微血管减压术治疗面肌痉挛合并三叉神经痛的手术策略

目的 探讨微血管减压术（MVD）治疗面肌痉挛合并三叉神经痛的策略。方法 以9例实施MVD手术的面肌痉挛合并三叉神经痛患者作为研究对象。所有患者术前均采用三维时间飞跃（3D-TOF）序列技术经磁共振成像（MRI）检查脑血管病变情况；分析术中所见、手术疗效及随访结果。结果 术前MRI显示粗大扭曲的椎动脉（VA）偏向患侧，甚至对侧VA也移位至患侧。术中见VA直接同时压迫面神经和三叉神经3例，小脑前下动脉 (AICA)和小脑后下动脉 (PICA)上抬间接压迫面神经和三叉神经5例，PICA和小脑上动脉（SCA）分别压迫面神经和三叉神经1例。术后，8例患者三叉神经痛和面肌痉挛症状即刻消失，1例术后3个月症状完全消失；1例术后1周疼痛缓解。所有患者随访未见复发。结论 粗大移位的VA通常是导致面肌痉挛合并三叉神经痛的直接或间接责任血管。MVD成功的关键是从后组颅神经开始解剖，逐渐将VA向下移位，而不是简单地在神经和血管间塞入垫片。

Strategy of microvascular decompression on patients with hemifacial spasm complicated with trigeminal neuralgia

Objective To explore the strategy of microvascular decompression (MVD) on patients with hemifacial spasm complicated with trigeminal neuralgia. Methods Nine patients with hemifacial spasm complicated with trigeminal neuralgia treated with MVD were selected. The conditions of cerebrovascular diseases were examined by three dimensional time of flight (3D-TOF) nuclear magnetic resonance (MRI). The intraoperative findings as well as outcomes were analysed. Results Preoperative MRI revealed that the big twisted vertebral arteries (VA) deviated to the affected side, and even the contralateral VA moved to the affected side. It was observed during operation that VA directly compressed both facial and trigeminal nerves in 3 patients, VA lifted the posterior inferior cerebellar arteries (PICA) or the anterior inferior cerebellar arteries (AICA) in 5 patients which compressed both facial and trigeminal nerves, and PICA and superior cerebellar artery compressed facial and trigeminal nerves respectively in one patient. The symptoms of hemifacial spasm and trigeminal neuralgia disappeared immediately after operation in 8 patients. For the other patient, the pain relieved one week after operation, and the symptoms completely disappeared 3 months after operation. There was no reoccurrence during the follow-up. Conclusion Large and dislocated VA may often be the direct and indirect responsible vessels for hemifacial spasm complicated with trigeminal neuralgia. The key to the operation is to move the VA proximally instead of stucking barely the pad between the nerve and vessel.