面神经水平段梳理术治疗半面痉挛

半面痉挛（HFS）病因机理不清，有神经冲动短路、局部癫痛、微血管压迫学说，尚无特效药物治疗。本文报告经鼓室探查术进路行面神经水平段减压术治疗HFS6例，平均随访1.2年，显效4例，复发2例，但程度减轻。5例术中未分离砧镫关节，听力不变。HFS行水平段神经梳理术不复杂，安全有效，是多种手术疗法中可取的一种。作者介绍提高手术效果的几点经验：①鼓室探查术外耳道鼓膜皮瓣比常现大一点，有利于暴露面神经水平段；②镫骨上层结构及砧镫关节是定位面神经骨管的重要标志；③为保持听力，一般不要分离砧镫关节；④面神经水平段骨管近卵圆窗缘较薄，可用细钩针挑开；⑤根据面痉挛病程和痉挛程度的不同，进行不同强度的梳理；⑥对病情顽固者，可行第二次梳理术。

Transtympanic splitting of facial nerve for treating hemifacial spasm

Six patients with hemifacial spasm (HFS) were treated by transtympanic needlingand splitting of horizontal segment of affected facial nerve. All of the patients were followed up 0. 5~2 years (average 1. 2 year) with good results in 4 cases, improvement in2 cases and hearing was unchanged in 5 cases. We suggeste that transtympanic facialnerve splitting is effective for treating HFS and superior to medical therapy. The experience of surgical management was discussed.