摘要
目的分析面肌痉挛病人是否有颅内责任血管压迫,为面肌痉挛微血管减压术(MVD)术中处理提供手术依据。方法回顾性分析108例经MVD治疗面肌痉挛病人的临床资料,术前通过影像学检查了解面神经是否存在责任血管,采用枕下乙状窦后入路显露面神经出脑干端面神经根区(REZ)至进内听道全程,在压迫点放置Teflon减压垫棉。结果术中发现单纯面神经REZ区有明确责任血管压迫88例,既有REZ区压迫又有面神经桥前池段被责任血管袢推拉成角6例,单纯面神经桥前池段被责任血管袢推拉成角5例,动脉血管与面神经之间蛛网膜黏连增厚但未见血管压迫或推拉神经9例。术后抽搐症状立即消失92例,症状明显缓解16例,3个月后延迟治愈,总有效率100%。结论血管压迫面神经REZ区是面肌痉挛的主要原因,但血管袢直接推拉桥前池段或者间接通过蛛网膜牵拉面神经主干也可引发相关症状,术中责任血管的准确辨识、面神经全程减压松解,才能达到手术疗效。
Objective To study whether patients with facial spasm had intracranial vascular compression to provide evidence for microvascular decompression（MVD）.Methods Clinical data of 108 facial spasm patients undergoing MVD were analyzed retrospectively.The preoperative imaging was used to check the existence of offending vessels.The whole process of the facial nerve from the root exit zone（REZ） at the end of the brainstem to the entry of the internal auditory canal was exposed by surgery via suboccipital retrosigmoid sinus approach.And then Teflon was placed on the compression position.Results There were 88 patients with offending vessel compression at facial nerve REZ.Six patients had both offending vessel at the facial nerve REZ and a corner which was formed by pushing or pulling of offending vascular loops in the prepontine cistern segment,5 had a such corner alone and 9 had thickening arachnoid adhesion between artery and facial nerve but without compression or pushing/pulling of the nerve.The symptoms disappeared immediately after surgery in 92 patients,significantly relieved in 16,who were delay-cured after 3 months.The overall response rate was 100%.Conclusions Vascular compression of facial nerve REZ is a major cause of facial spasm.But vascular loops can directly push/pull prepontine cistern segment of facial nerve or indirectly pull facial nerve trunk through the arachnoid,which could also cause symptoms.Intraoperative identification of the offending vessel and intracranial segment decompression of the facial nerve are important factors for achieving surgical success.
作者
郭宏川
赵程欣
宋刚
李茗初
张秋航
Guo Hongchuan Zhao Chengxin Song Gang Li Mingchu Zhang Qiuhang(Department ofNeurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China Department of Neurosurgery, Tongliao City Hospital, Inner Mongolia 028000, China)
出处
《中国微侵袭神经外科杂志》
CAS
2016年第10期440-443,共4页
Chinese Journal of Minimally Invasive Neurosurgery
关键词
面肌痉挛
微血管减压术
责任血管
面神经根区
facial spasm
microvascular decompression
offending vessels
root exit zone
