内窥镜辅助下显微神经血管减压术治疗 特发性偏侧面肌痉挛

目的为进一步提高神经血管减压术治疗特发性偏侧面肌痉挛的疗效。方法经乙状窦后小骨窗开颅加用内窥镜辅助显微血管减压术治疗特发性偏侧面肌痉挛３５例。结果术后３４例症状消失,１例症状减轻,３５例随访６个月至３年半,术后面肌抽搐消失者３３例,１例症状减轻,１例１年后复发。结论内窥镜可弥补手术显微镜的不足之处,减少组织损伤和判断错误,提高治疗效果。     

Small volume of the posterior cranial fossa and arterial hypertension are risk factors of hemifacial spasm

ObjectivesSo far, there are only two studies evaluating the relation between the small volume of the posterior cranial fossa (VPCF) and the occurrence of HFS, both on Asian population. The aim of the study was to determine small VPCF and arterial hypertension (AH), as risk factors for hemifacial spasm (HFS) and their relation to neurovascular conflict (NVC) in Polish Caucasian-origin patients.Materials and methodsThe study included 60 patients with idiopathic HFS and 60 healthy volunteers matched by sex and age. AH was defined according to WHO. The VPCF measured the volume of the prepontine, prespinal and both cerebellopontine angle cisterns in MRI scans.ResultsThere were no significant differences between occurrence of AH and the VPCF of patients and controls but the mean VPCF in women was significantly smaller than in men, In the multivariate regression analysis model only NVC was the statistically significant. In the subgroup of >50-year-old patients the most dominant risk factor was NVC (OR 71.09; 95% CI 21.08–239.77; p = 0.0000), followed by the AH duration (OR 1.07; 95% CI 1.00–1.16; p = 0.047). In the subgroup of <50 years, NVC was also the dominant risk factor, followed by the lower VPCF (Walad test: OR 0.4; 95% CI 0.16–1.04; p = 0.045).ConclusionThere was no significant difference in VPCF and in frequency of AH diagnosis in HFS patients and age- and sex-related controls, but the logistic regression analysis showed that small VPCF and AH duration are risk factors of HFS in younger and older patients respectively.     

面肌痉挛显微血管减压术中对静脉压迫的处理(附29例分析)

目的探讨特发性面肌痉挛显微血管减压术中对静脉压迫的处理。方法回顾性分析2001年3月．2006年3月采用显微血管减压术治疗的422例面肌痉挛病例，29例（6．9％）术中探查发现面、听神经出（进）脑干区有静脉通过．其中8例（1．9％）确认为责任动脉压迫之外并存静脉压迫。责任静脉处理方法：电凝后切断7例，将静脉充分游离后以Teflon棉垫开1例。另外21例（5．0％）由于静脉不是责任血管，未予处理。结果29例病人术后即刻有效率100％，治愈28例（96．6％），另l例即刻未治愈而于术后3周延迟治愈。平均随访44个月，无复发病例。与静脉处理有关的术后并发症：轻一中度面瘫、听力下降伴耳鸣2例，随访期间均好转，暂时性单纯耳鸣l例，一过性轻度面瘫l例。结论特发性面肌痉挛显微血管减压术中，对与面神经出脑干区责任动脉压迫并存的静脉性压迫应电凝后切断．方能彻底减压；但术后面、听神经并发症的发生率增加。静脉性压迫均合并动脉性压迫，且为次要压迫因素时．静脉不会单独对面神经出脑干区构成压迫；在面、听神经出（进）脑干区之间通过的静脉不是责任血管，可不予处理。     

面肌痉挛微血管减压术的远期疗效分析

目的探讨影响微血管减压术治疗面肌痉挛远期疗效的因素及提高疗效的方法。方法分析253例随访13～144个月(平均73个月)的资料。结果痉挛消失232例(91.7%),痉挛部分缓解10例(4%),痉挛复发11例(4.3%)。痉挛复发者再手术时发现遗漏压迫血管、减压材料移动是造成手术失败及复发的原因。结论采用微血管减压术治疗面肌痉挛,不遗漏面神经根附近的责任血管,是提高远期疗效的重要环节。     

