【省立疼痛英语晨读】面肌痉挛 ——保守疗法和手术治疗（一）

 英语晨读 ·

山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。

本次文献选自Schroeder H: Hemifacial spasm—conservative and   surgical treatment options. Dtsch Arztebl Int 2012;  109(41): 667−73.

SUMMARY 

Background: Hemifacial spasm is a neuromuscular movement disorder characterized by brief or persistent involuntary contractions of the muscles innervated by the facial  nerve. Its prevalence has been estimated at 11 cases per  100 000 individuals. Among the patients who were operated on by our team, the mean interval from diagnosis to  surgery was 8.2 years, and more than half of them learned  of the possibility of surgical treatment only through a personal search for information on the condition. These facts  motivated us to write this article to raise the awareness of  hemifacial spasm and its neurosurgical treatment among  physicians who will encounter it.  

Methods: This review article is based on a selective literature search and on our own clinical experience.

Results: Hemifacial spasm is usually caused by an artery  compressing the facial nerve at the root exit zone of the  brainstem. 85–95% of patients obtain moderate or marked  relief from local injections of botulinum toxin (BTX), which  must be repeated every 3 to 4 months. Alternatively,  microvascular decompression has a success rate of about  85%. 

Conclusion: Local botulinum-toxin injection is a safe and  well-tolerated symptomatic treatment for hemifacial  spasm. In the long term, however, lasting relief can only  be achieved by microvascular decompression, a micro - surgical intervention with a relatively low risk and a high  success rate.

摘要

背景：面肌痉挛是一种神经肌肉运动障碍，其特征是面神经支配区肌肉短暂或持续的非自主性收缩。据估计，其发病率为11/10万。在我们的手术患者中，从诊断到手术的平均时间是8.2年，其中超过一半的患者是通过个人搜索与该病相关的信息才了解到手术治疗这一方法的。这一现象激励我们写了这篇文章，目的是为了提高有可能遇到这种情况的医生对面肌痉挛的认识以及该病神经外科的治疗方法。

方法：这篇综述是根据选择性文献检索和我们自己的临床经验撰写的。

结果：半侧面肌痉挛通常是由于脑干根部出口区的动脉压迫面神经引起的。85-95%的患者通过局部注射肉毒素（BTX）其面肌痉挛可以得到中度或显著缓解，但是，该方法必须每3-4个月重复一次。另外，微血管减压术（MVD）的成功率约为85%。

结论：局部注射肉毒杆菌毒素是一种安全、耐受性好的对症治疗方法。然而，从长期来看，持久缓解只能通过微血管减压术来实现，这是一种风险相对较低、成功率较高的显微外科治疗方法。