2023年 · 第103卷第07期

Hefacial spasm (HFS) refers to unilateral involuntary twitching of facial muscles, which can lead to functional blindness in severe cases. Its pathogenesis is mostly that the facial nerve root is compressed by accompanying blood vessels in the anterior pontic cistern, resulting in demyelination of nerve fibers and ectopic discharge, which is conducted to the effector (expression muscle) and causes involuntary twitching. At present, the first-line treatment plan is carnitine injection into expression muscle to block nerve-muscle excitation-contraction coupling, but the duration is only about 3 months; Craniotomy microvascular decompression can achieve the therapeutic effect by relieving the compression of accompanying blood vessels on nerves, but it is risky and expensive. This study describes a novel minimally invasive procedure: CT-guided percutaneous stylomastoid foramen partial facial nerve radiofrequency ablation (RFA) for HFS. By observing the clinical efficacy and safety follow-up of 53 patients with HFS who underwent CT-guided partial facial nerve RFA under conscious sedation for immediate and up to 19 months, it was found that the mean operation time of partial facial nerve RFA was only 32~34 min. 91% of patients (48/53) had complete HFS remission after surgery, and mild to moderate facial paralysis that could recover within one month could provide effective relief for patients with HFS lasting more than 15 months. This study suggests that CT-guided partial RFA of facial nerve of stylomastoid foramen can effectively block the conduction of ectopic electrical excitation to expression muscle, thus relieving hemifacial spasm for a long time. This technique is a minimally invasive procedure without intracranial entry, and according to current efficacy observations, it can be an effective treatment option for HFS.

At present, the treatment methods of trigeminal neuralgia include nerve block, radiofrequency ablation, balloon compression, craniotomy and microvascular decompression, etc. Among them, the classic balloon compression treatment is to complete the puncture operation under the guidance of C-arm X-ray under general anesthesia. Because of the inability to communicate with patients under general anesthesia, the effective standard of surgery can only be judged by the "inverted pear shape" of the lateral X-ray projection of the inflated balloon. This study describes the method of CT-guided percutaneous balloon compression in the treatment of trigeminal neuralgia in awake state, and observes its efficacy and safety. A total of 66 patients with medically refractory trigeminal neuralgia were enrolled in this study. The surgery was performed under moderate sedation and consciousness. After the balloon catheter was inserted through a trocar under CT guidance to reach the Meckel cavity, the position and optimal morphology of the filling balloon were determined by CT three-dimensional reconstruction. The efficacy was judged according to the intraoperative test of patients with facial hypoesthesia or disappearance of trigeminal neuralgia symptoms. All patients were followed up for 12 months and monitored for efficacy and complications. The trigeminal ganglion compression time was (272 ± 81) s, when there was significant facial hypoesthesia on the affected side, or resolution of triggered pain on the affected side, compared to the contralateral side. Trigeminal neuralgia symptoms were relieved within 6 months in all patients, with a 1-year recurrence rate of 13%. The CT-guided balloon compression technique described in this study improves the overall safety of trigeminal neuralgia treatment because it can communicate with patients during surgery, is easy to test the efficacy, and CT guidance is more accurate than X-ray fluoroscopy guidance.

Meige syndrome, also known as segmental craniocervical dystonia, currently lacks an effective treatment. Treatment of dystonia can be achieved by blocking the generation and transmission of abnormal motor signals. Meige syndrome (craniocervical dystonia often symmetrically distributed on both sides of the craniofacial axis) is not caused by concomitant vascular compression of cranial nerve roots, so it cannot be treated by craniotomy microvascular decompression. The present study found that CT-guided radiofrequency ablation of bilateral stylomastoid facial nerve and/or trigeminal mandibular branch of foramen ovale can effectively treat the corresponding type of Meige syndrome. According to preliminary observation, the efficacy can last for more than 18 months. Current studies include blepharospasmic dystonia syndrome (BDS), oromandibular dystonia syndrome (ODS), blepharospasm with oromandibular dystonia syndrome (B-ODS). BDS patients underwent bilateral radiofrequency ablation of facial nerve of stylomastoid foramen; Patients with ODS underwent bilateral radiofrequency ablation of the mandibular branch of the trigeminal nerve of the foramen ovale, and patients with B-ODS underwent bilateral radiofrequency ablation of the facial nerve of the stylomastoid foramen and the mandibular branch of the trigeminal nerve of the foramen ovale. This study showed that after radiofrequency treatment of bilateral facial nerves, there was simultaneous mild facial paralysis without skewed mouth angles, but the sucking ability was significantly reduced, resulting in the inability of the patient to complete the smiling action, and other than this, no other complications occurred. After radiofrequency surgery of the mandibular branch of the bilateral trigeminal nerve, there was no difficulty in opening the mouth. However, there is still dullness and numbness in the innervation area of the mandibular branch of the bilateral trigeminal nerve. After 24 months of follow-up, 2 patients experienced symptom relapse at 18 and 22 months, respectively. CT-guided extracranial radiofrequency ablation of bilateral facial nerve in stylomastoid foramen and/or mandibular branch of trigeminal nerve in foramen ovale may be a feasible treatment option for Meige syndrome. In addition to botulinum toxin injection and deep brain electrical stimulation, extracranial cranial nerve radiofrequency technology may become a new therapy for Meige syndrome.