Arterial hypertension in patients with left primary hemifacial spasm is associated with neurovascular compression of the left rostral ventrolateral medulla

The aim of the study was to clarify the relationship between neurovascular compression of the rostral ventrolateral medulla and arterial hypertension in patients with primary hemifacial spasm. We enrolled 82 patients with primary hemifacial spasm and 82 age- and sex-matched magnetic resonance imaging (MRI) controls of the posterior cranial fossa. Neurovascular compression of the rostral ventrolateral medulla was assessed by MRI, and its association with arterial hypertension was investigated. No significant differences were found in prevalence of arterial hypertension between patients with primary hemifacial spasm and control subjects (39.0 vs. 29.3%, p=0.19). Thirty-two percent of the patients with left primary hemifacial spasm (n=44) and 47% of the patients with right primary hemifacial spasm (n=38) were hypertensive. Neurovascular compression of the left rostral ventrolateral medulla was observed in 86% of those with left (ipsilateral) primary hemifacial spasm with arterial hypertension (n=14) and 33% of those with left (ipsilateral) primary hemifacial spasm without (n=30). The association between neurovascular compression of the left rostral ventrolateral medulla and arterial hypertension was significant in patients with left (ipsilateral) primary hemifacial spasm (p=0.0012), but not in patients with right (contralateral) primary hemifacial spasm (p=0.18). Neurovascular compression of the left rostral ventrolateral medulla was more frequently observed in hypertensive patients with left primary hemifacial spasm, and neurovascular compression of the left rostral ventrolateral medulla correlated with arterial hypertension in these patients. These results are of potential clinical importance for the treatment of primary hemifacial spasm with arterial hypertension.     

Botulinum toxin as a treatment for blepharospasm, spasmodic torticollis and hemifacial spasm.

Fifty-two patients affected by focal dystonia or hemifacial spasm were treated with repeated injections of botulinum toxin. A clinical improvement was observed in all patients with blepharospasm; clinical benefit had a mean duration of 10 weeks. Clinical results were less impressive, but also favorable in patients affected by spasmodic torticollis and by hemifacial spasm. In the latter, the incidence of drug-induced paresis was much higher than that observed in patients with blepharospasm, even though the doses of toxin injected were significantly lower.     

Hemifacial spasm: a long term follow-up of patients treated by posterior fossa surgery and facial nerve wrapping.

Sixteen patients with hemifacial spasm were treated by posterior fossa surgery and wrapping of sponge around their facial nerve. A good or excellent result has been obtained in fourteen of the sixteen cases, and in seven cases followed by four years or longer. Two patients had a mild recurrence of their hemifacial spasm after a cessation of their spasm for eighteen months and two years following surgery. Contrary to the experience of other authors a definite vascular abnormality was found in only four cases. In the other twelve cases circumferential fibrosis about the nerve is again proposed as a mechanism for the effectiveness of the procedure.     

面神经受压程度对微血管减压术治疗面肌痉挛疗效的影响

目的 探讨微血管减压术后面肌痉挛缓解率与神经受压程度的关系.方法 回顾性分析48例面神经严重受压(A组)和同期365例面神经受压不明显的面肌痉挛病人(B组)的临床资料,均行微血管减压术,并对比两组术后效果.结果 A组:术后面肌痉挛即刻完全缓解44例(91.7％),明显减轻2例,部分减轻2例,总有效率为95.8％;术后并发症3例(6.2％).B组:术后面肌痉挛即刻完全缓解338例(92.6％),明显减轻18例,部分减轻6例,无效3例,总有效率97.5％;术后并发症19例(5.2％).两组术后即刻完全缓解率、总有效率及并发症发生率差异均无统计学意义(P ＞0.05).结论 微血管减压术是治疗面肌痉挛的首选方法,面神经受压程度对微血管减压术后痉挛缓解率无明显影响.     

Diagnosis and misdiagnosis of hemifacial spasm: a clinical and video study.

