11例表皮样囊肿继发面肌痉挛患者临床特征及预后分析  

Clinical features and prognostic analysis of 11 cases of epidermoid cysts complicated with secondary hemifacial spasm

作　　者：崔滨 刘江[2] 王丹慧 陈国强 王林 CUI Bin;LIU Jiang;WANG Danhui(Department of Neurosurgery,Aviation General Hospital,Beijing 100012,China)

机构地区：[1]航空总医院神经外科,北京100012 [2]中日友好医院神经外科,北京100029 [3]河南科技大学附属许昌市中心医院神经内科,河南许昌461001

出　　处：《中风与神经疾病杂志》2024年第11期1024-1028,共5页Journal of Apoplexy and Nervous Diseases

摘　　要：目的原发性面肌痉挛(HFS)是由面神经根出脑干区(REZ)处血管压迫引起的。而目前关于桥小脑角肿瘤尤其是表皮样囊肿引起的继发性HFS报道较少,且其具体机制尚不明确。本文研究旨在描述表皮样囊肿继发性HFS患者的临床和术中特点,提供治疗建议。方法回顾2010—2022年航空总医院收治的3950例HFS患者,对其中11例HFS合并表皮样囊肿患者进行了回顾性分析,重点分析其症状、肿瘤和血管之间的关系。结果所有患者均接受表皮样囊肿切除术,平均随访时间为45个月。11例患者中8例实现肿瘤全切除、3例实现次全切除,所有患者在随访期间均未出现复发情况。7例面神经REZ被动脉压迫,肿瘤切除后用聚四氟乙烯完全减压。9例患者术后症状立即缓解,2例无动脉压迫症状逐渐好转,2个月后痊愈。结论HFS可能是桥小脑角表皮样囊肿的最初症状,本组病例多为肿瘤和面神经REZ处的动脉共同压迫所致。为了彻底缓解症状,建议肿瘤切除后常规探查面神经根血管压迫情况。Objective Primary hemifacial spasm(HFS)is caused by vascular compression in the root exit zone(REZ)of the facial nerve.Currently,there are few reports on secondary HFS caused by cerebellopontine angle tumors,especially epidermoid cysts,and its specific mechanism is still unclear.The purpose of this article is to provide clinical in⁃sights into the pathological characteristics and intraoperative findings of patients with HFS secondary to epidermoid cysts.Methods Among 3950 HFS patients treated between 2010 and 2022,a retrospective analysis was conducted on 11 pa⁃tients with HFS and epidermoid cysts,focusing on the correlations of symptoms,tumors,and blood vessels.Results All patients underwent epidermoid cyst resection,with a mean follow-up of 45 months.Among the 11 patients,8 patients achieved total tumor resection and 3 patients achieved subtotal tumor resection.No recurrence occurred in these patients during the follow-up period.In 7 cases,the REZ of the facial nerve was compressed by the artery and was completely de⁃compressed with polytetrafluoroethylene after tumor resection.The symptoms of 9 patients were relieved immediately after surgery,and the symptoms of 2 patients without arterial compression gradually improved and they recovered after two months.Conclusion HFS may be the initial symptom of cerebellopontine angle epidermoid cyst,and most cases in this group were caused by the compression from both the tumor and the artery at the REZ of the facial nerve.To completely re⁃lieve symptoms,it is essential to examine the vascular compression of the facial nerve root following tumor resection.

关 键 词：面肌痉挛 表皮样囊肿 微血管减压 桥小脑角 

分 类 号：R742[医药卫生—神经病学与精神病学]