In daily life, you often encounter two kinds of patients: an old man playing with his grandchildren in the park, with gray hair and amiable, inadvertently touches the corners of his mouth, and in a moment the pain strikes and keeps slapping his face, painful; a pretty girl at the neighboring table, laughing and smiling, suddenly blinks her eyelids, the corners of her mouth keep twitching, and her face is full of blush. These are the two diseases that affect the face, trigeminal neuralgia and facial spasm. So many patients suffer from them and seek medical help everywhere, while most of them have poor treatment results. For this reason, the reporter interviewed Associate Professor Zhang Liangwen of the Department of Neurosurgery, Qilu Hospital of Shandong University (MD, early to carry out surgical treatment of facial spasm and trigeminal neuralgia in the province). Reporter: These two types of patients are so common in life, how high is the incidence? Is the etiology clear? A: In 1985, the epidemiological survey on trigeminal neuralgia (TN) in rural areas of 21 provinces and cities in China showed that the incidence of TN was 21.87/100,000 people, and the incidence of facial spasm was 11/1 million in foreign epidemiological surveys, and there are millions of these two types of patients in China, so they are often encountered in daily life. The etiology of trigeminal neuralgia and facial spasm is now basically clear, divided into primary and secondary. Secondary causes are mostly due to localized occupational lesions in the posterior cranial fossa such as cholesteatoma. The primary cause, on the other hand, is the compression of blood vessels. The facial nerve and the intracranial segment of the trigeminal nerve are subject to long-term vascular compression, resulting in demyelination of the above nerves. The normal axons of the demyelinated nerve are very sensitive to external changes, and abnormal excitation of the facial nerve forms nerve impulses, resulting in involuntary twitching of facial muscles; while abnormal excitation of the trigeminal nerve leads to discharge-like pain. Reporter: Is it possible to diagnose trigeminal neuralgia with facial pain and facial muscle spasm with eyelid blinking? A: Trigeminal neuralgia refers to recurrent episodes of transient paroxysmal severe pain in the trigeminal nerve distribution area of the face. The pain site is limited to the trigeminal nerve distribution area, and is most common in the middle and lower part of the face, while pain in the upper part of the face alone is rare. The pain is particularly sensitive in a certain area and can be triggered by the slightest touch, which is called the “trigger point”. The pain is sudden and lightning-like, like a cut, burn, pinprick or electric shock. As the disease progresses, the frequency of attacks increases and the pain level worsens. The disease seriously endangers the health and work life of patients. It can be differentiated from other types of pain. Facial muscle spasm (unilateral facial muscle twitching) refers to paroxysmal, involuntary muscle spasms on one side of the face. The twitching mostly starts around the eyes and gradually expands downward, affecting the perioral and facial expression muscles, and in severe cases, it may involve the ipsilateral neck. Facial muscle spasms affect the patient’s appearance and cause inconvenience to daily life and work. In contrast, bilateral blepharospasm, which is not involved below the eyelid, is usually seen in children and adolescents and can be controlled by the will, and is not considered facial spasm. Reporter: What are the current treatments and how effective are they? A: In the past, people lacked in-depth and detailed research on the causes of the above diseases, did not understand their pathogenesis, and tried various treatments, such as sedatives, anti-epileptic drugs such as carbamazepine, phenytoin sodium, vitamins, Chinese medicine, acupuncture, botulinum toxin injection, closure, physical therapy, etc. All these methods failed to target the causes, so patients failed to see results despite long-term treatment. Even if there is some effect, the patient relapses after a few months. Neurosurgery microvascular decompression for facial spasm and trigeminal neuralgia is an effective and safe procedure, and has become the preferred treatment for this type of disease. Reporter: Can microvascular decompression achieve a radical effect? A: In 1966, Jannetta, an American, pioneered microvascular decompression, which is performed by pushing the responsible vessels away from the trigeminal nerve and facial nerve roots with a cushion to achieve treatment. A spacer is placed between the vessel and the nerve, which is like wrapping a layer of insulating tape around a frayed wire, relieving the compression, releasing the bioelectricity build-up, and allowing the nerve to return to normal function. The cure rate of facial spasm can reach about 95%, and invalid or recurrent patients can be operated again six months after the first surgery, and still can be expected to achieve the cure effect. Trigeminal nerve root microvascular decompression surgery can preserve the function of the trigeminal nerve, and the cure rate is about 85%. Reporter: Could you briefly introduce the operation method and what are the complications? A: The operation has small incision, less bleeding, light injury, and fast recovery after surgery. Anyone without systemic organic pathology such as serious cardiovascular disease and under the age of 75 can be considered for treatment by microvascular decompression. The procedure is performed under general anesthesia, with a small incision, 4cm incision in the hairline behind the ipsilateral ear, and a local cranial borehole of about 1.5cm in diameter (minimally invasive lock-hole surgery), where the root of the trigeminal nerve is explored under a microscope, the vessel and nerve root are separated and a special material (Tefflon cotton) is placed between them to isolate the responsible vessel compressing the nerve. The treatment is achieved by relieving the nerve compression. The procedure usually takes 1.0-2.0 hours, and the patient is bedridden for 3 days after the procedure and can be discharged after the incision is removed in 7 days. Possible complications include mild facial paralysis, hearing impairment, infection, etc. The chance of occurrence is very low and most of them can be recovered.