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目的回顾性分析桥小脑角肿瘤继发性面肌痉挛的临床特点,探讨肿瘤继发性面肌痉挛的病理机制,治疗方案和手术要点。方法分析2004年10月～2007年4月间1281例面肌痉挛手术病例中的9例肿瘤继发病例,对照同期血管压迫型面肌痉挛的临床治疗,总结此类病例的鉴别诊断,治疗效果,以及手术要点。结果本组中共有桥小脑角上皮样囊肿5例、脑膜瘤1例、听神经瘤1例、舌咽神经鞘瘤1例、迷走神经鞘瘤1例。肿瘤全切7例,部分切除2例。9例手术治疗的继发性面肌痉挛的总有效率为77.7%,无复发病例。术后长期并发症包括听力丧失2例,面瘫2例。结论常规头颅核磁共振检查是肿瘤继发性面肌痉挛鉴别诊断的最佳方法。致病机制可分为脑外肿瘤继发和脑内肿瘤继发两种类型。脑外肿瘤通过占位效应和肿瘤包膜与周围神经血管以及蛛网膜的粘连致病。脑内肿瘤则除了具有间接占位效应外,主要通过直接占位效应刺激面神经核发病。总体上继发性面肌痉挛手术治疗效果比原发性面肌痉挛的差,手术并发症发生率高。肿瘤切除术加血管减压术是首选治疗方案。手术原则是保护颅神经功能的前提下争取肿瘤全切和面神经的充分减压。
Objective To retrospectively analyze the clinical features of secondary hemifacial spasm in cerebellopontine angle tumors and to explore the pathological mechanism, treatment options and operative points of secondary hemifacial spasm. Methods From October 2004 to April 2007, 1281 cases of hemifacial spasm surgery cases in 9 cases of tumor secondary cases, the control of vascular compression hemifacial spasm clinical treatment, to summarize the differential diagnosis of such cases, the treatment effect , As well as the main points of surgery. Results There were 5 cases of cerebellopontine angle epithelioid cyst in this group, 1 case of meningioma, 1 case of acoustic neuroma, 1 case of glossopharyngeal schwannoma and 1 case of vagus nerve sheath tumor. Tumor resection in 7 cases, partial resection in 2 cases. Nine cases of surgical treatment of secondary hemifacial spasm, the total effective rate was 77.7%, no recurrence. Postoperative long-term complications, including hearing loss in 2 cases, 2 cases of facial paralysis. Conclusion Conventional cranial MRI is the best method for the differential diagnosis of secondary hemifacial spasm. Pathogenesis can be divided into secondary brain tumors and brain tumors secondary to two types. Brain tumors through the placeholder effect and the tumor capsule and peripheral neurovascular and arachnoid adhesions pathogenic. In addition to the brain tumor has an indirect space-occupying effect, mainly through the direct placeholder effect to stimulate facial nerve nucleus. Overall, secondary hemifacial spasm surgery is less effective than the primary hemifacial spasm, the incidence of complications is high. Tumor resection plus vascular decompression is the treatment of choice. The principle of surgery is to protect cranial nerve function under the premise of full tumor resection and facial nerve decompression.