状况以及围手术期疼痛视觉模拟量表(VAS)分值、脑干听觉诱发电位(BAEP)。结果与竖切口组相比,横切口组手术时长与切口长度较短,术中出血量较少(P<0.05)。术后12 h横切口组VAS评分均低于竖切口组,且改善幅度大于竖切口组(P<0.05)。横切口组术后12 h波间期、潜伏期以及波幅的BAEP均高于竖切口组(P<0.05)。横切口组并发症发生率低于竖切口组(P<0.05)。横切口组面部美观满意度高于竖切口组(P<0.05)。结论与竖切口相比,耳后横切口MVD治疗HFS效果确切,可明显改善手术效果,减轻术后疼痛度,增强BAEP,减少并发症,并提升面部美观度。

基于ALE的面肌痉挛功能和结构异常脑区的Meta分析

目的 通过荟萃分析探讨原发性面肌痉挛(hemifacial spasm,HFS)患者脑功能和结构的改变特点,进一步了解HFS的病理生理机制。方法收集2023年4月之前发表在相关数据库中关于HFS患者静息态功能磁共振成像(rest-state functional Magnetic resonance imaging,Rs-fMRI)和基于体素的形态学分析方法(voxel-based morphometry,VBM)的所有文章。根据纳入和排除标准筛选后,采用激活似然估计(activation likelihood estimation,ALE)方法进行meta分析。结果共纳入7篇文献、10项研究(原发性面肌痉挛患者315例,健康受试者315名),对低频振荡幅度(amplitude of low frequency fluctuation,ALFF)、低频振荡分数(Fractional amplitude of low-frequency fluctuation,fALFF)及局部一致性(regional homogeneity,ReHo)等RsfMRI指标进行功能分析。ALE-meta结果显示,相对于健康受试者,HFS患者的自发性脑功能活动在中央前回、后扣带回、脑桥及小脑显著升高,而在额中回及颞上回降低。将所有基于VBM的HFS患者灰质改变的文献进行结构分析,结果显示,相对于健康受试者,HFS患者的海马旁回、丘脑体积显著减小。结论HFS患者存在脑功能和结构的改变,主要表现为中央前回、脑桥、小脑和后扣带回脑区自发性脑功能活动的异常,以及突显网络结构的异常,初步阐明了HFS患者静息态脑功能活动及结构改变的规律及特征。

原发性面肌痉挛患者微血管减压术后发生手术部位感染的影响因素分析

目的探讨原发性面肌痉挛患者微血管减压术后发生手术部位感染的影响因素。方法收集2020年1月至2022年12月于三六三医院行微血管减压术的252例原发性面肌痉挛患者的临床资料,根据手术部位是否感染将其分为感染组(n=30)和非感染组(n=222)。收集患者一般资料、手术时间、切口长度、术前血清蛋白水平、抗生素使用情况、住院时间,分析原发性面肌痉挛患者微血管减压术后发生手术部位感染的独立危险因素。结果单因素分析结果显示,年龄、体重指数(BMI)、手术时间、住院时间、切口长度、糖尿病、术前血清蛋白水平均是原发性面肌痉挛患者微血管减压术后发生手术部位感染的影响因素(P﹤0.05)。多因素分析结果显示,合并糖尿病、手术时间﹥180 min、切口长度≥8 cm、术前血清蛋白﹤30 g/L均是原发性面肌痉挛患者微血管减压术后发生手术部位感染的独立危险因素(P﹤0.05)。结论合并糖尿病、手术时间﹥180 min、切口长度≥8 cm、术前血清蛋白﹤30 g/L均是原发性面肌痉挛患者微血管减压术后发生手术部位感染的独立危险因素,根据各影响因素给予相应的干预措施,可降低手术部位感染发生率。

黄培新从虚、风、痰、瘀四维论治面瘫后面肌痉挛经验介绍

介绍黄培新教授从虚、风、痰、瘀四维论治面瘫后面肌痉挛的临床经验。黄培新教授认为,面肌痉挛病机为本虚标实,本虚为气血阴阳不足,久病耗损,筋失濡养;标实为风、痰、瘀相合,阻滞面络。病位主要与肺、脾、肝三脏有关;临证从虚、风、痰、瘀四维论治,以燮理肺肝脾三脏气机升降为期。以补虚祛邪、调和气血为治疗原则,扶正、祛风、活血、化痰有所侧重,灵活变通,随证治之,以平为期。

针灸治疗面肌痉挛的系统评价再评价

目的:对针灸治疗面肌痉挛的系统评价进行再评价。方法:筛选知网、维普、万方、Sinomed、Embase、PubMed、CochraneLibrary、ClinicalTrials.gov和中国临床试验注册中心数据库后纳入符合的文献,使用AMSTAR2工具进行方法学质量评价,及使用GRADE工具进行证据质量评价,并将结果进行描述性分析。结果:共纳入6篇SR/MA,包括92个RCT、7714个样本及21个证据,针灸治疗HFS的SR/MA方法学质量较低,AMSTAR2评定显示6篇文献均为极低;针灸治疗HFS的证据质量较低,GRADE评价显示:无高级证据,3个中级证据,其余18个证据均为低级或极低级。结论:针刺可能是治疗面肌痉挛的有效方法,但仍需要方法学更严谨的RCT及SA/MA进一步证实。

神经内镜下微血管减压术治疗面肌痉挛患者的效果及对术后康复、复发的影响

目的:分析神经内镜下微血管减压术治疗面肌痉挛患者的效果,探讨其对术后康复及复发的影响。方法:选取2020年1月—2023年1月蚌埠医科大学第一附属医院神经外科收治的80例面肌痉挛患者作为研究对象,随机分为对照组和观察组,各40例。对照组采取常规微血管减压术治疗,观察组采取神经内镜下微血管减压术治疗,比较两组手术指标、治疗效果、术后并发症、复发情况等。结果:观察组手术时间、住院时间短于对照组,差异有统计学意义(P<0.05);观察组治疗总有效率高于对照组,而术后并发症发生率及术后1年复发率低于对照组,差异有统计学意义(P<0.05)。结论:常规微血管减压术、神经内镜下微血管减压术都是治疗面肌痉挛的方法,而神经内镜下微血管减压术是在微血管减压术的基础上利用神经内镜辅助观察和操作,进一步提高了手术视野清晰度,不仅有利于缩短手术时间,还能减少并发症风险,从而提高手术效果和术后康复速度,有效缩短住院时间,随访1年复发率也明显更低。

神经内镜锁孔入路微血管减压术治疗三叉神经痛和面肌痉挛的效果

目的通过与显微镜常规骨窗入路比较,分析神经内镜锁孔入路治疗三叉神经痛和面肌痉挛的临床效果。方法对本院神经外科2018年1月至2022年12月的41例三叉神经痛和面肌痉挛患者进行手术治疗,按照手术方式差异,分为观察组(神经内镜锁孔入路21例)和对照组(显微镜常规骨瓣入路20例),两组均采用微血管减压术,比较手术时间、术后2周和1年的临床疗效,术后并发症发生率,术后复发率、满意率和推荐率。结果两组手术时间和术后2周治疗总有效率比较,差异无统计学意义(均P>0.05);术后1年,观察组治疗总有效率比对照组高(P<0.05);术后1年,观察组并发症总发生率低于对照组(P<0.05);术后1年,两组复发率差异无统计学意义(P>0.05);观察组满意率和推荐率都高于对照组(均P<0.05)。结论神经内镜锁孔入路微血管减压术治疗三叉神经痛和面肌痉挛安全可靠,具有更好的远期疗效,可有效降低并发症发生率。