Early recognition of hemifacial spasm (HFS) is important as it can be effectively treated. 203 family physicians participated in a video "test" on HFS. Only 9.4% (19/203) were able to diagnose HFS. 94 (46.3%) of them did not know how to manage the condition. Twenty-two (10.8%) would use steroids as a treatment and 13 (6.4%) felt no treatment was needed. Only 27 (13.3%) indicated that botulinum toxin could be employed to treat HFS. The year of graduation of the doctors significantly correlated with a correct diagnosis (P<0.05). The low positive diagnostic rate (25.7%) of HFS from referrals to the movement disorder clinic corroborated findings from the video test.     

Bilateral hemifacial spasm: a report of five cases and a literature review.

We describe five patients with bilateral hemifacial spasm evaluated in a Movement Disorders Clinic to illustrate the clinical characteristics and to draw attention to the differential diagnosis of this condition. All patients had unilateral onset followed by bilateral, asymmetric, and asynchronous facial contractions. The mean age of the patients (4 women and 1 man) was 70.6 years (range, 54-81 yrs), and the mean duration of symptoms was 17 years (range, 2-30 yrs). The facial twitching started in the left eyelid in all cases and the opposite side of the face began to twitch on the average 8.4 years (range, 0.2-15 yrs) later. Imaging studies revealed tortuous vertebrobasilar arteries in three patients. Four patients were successfully treated with botulinum toxin injections. Bilateral hemifacial spasm is a rare, peripherally induced disorder that must be differentiated from tics, dystonia including blepharospasm and other cranial dystonia, and other facial dyskinesias. Botulinum toxin injection appears to be the treatment of choice.     

微血管减压术治疗椎动脉相关性面肌痉挛的疗效分析

目的分析微血管减压术(MVD)治疗椎动脉(VA)相关性面肌痉挛的效果及延迟治愈发生情况,同时探讨椎动脉相关性面肌痉挛的手术策略。方法回顾性分析90例面肌痉挛患者的临床资料,依据责任血管的差别分为小血管组和椎动脉相关组,并随访术后疗效及延迟治愈情况。结果两组患者术后有效率无明显差异,椎动脉相关组延迟治愈率明显高于小血管组。结论微血管减压术治疗椎动脉相关性面肌痉挛疗效良好,评估椎动脉相关性面肌痉挛患者术后疗效时应考虑到延迟治愈现象,并适当延长疗效评估的时间。     

微血管减压术治疗椎动脉复合体为责任血管的面肌痉挛的手术疗效分析

目的 探讨微血管减压术（MVD）治疗椎动脉复合体为责任血管的面肌痉挛（HFS）的效果。 方法 回顾性分析2014 年5 月— 2016 年8 月航空总医院收治的1 033 例HFS患者资料,根据责任血管情 况,分为椎动脉复合体组（208 例）与非椎动脉复合体组（825 例）,共随访12～28 个月,比较两组进行MVD 的效果。结果 两组患者年龄差异无统计学意义,但椎动脉复合体组男性比例更高（54.3% 比20.5%）, 更易多发在左侧（81.7% 比51.0%）,差异有统计学意义（P＜ 0.01）。椎动脉复合体组MVD 手术效果满意 率为95.1%（198/208）,失败率为1.9%（4/208）,与非椎动脉复合体组（94.9%、1.2%）比较差异无统计学意义; 两组患者的短期和长期并发症差异亦无统计学意义（P ＞ 0.05）。结论 在手术治愈率和并发症方面, 椎动脉复合体组与非椎动脉复合体组行MVD 的结果相似。MVD 可以作为治疗椎动脉复合体压迫类型 的HFS的安全且有效方法。     

