• Huidan Lin, Gang Cao, Zhaodong Yang, Dan Wu, Ming Yao, Guanjun Jin, Xindan Du, Changshun Huang, and Bing Huang.
• First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, China.
• Pain Physician. 2022 Oct 1; 25 (7): E1063E1071E1063-E1071.

BackgroundHemifacial spasm (HFS) is mainly characterized by paroxysmal involuntary twitches of one side of the facial muscles. We developed an awake CT-guided percutaneous puncture of the stylomastoid foramen for radiofrequency ablation (RFA) therapy for the treatment of hemifacial spasm and successfully used it in our clinic.ObjectiveWe aimed to compare anterior or posterior mastoid approaches in CT-guided percutaneous RFA at the stylomastoid foramen for the treatment of HFS.Study DesignProspective, clinical research study.SettingDepartment of Anesthesiology and Pain Medical Center, Ningbo, China.MethodsSixty-eight patients with HFS were recruited. They were divided into 2 groups: anterior mastoid approach and posterior mastoid approach. With the patient were under minimal sedation, a radiofrequency  needle was used to reach the stylo-mastoid foramen on the affected side by an anterior approach or posterior approach; the facial nerve was localized using a low-frequency stimulation current. Ablation stopped when the patient's hemifacial contracture resolved. The puncture depth, angle, intraoperative and postoperative complications, and the short-term and long-term efficacy of the 2 puncture approaches were recorded.ResultsThe HFS disappeared completely in 37 and 24 cases of the anterior and posterior group, but cases of both groups exhibited a House-Brackmann Facial Paralysis Scale Grade II or Grade III. During one-24 months of follow-up, 5 cases and 3 cases recurred respectively in the two groups. After 6 months of follow-up, the facial paralysis symptoms of patients in both groups disappeared.ConclusionThere was no difference in the operation time or efficacy between the 2 approaches. The anterior mastoid approach is easier to perform and is recommended based on our experience.

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