Background Microvascular decompression of facial nerve provides definitive and long-term cure for hemifacial spasm. We review our experience of treating hemifacial spasm by microvascular decompression. Objectives To evaluate the results of microvascular decompression of facial nerve for hemifacial spasm and to discuss the critical steps during surgery necessary to achieve a good result. Patients and methods Twenty-one cases of hemifacial spasm operated by the author were analysed. All the patients underwent microvascular decompression of the facial nerve by the retromastoid approach. Preoperative and postoperative videos of the patients were made with their consent. Patient outcome and complications were analysed. Results Twenty patients had complete resolution of the spasm after surgery. The second operated patient had facial palsy with hearing loss in the immediate postoperative period and recurrence of the spasm after 6 months of surgery. Postoperative mild transient facial weakness in one patient, mild sensory-neural hearing loss in two, delayed facial palsy which resolved completely in two patients, transient facial twitching which responded to carbamazepine in one and paradoxical CSF rhinorrhea treated successfully by lumbar drainage in one patient were the complications noted. Conclusion Hemifacial spasm is best treated by surgery, and our results compare favourably with those in the existing literature. Sensorineural hearing loss and facial nerve palsy are the main complications to be expected during the learning curve.

中文翻译：

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面肌痉挛微血管减压术21例手术回顾

背景 面神经微血管减压术为面肌痉挛提供了明确和长期的治疗方法。我们回顾了我们通过微血管减压治疗面肌痉挛的经验。目的 评价面神经微血管减压治疗面肌痉挛的效果，并探讨术中取得良好效果所需的关键步骤。患者与方法 对笔者所手术的21例面肌痉挛病例进行分析。所有患者均采用乳突后入路行面神经微血管减压术。患者的术前和术后视频均在征得患者同意后制作。分析了患者的结果和并发症。结果 20例患者术后痉挛完全缓解。第二位手术患者在术后即刻出现面瘫伴听力丧失，术后 6 个月痉挛复发。术后轻度一过性面部无力 1 例，轻度感觉神经性听力损失 2 例，迟发性面瘫 2 例完全缓解，1 例对卡马西平有反应的一过性面部抽搐，1 例腰椎引流术治疗反常性脑脊液鼻漏。注意到的并发症。结论 面肌痉挛最好通过手术治疗，我们的结果与现有文献的结果相比具有优势。感音神经性听力损失和面神经麻痹是学习曲线期间预期的主要并发症。术后轻度一过性面部无力 1 例，轻度感觉神经性听力损失 2 例，迟发性面瘫 2 例完全缓解，1 例对卡马西平有反应的一过性面部抽搐，1 例腰椎引流术治疗反常性脑脊液鼻漏。注意到的并发症。结论 面肌痉挛最好通过手术治疗，我们的结果与现有文献的结果相比具有优势。感音神经性听力损失和面神经麻痹是学习曲线期间预期的主要并发症。术后轻度一过性面部无力 1 例，轻度感觉神经性听力损失 2 例，迟发性面瘫 2 例完全缓解，1 例对卡马西平有反应的一过性面部抽搐，1 例腰椎引流术治疗反常性脑脊液鼻漏。注意到的并发症。结论 面肌痉挛最好通过手术治疗，我们的结果与现有文献的结果相比具有优势。感音神经性听力损失和面神经麻痹是学习曲线期间预期的主要并发症。观察到的并发症包括一过性面部抽搐，其中一名患者对卡马西平有反应，一名患者通过腰椎引流成功治疗了矛盾的脑脊液鼻漏。结论 面肌痉挛最好通过手术治疗，我们的结果与现有文献的结果相比具有优势。感音神经性听力损失和面神经麻痹是学习曲线期间预期的主要并发症。观察到的并发症包括一过性面部抽搐，其中一名患者对卡马西平有反应，一名患者通过腰椎引流成功治疗了矛盾的脑脊液鼻漏。结论 面肌痉挛最好通过手术治疗，我们的结果与现有文献的结果相比具有优势。感音神经性听力损失和面神经麻痹是学习曲线期间预期的主要并发症。