微血管减压术治疗半面痉挛时责任血管的辨别和处理

目的分析半面痉挛(hemifacial spasm,HFS)患者颅内责任血管与面神经之间的解剖关系,为HFS微血管减压术(microvascular decompression,MVD)治疗提供临床解剖学依据。方法回顾性分析78例经MVD治疗的HFS患者的临床资料,了解面神经受压迫是否存在责任血管及其来源与走向,并总结MVD治疗HFS的效果。结果78例HFS患者中77例(98.72%)存在责任血管压迫,责任血管类型分别为小脑前下动脉(AICA)39例(50.00%),小脑后下动脉(PICA)21例(26.93%),AICA及PICA 10例(12.82%),PICA及椎动脉(VA)3例(3.85%),PICA及VA 2例(2.56%),AICA、PICA及VA 2例(2.56%),无明确责任血管1例(1.28%)。术后72例抽搐症状立即消失;5例抽搐症状好转,3～6个月内延迟治愈。结论血管压迫可能是HFS的主要病因,MVD治疗可取得较好的疗效。术中面神经根脑干区(root exit zone,REZ)的显露,准确判断责任血管,面神经REZ充分减压以及垫棉大小和放置的位置等是影响手术效果的重要因素。

Recognition and Management of Offending Vessels in the Treatment of Hemifacial Spasm with Microvascular Decompression: Analysis of 78 Cases

Objective To analyze the anatomical relationship between the offending vessels and the facial nerve in hemifacial spasm(HFS) and to provide anatomical basis for microvascular decompression(MVD) in patients with HFS.Methods The clinical data of 78 patients with HFS treated with MVD were analyzed retrospectively to find out whether the offending vessels existed or not and their origin and running course,and to summarize the efficacy of microvascular decompression on hemifacial spasm.Results There were offending vessels in 77 patients(98.72%)out of the 78 patients with HFS,including 39 cases(50.00%) of anterior inferior cerebellar artery(AICA),21 cases(26.93%) of posterior inferior cerebellar artery(PICA),10 cases(12.82%) of AICA and PICA,3 cases(3.85%) of PICA and vertebral artery(VA),2 cases(2.56%) of AICA and VA,and 2 cases(2.56%) of AICA,PICA and VA.1 case(1.28%) had no offending vessels.The spasm disappeared immediately after the operation in 72 patients,and the symptoms of spam improved significantly in 5 patients,who were cured in three to six months.Conclusion Vascular compression may be the main cause of HFS,and the operation of MVD for HFS could achieve satisfactory efficacy.Exposing REZ during operation,accurately identifying the offending vessels,fully decompressing of REZ,the size of graft and the location of graft are important factors influencing surgical efficacy.