面肌痉挛显微血管减压术中的面神经根解剖变异

目地 探讨小脑脑桥角面神经根解剖变异与原发性面肌痉挛的关系及手术治疗.方法 采用显微血管减压术治疗的1221例面肌痉挛病例中,10例(0.82%)术中探查发现面神经根存在解剖变异,面神经根出脑干区距离听神经根进脑干区均大于10mm.均采用显微血管减压术治疗,其中4例术中采用责任动脉悬吊法.结果 9例患者术后面肌痉挛立即消失,1例患者术后痉挛减轻但未消失,随访5个月时完全消失.所有患者随访2-96个月,平均26.8个月,复发1例,治愈率90%.术后并发症包括:中度面瘫2例,1例随访期间恢复正常,1例轻度恢复;展神经麻痹致复视3例,2例随访期间恢复正常,1例仅随访3个月,有好转;患侧听力丧失1例,随访21个月未恢复.结论 小脑脑桥角面神经出脑干区异位至距离听神经进脑干区大于10mm者罕见,动脉性血管压迫仍然是此类患者原发性面肌痉挛的主要病因,采用显微血管减压术治疗可获良效,但术后发生面瘫、展神经麻痹、听力障碍的概率升高.应用责任动脉悬吊法有利于提高疗效、减少并发症.

Anatomical variation of facial nerve in cerebellopontine angle in microvuscular decompression for treatment of idiopathic hemifaciai spasm

Objective To study the relationship of anatomical variation of facial nerve in cerebellopentine angle and idiopathic hemifacial spasm and surgical treatment. Methods 10 facial nerve anatomical variations were observed in 1221 microvascular decompressions (MVD) for hemifacial spasm (HFS) from October 2000 to March 2008. The distance between the root exit zoon (REZ) of facial nerve and the root enter zoon (REZ) of vostibulocochlear nerve was more than lOmm. All the 10 patients received MVD( offending artery suspension method was used in 4 eases ). Results The HFS disappeared immediately in 9 patients. The postoperative spasm was weaker in 1 patient and the residual spasm was disappeared within 5 months. The reoccurrence of spasm was observed in 1 patient during follow-up period (2-96 months, mean duration 26.8 months). Postoperative complications included: 2 cases of transient moderate facial paralysis, 3 cases of transient abducent paralysis and 1 case of hearing loss of the operative side. Conclusion It's a really rare condition that the distance between the REZ of facial nerve and the REZ of vestibulocochlear nerve was more than 10mm. The compression of arteries is still the main reason of these HFS patients. The effectiveness could be predicted after MVD. But the rates of facial and/or abducent paralysis were relatively higher. The application of offending artery suspension method was helpful to raise the effective rate and lower the incidence of complications.