南通大学学报(医学版)

目的：对面肌痉挛非典型压迫病例[出脑干区(root exit zone, REZ)以外存在责任因素]进行发病机制分析，探讨面神经显微血管减压(microvascular decompression, MVD)中血管神经探查方式。方法：回顾南通大学附属医院神经外科2022年1月—2025年1月因面肌痉挛行MVD的相关病例，对术中电生理监测情况、血管神经探查及处理情况进行分析，结合术后随访，对非典型压迫病例的发病机制及血管探查方法进行探讨。结果：共213例患者，于REZ区以外发现责任血管15例，其中血管袢型5例，蛛网膜型3例，血管夹持型2例，串联压迫型5例。术后即刻治愈137例，延迟治愈73例，未愈3例，随访结束时未有复发。非典型血管压迫15例术后患侧面部抽搐症状均即刻消失，其中双侧面肌痉挛1例对侧面部抽搐也同时消失。结论：面肌痉挛的发病基础可能是涉及其颅内段全长的周围因素造成的神经脱髓鞘，中枢因素在部分病例中起重要作用。在面神经MVD术中不应忽视对REZ区以外责任因素的探查。

Objective: To analyze the pathogenetic mechanisms of hemifacial spasm caused by atypical compression [responsible factors located outside the root exit zone(REZ)] and to explore intraoperative neurovascular exploration strategies during microvascular decompression(MVD) of the facial nerve. Methods: Clinical data of patients who underwent MVD for hemifacial spasm in the Department of Neurosurgery of Affiliated Hospital of Nantong University from Jan. 2022 to Jan. 2025 were retrospectively reviewed. Intraoperative electrophysiological monitoring findings, neurovascular exploration and management, as well as postoperative follow-up outcomes were analyzed to investigate the pathogenetic mechanisms of atypical compression and appropriate vascular exploration techniques. Results: A total of 213 patients were included in this study. In 15 cases, responsible vessels were identified outside the REZ, including 5 cases of vascular loop compression, 3 cases of arachnoid-related compression, 2 cases of vascular clamping, and 5 cases of tandem compression. Immediate postoperative cure was achieved in 137 cases, delayed cure in 73 cases, and 3 cases showed no improvement. No recurrence was observed during follow-up. In all 15 cases with atypical vascular compression, facial spasm on the affected side resolved immediately after surgery. Notably, in one patient with bilateral hemifacial spasm, the contralateral facial spasm also disappeared simultaneously. Conclusion: The pathogenesis of hemifacial spasm may be based on demyelination of the facial nerve caused by peripheral factors involving the entire intracranial course of the nerve, while central factors may play an important role in some cases. During facial nerve MVD,exploration of responsible factors outside the REZ should not be neglected.