1.How do I know if I am suffering from facial spasm, trigeminal neuralgia or glossopharyngeal neuralgia? Trigeminal neuralgia is a recurrent severe pain of pins and needles and burning-like pain in the distribution area of the trigeminal nerve of the face. It is mostly pain in 2 or 3 branches of the trigeminal nerve alone or combined, and it is rare that all three branches are involved at the same time or just one branch of pain. The pain often occurs suddenly without aura and lasts for a few seconds or minutes, with intermittent periods as normal. However, as the disease progresses, the frequency of attacks increases, the pain level increases, and the interval is shortened. Some patients have “trigger points”, which can cause painful episodes by slight touching of this area. The trigger points are mostly located at the affected side of the mouth and nose, and patients often refuse to talk, wash their faces, eat, brush their teeth, etc. because of fear of pain. Facial muscle spasm is a recurrent involuntary twitching of the facial nerve innervated expression muscles, mostly on one side of the face, also known as hemifacial spasm, bilateral seizures are rare. It starts as an involuntary twitch from the lower eyelid of one side, which can last from a few seconds to several minutes, with intervals as normal. As the disease progresses, the spasm may extend to half of the affected side of the face, and even the broad neck muscles may also spasm together and cause the head to shake. It is more likely to be triggered by emotional tension and speech. In severe cases, the spasm continues without intervals, which seriously affects the patient’s social and cosmetic appearance, and may also affect the patient’s vision, leading to difficulties in work, study, reading, driving and other activities. Glossopharyngeal neuralgia is a paroxysmal severe pain confined to the distribution area of the glossopharyngeal nerve: such as the posterior pharyngeal wall, the root of the tongue, the tonsillar area and the soft palate, which may radiate to the distribution area of the Eustachian branch of the vagus nerve, such as the deep external auditory canal and the angle of the mandible. The diagnosis of these three diseases is mainly based on typical symptomatic manifestations, while cranial CT or MR examinations should be performed to exclude other intracranial diseases. 2.How is the lock-hole surgery for trigeminal neuralgia and facial spasm surgery done and what is the advanced point compared with other surgeries? Locked foramen surgery: This surgery is a creative application of the most advanced locking foramen surgery technique in the world to cure cranial nerve diseases by microvascular decompression. This surgery is less traumatic, more effective and has fewer complications than other surgeries in China. A vertical incision of only 5cm in length is made behind the ear, and then a bone hole of 1.5cm in diameter is opened as the “locking hole” (the traditional bone window of 3-4cm in diameter is very traumatic). Then, under the microscope, the nerve root and the compressing blood vessel are found through the “locking hole”, and the blood vessel is pushed away from the nerve root without damaging the nerve or the blood vessel, and the blood vessel is padded with a special material called “teflon pad”, so that the nerve root is released from compression and the disease is treated. The nerve root is released from compression and the disease is cured. It is a more advanced surgical treatment method with less trauma, higher efficacy and fewer complications. The cure rate of facial muscle spasm is 98%, trigeminal neuralgia is 95%, and linguopharyngeal neuralgia is 90%. The complication rate is reduced to less than 2% (the complication rate of traditional surgery is 5%). Attachment: Introduction to lock-hole surgery: In the latter half of the 20th century, minimally invasive surgery came into being as diagnostic tools were updated, the pursuit of perfect surgery, and sophisticated surgical equipment emerged. It is one of the important symbols of minimally invasive neurosurgery and has been used in neurosurgery since 1990. The advantages of the procedure are less trauma, less medical injury, and improved surgical results, which improves the micro-neurosurgery technology to a new level. Introduction of microvascular decompression: trigeminal neuralgia, facial spasm and glossopharyngeal neuralgia are the most common cranial nerve diseases, and microvascular decompression is the most scientific treatment method for trigeminal neuralgia, facial spasm and glossopharyngeal neuralgia that is recognized and