1.Nanjing Medical University,Nanjing Jiangsu;2.Department of Neurosurgery,Affiliated Nanjing Brain Hospital,Nanjing Medical University,Nanjing Jiangsu
面肌痉挛 (Hemifacial Spasm,HFS) 是一种临床常见的颅神经疾病,主要表现为与面部有关肌肉的良性、慢性、非自主的抽动,其通常始于单侧眼轮匝肌,并在一定时间内扩散到同侧其他面部表情肌肉。HFS的发病机制至今尚不明确,目前被普遍接受为面神经的根入口区 (Root Exit Zone,REZ)被血管压迫(Neurovascular compression ,NVC)造成脱髓鞘的改变。原发性HFS的微血管减压术 (Microvascular decompression ,MVD) 被认为是治疗该疾病的经典的方式,随着神经影像,神经解剖学,电生理学和技术设备发展以及实践认识,进一步提高了MVD手术的神经血管的功能保护,使得HFS-MVD更加安全、有效。本文将从HFS发病机制、术前评估、电生理监测、手术技术应用以及术后转归等多方面介绍HFS-MVD的主要临床研究进展。
Hemifacial spasm (HFS) is a common cranial nerve disorder characterized by involuntary twitching of facial muscles primarily starting in the orbicularis oculi and gradually affecting other facial expression muscles on the same side. The exact cause of HFS is not yet fully understood, but it is widely accepted that vascular compression at the root exit zone (REZ) of the facial nerve leads to demyelination. Microvascular decompression (MVD) is considered to be the gold-standard treatment for primary HFS, aiming to alleviate the compression and restore normal nerve function. Advancements in neuroimaging, neuroanatomy, electrophysiology, technical equipment, and surgical understanding have led to improved functional protection of neurovascular structures during MVD surgery, enhancing the safety and effectiveness of HFS-MVD. This article aims to present the recent clinical research progress in HFS-MVD including the understanding of HFS pathogenesis, preoperative evaluation, electrophysiological monitoring techniques, application of surgical techniques, and postoperative regression analysis.