后颅窝肿瘤术后小脑性缄默症:相关危险因素分析

目的探讨后颅窝肿瘤术后小脑性缄默的发生与相关危险因素的关系。方法回顾性分析我院2002年1月至2007年12月后颅窝肿瘤手术357例,统计术后小脑性缄默的发生次数,同时统计患者的年龄、性别、肿瘤直径、肿瘤类型、术中小脑蚓部是否切开、术后是否发生颅内感染、肿瘤与脑干界面是否清楚以及术后是否发生急性梗阻性脑积水等可能相关因素。利用统计学方法,以明确小脑性缄默症与上述因素的关系。结果在357例后颅窝肿瘤患者中,术后31人出现小脑性缄默(8.7%),通过统计学分析,患者年龄、肿瘤直径与类型、肿瘤与脑干面是否清楚和术后是否发生急性梗阻性脑积水等因素与缄默的发生在统计学上具有相关性。结论小脑性缄默症常见于儿童后颅窝、髓母细胞瘤术后,且当肿瘤体积大、肿瘤与脑干界面不清以及术后发生急性脑积水时更易发生。     

Ependymoma of the fourth ventricle presenting with hemifacial spasm. Report of a case.

According to Gardner's hypothesis (1962) later confirmed by Jannetta (1982, 1985), hemifacial spasm can usually be related to a "vascular conflict" which takes place inside the cerebellopontine angle (CPA). Occasionally, the causative lesion can be identified as a mass encasing the facial nerve at its root exit zone (REZ) from the brain stem. The hemifacial spasm has been rarely reported in presence of a contralateral CPA mass ("false localising sign"). Hemifacial spasm in patients with masses in anatomical regions other than the CPA has to be considered exceptional. The case of an adult man harboring an ependymoma of the fourth ventricle whose only neurological sign was a left hemifacial spasm is reported. The rarity of such a condition prompted us to review the literature. Particular attention has been paid to the possible pathogenetic mechanisms and their therapeutic implications.     

The mechanism of hemifacial spasm: a new understanding of the offending artery

Abstract

Although neurovascular confliction was believed to be the cause of hemifacial spasm (HFS), the mechanism of the disorder remains unclear to date. Current theories, merely focusing on the facial nerve, have failed to explain the clinical phenomenon of immediate relief following a successful microvascular decompression surgery (MVD). With the experience of thousands of microvascular decompression surgeries and preliminary investigations, we have learned that the offending artery may play a more important role than the effect of merely mechanical compression in the pathogenesis of the disease. We believe that the attrition of neurovascular interface is the essence of the etiology, and the substance of the disease is emersion of ectopic action potentials from the demyelinated facial nerve fibers, which were triggered by the sympathetic endings from the offending artery wall. In this paper, we put forward evidence to support this hypothesis, both logically and theoretically.     

Nausea as a complication of low-frequency repetitive transcranial magnetic stimulation of the posterior fossa.

BACKGROUND: Transcranial magnetic stimulation (TMS) can non-invasively investigate the function of human brain. However, it can induce a focal pain at the stimulated site on the scalp or seizures when applied with high frequency (>1 Hz). Here we report an induction of nausea as a complication of low-frequency repetitive TMS (rTMS) of the cerebellum. SUBJECTS AND METHODS: Eight right-handed normal volunteers underwent low-frequency (0.9 Hz) rTMS of the right cerebellum. The stimulus intensity was set at 90% of the resting motor threshold determined by TMS to motor cortex. RESULTS: Nausea lasted as long as 10 min after the end of rTMS without apparent neurological deficit in two subjects. This symptom was replicated when the same protocol was applied on a different day in the same subjects. CONCLUSIONS: Low-frequency rTMS of cerebellum is still a safe procedure, but the experimenters should keep in mind the possibility of inducing nausea.     

Protracted vomiting as the presenting sign of posterior fossa mass lesions.

Four patients with mass lesions of the posterior fossa experienced protracted vomiting as their only symptom for extended periods of time. The responsible lesions were a cerebellar tumour in two patients, a ventricular cysticercus in one patient, and a giant vertebral artery aneurysm in another. All four cases had compression or displacement of the floor of the fourth ventricle, where the "vomiting centre" has been located. The value of vomiting as a sign of a posterior fossa lesion is emphasised.     

Giant aneurysms of the posterior fossa presenting as space occupying lesions.

In relation to the case history of a patient, who was observed at the Ursula Clinic, Wassenaar, Holland, a survey from the literature is given of 47 cases of giant aneurysms of the posterior fossa, which primarily presented as space occupying lesions.