面神经临床分段与面肌痉挛术中责任血管分布初探

目的介绍一种面神经临床分段方法并初步总结术中发现的责任血管的分布及特点,以帮助找到主要责任血管。方法回顾性分析连续123例面肌痉挛病例。将面神经分为中枢髓鞘段、髓鞘移行段和外周髓鞘段。血管压迫程度分为轻、中、重三型。术中打开小脑桥脑裂上、下支,探查责任血管的分布情况与压迫程度。结果所有病人均发现有血管压迫。中枢髓鞘段压迫98例,髓鞘移行段压迫15例,外周髓鞘段压迫10例;主要责任血管为小脑前下动脉68例,小脑后下动脉23例,椎基底动脉合并小脑前下动脉和/或小脑后下动脉共26例,其他6例;轻度压迫28例,中度压迫82例,重度压迫13例。术后112例痉挛立即消失,术后1年仅1例痉挛未完全消失;无死亡。2例轻、中度复发。结论打开小脑桥脑裂并根据面神经分段探查责任血管,重点为中枢髓鞘段,将有助于发现主要责任血管,避免遗漏,提高治愈率。

Facial nerve clinical subsections and neurovascular compression findings in hemifacial spasm

Objective To introduce a new method of facial nerve clinical subsections and to summarize the distribution and characterizations of the responsible vessels for hemifacial spasm（HFS）,in order to help neurosurgeons find the main responsible vessels.Methods Clinical data of 123 consecutive patients with HFS was analyzed retrospectively.The facial nerve is divided into central glial myelin segment,central-peripheral myelin transitional segment and peripheral Schwann cell myelin segment.The severity of neurovascular compression was defined as three types：mild,moderate and severe.Dissection of the superior and inferior limbs of the cerebellopontine fissure was performed to explore the distribution and the severity of compression of the responsible vessel（s）.Results Neurovascular compression was found in all patients,and the primary responsible vessel（s）location was at central myelin segment in 98 cases,myelin transitional segment in 15 cases,and peripheral myelin segment in 10 cases.The main responsible vessels were AICA in 68 cases,PICA in 23 cases,VA with AICA and/or PICA in 26 cases,and the others in six cases.The severity of compression was mild in 28 cases,moderate in 82 cases,and severe in 13 cases.Complete spasm alleviation was immediately achieved in 112 cases postoperatively,and only one case with postoperative residual spasm exhibited delayed incomplete gradual resolution one year after MVD.No patient died.Mild to moderate recurrences have occurred in two cases.Conclusion To explore the responsible vessel（s）according to the facial nerve segment through the dissected transcerebellopontine fissure,the central myelin segment was most important,will help to find the main responsible vessel（s）,and greatly improve consistent successful rate.