继发性面肌痉挛(附5例分析)

目的探讨继发性面肌痉挛的病因及手术治疗。方法回顾性分析2000年10月．2007年7月采用手术治疗的977例面肌痉挛病例中的5例（0．5％）继发性者。其中3例为桥小脑角胆脂瘤，术中除将肿瘤切除减压外，还行显微血管减压术；1例为听神经瘤．行肿瘤切除；另外1例双侧面肌痉挛病人为右上矢状窦旁前中1/3交界处脑膜瘤，行常规开颅肿瘤切除。结果5例病人术后面肌痉挛均消失，分别随访1、15、37、40、79个月，治愈率100％。术后并发症包括：暂时性单纯耳鸣1例；轻度面瘫并听力下降1例：无菌性脑膜炎1例，出院时均治愈。结论继发性面肌痉挛多由桥小脑角生长较广泛的胆脂瘤引起：除行颅后窝显微手术切除肿瘤外，如发现动脉通过面神经出脑干区，还应行责任动脉显微血管减压术，方能彻底减压。

Secondary hemifacial spasm: report of 5 cases

Objective To explore the etiology and surgical management of secondary hemifacial spasm, Methods Five secondary cases of 977 cases with hemifacial spasm underwent microvascular decompression from October 2000 to July 2007 were retrospectively analyzed. Among the 5 cases, 3 were cerebellopontine angle cholesteatomas, which were removed, and additional microvascular decompression was performed; One was of acoustic neuroma, which was removed totally; and the other one had bilateral hemifacial spasm, secondary to a parasagittal meningioma at the junction of the anterior and middle third of the right superior sagittal sinus, and total removal of the tumor was performed. Results The immediate and follow-up cure rates were both 100%. The follow-up period was 1, 15, 37, 40, 79 months retrospectively. The postoperative complications included 1 case of transient tirmitus, 1 of mild facial palsy with decreased hearing ability and 1 chemical meningitis which recovered before discharge. Conclusion Cerebellopontine angle cholesteatoma was the main reason of secondary hemifacial spasm. Besides total removal of cerebellopontine tumors, microvascular decompression should be performed for the vessels passing through root exit zone of facial nerve to achieve cure.