recommended by the public and is internationally accepted. The common mechanism of cranial nerve disorders is the compression of nerve roots by blood vessels, resulting in demyelinating lesions, “short-circuiting” of nerve conduction, and increased excitability of brain nuclei, resulting in a clinical hyperfunctional syndrome. The procedure is performed by opening the posterior cranial fossa, exposing and dissecting the nerve in question, and finding the compressing blood vessel. On the premise of preserving the normal function of the nerves and blood vessels, the nerve-compressed blood vessels are pushed away and appropriate padding is used to prevent the blood vessels from returning, thereby relieving the nerve compression and providing relief of clinical symptoms. Microvascular decompression is the preferred treatment for facial spasm, and is the best treatment for patients with trigeminal neuralgia and glossopharyngeal neuralgia who are ineffective with medication or unwilling to take oral medication. 3.Does trigeminal neuralgia and facial spasm surgery require hospitalization? How long does the surgery take? How long is the hospital stay? The lock-hole surgery for trigeminal neuralgia and facial spasm requires hospitalization under general anesthesia. The hospital stay is approximately 10 days. The first 3 days are for preoperative examination, and the surgery will be performed after there is no contraindication to surgery. The surgery will take about 2-3 hours, and the patient will be awake half an hour after surgery. The stitches are removed and discharged 7 days after surgery. 4.Will trigeminal neuralgia, facial spasm and glossopharyngeal neuralgia produce facial paralysis and loss of facial sensation after surgery? The operation is performed through a “locking hole” approach to find the relevant nerve root and the compressing blood vessel, and without damaging the nerve and blood vessel, the blood vessel is pushed away from the nerve root, and a special material “teflon pad” is used to pad the blood vessel, so that the nerve root can be released from the compression. The nerve root is then released from compression and the disease is cured. This procedure does not damage the nerves and blood vessels, and therefore does not produce facial paralysis or loss of facial sensation. Other surgeries such as radiofrequency ablation, botulinum toxin injection and gamma-knife therapy are designed to block or destroy part of the nerve, so that the nerve function is partially or completely lost to achieve the treatment purpose, so it will lead to facial paralysis and facial sensory disorders. 5.Does trigeminal neuralgia, facial spasm and glossopharyngeal neuralgia get better by themselves? Trigeminal neuralgia, facial spasm and glossopharyngeal neuralgia will generally worsen gradually, or they may stay in a certain condition of development and not progress anymore, but they will not heal themselves. In some patients, there may be an attack-remission period, during which there may be no attacks, but the attacks may still occur after the remission period. In severe cases, there is no remission period. 6.What kind of patients are suitable for surgery? Patients with facial muscle spasm, trigeminal neuralgia and glossopharyngeal neuralgia that cannot be controlled by medication, as long as their physical condition can tolerate surgery, lock-hole radical surgery is the first choice, which is the internationally accepted treatment option. Advanced age is not a contraindication to surgery. Patients over 80 years of age can still safely benefit from surgery as long as their physical condition permits. Trigeminal neuralgia and glossopharyngeal neuralgia can be treated orally with drugs such as carbamazepine and phenytoin sodium at the early stage of onset, which have certain efficacy. Long-term use should pay attention to the toxic side effects, and women of childbearing age should take into account the teratogenic effects of the drugs. The pain is often uncontrollable in the later stages of the disease due to toxic side effects of drugs or decreasing efficacy, and should be treated promptly with lockhole radical surgery. Once the diagnosis of facial myasthenia gravis is established, radical surgery of the foramen ovale is the treatment of choice. Oral medications for facial myospasm are generally ineffective. Patients who cannot tolerate surgery due to serious medical diseases can choose radiofrequency treatment or botulinum toxin injection. 7.What is the cure rate of lockhole radical surgery and is the surgery risky? What are the common complications? Lockhole surgery is a more advanced surgical treatment method with less trauma, higher efficacy and fewer complications. The cure rate of facial muscle spasm is 98%, trigeminal neuralgia is 95%, and linguopharyngeal neuralgia is 90%. The incidence of permanent complications is reduced to less than 2% (5% for traditional surgery). The chance of death due to serious conditions is less than 1/1000, which is comparable to the mortality rate of appendicitis surgery. Common complications: ① Hearing impairment is the most common complication, at about 1-2%, but it only affects the operated side, not the opposite side. ②Temporary facial palsy occurs in 5% and will usually recover in 1 week to 3 months. ③Other complications such as intracranial infection, cerebrospinal fluid leakage, cerebellar hemispheric hematoma, which can also occur in general craniotomy, have a very low chance of occurring in lock-hole surgery. Once they occur, they can be treated and improved in time. 8.Will the surgery affect the beauty? We take minimally invasive surgery, the incision is about 3 or 5 cm long transverse incision in the hairline behind the ear, shaving the head only requires an area behind the fist of the sick side of the ear, female patients and male patients with long hair, the surgical incision is hidden by the hair, almost can not see the surgery. When the hair grows out, the incision scar will be hidden and it will not affect the beauty at all. 9.Does the defective skull have any effect on the patient? The soft tissue behind the occipital ear is relatively thick, and the diameter of the skull defect after surgery is only about 1 or 5 centimeters, so the patient will not feel the skull defect, and it will not cause any risk. 10.Will the disease recur after surgery? Generally, there is no recurrence after surgery, but it can recur because new blood vessels will be displaced to the nerve roots again to produce compression, thus producing symptoms. The chance of recurrence is less than 1 in 1000. Patients with recurrence can still be effectively treated with surgery again. 11.How much does the surgery cost? The total cost of the whole inpatient surgery is about 30,000 RMB. 12.What are the causes of trigeminal neuralgia, facial spasm and glossopharyngeal neuralgia? There are 12 pairs of cranial nerves in our brain, which manage the sensory, motor, visual and olfactory functions of our head and face. The fifth, eighth and ninth pairs of cranial nerves are the trigeminal nerve, the facial nerve and the glossopharyngeal nerve, which manage the sensation of the face, the movement of the expression machine, and the sensation of the tongue and throat, respectively. These three nerves have a physiological myelin weak zone (root exit zone (REZ)) at the nerve roots entering and leaving the brainstem. The myelin sheath that surrounds the nerves is replaced by the central glial cells by the Schwann cells of the peripheral nerves, and the nerves are like the wire conductors we use, while the myelin sheath is similar to the insulating sheath of the wire. When the nerve travels inside the brain, the environment does not change much, so the myelin sheath of the glial cells is able to function properly, and when the cranial nerve travels out of the brain, the environment outside changes, so in order to cope with this change, the myelin sheath made of Schwann cells is used instead of the myelin sheath of the glial cells inside the brain. . However, at the site where the nerve exits the brain parenchyma, the site where these two myelin sheaths alternate, a physiological zone of weakness is formed. In this area, if there is compression by displaced blood vessels, adhesions of the arachnoid membrane, etc., the nerve is damaged, similar to the weakness of a wire wrapper, which “short-circuits” and even creates a conduction loop, thus making the nerve hyperfunctional. On the other hand, the “short circuit” also causes the central nucleus of the nerve to become overexcited, which causes the nerve to become further hyperactive. As a result, what was originally a command from the brain to blink causes a continuous facial twitch because of a “short circuit” in the conduction pathway. Similarly, this condition produces trigeminal neuralgia in the trigeminal nerve and glossopharyngeal neuralgia in the glossopharyngeal nerve. Of course, these problems also exist in some other cranial nerves and even peripheral nerves (e.g., spastic slanting neck due to paraneopathy, persistent vertigo due to vestibular neuropathy, etc.), but they are far less likely to occur than these diseases, so they are not covered in this interview for the time being due to time constraints.