颅神经血管压迫综合征的手术治疗探讨

目的:探讨用微血管减压术治疗三叉神经痛,面肌痉挛,舌咽神经痛等神经血管压迫综合征治疗方法临床经验。方法:系统回顾1999年至2005年我们采用微血管减压术治疗神经血管压迫综合征病例420例,其中三叉神经痛282例,面肌痉挛120例,舌咽神经痛18例结果:总有效406例,有效率96.7%,本组无死亡。结论:微血管减压术是治疗颅神经血管压迫综合征的有效方法。     

Neurovascular compression syndromes

As I have indicated in the foregoing discussion, there are several syndromes that with various degrees of proof seem to be caused by unilateral vascular compression of a cranial nerve at the brain stem. Jannetta has summarized this concept as follows: "As we age, our arteries elongate and our brains 'sag'. As a consequence of these processes, redundant arterial loops and bridging or intrinsic hindbrain veins may cause cross-compression of cranial nerve root entry zones in the cerebellopontine angle. This pulsatile compression can be seen to produce hyperactive dysfunction of the cranial nerve. Symptoms of trigeminal or glossopharyngeal neuralgia (somatic sensory), hemifacial spasm (somatic motor), tinnitus and vertigo (special sensory), and some cases of 'essential' hypertension are caused by these vessels compressing cranial nerves V, IX-X, VII, VIII, and left X and medulla oblongata. Using microsurgical techniques, the symptoms may be relieved by vascular decompression. . .".     

Hemifacial spasm in vertebrobasilar dolichoectasia

Vascular compression of the facial nerve is a well recognized cause of hemifacial spasm (HFS). Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) provide vascular and brain tissue diagnosis in a single non-invasive examination and should be recommended as primary neuroradiological procedure in HFS. We report a rare case of symptomatic HFS caused by a vertebrobasilar dolichoectasia. A 49-year-old women experienced left hemifacial spasm for 10 months. MRI showed an enlarged vertebrobasilar dolichoectasia of the left vertebral artery which compressed the seventh cranial nerve at its exit from the caude pons. MRI is essential in establishing the cause of HFS. Together with MR angiography it shows the correlation among the seventh cranial nerve, blood vessels and the structures of mid-brain. Vertebrobasilar delichoestasia is just one of the blood vessel anomalies which causes HFS and which can be shown by MRI. HFS caused by vertebrobasilar dolichoectasia is quite rare.     

The many faces of hemifacial spasm: Differential diagnosis of unilateral facial spasms

Hemifacial spasm is defined as unilateral, involuntary, irregular clonic or tonic movement of muscles innervated by the seventh cranial nerve. Most frequently attributed to vascular loop compression at the root exit zone of the facial nerve, there are many other etiologies of unilateral facial movements that must be considered in the differential diagnosis of hemifacial spasm. The primary purpose of this review is to draw attention to the marked heterogeneity of unilateral facial spasms and to focus on clinical characteristics of mimickers of hemifacial spasm and on atypical presentations of nonvascular cases. In addition to a comprehensive review of the literature on hemifacial spasm, medical records and videos of consecutive patients referred to the Movement Disorders Clinic at Baylor College of Medicine for hemifacial spasm between 2000 and 2010 were reviewed, and videos of illustrative cases were edited. Among 215 patients referred for evaluation of hemifacial spasm, 133 (62%) were classified as primary or idiopathic hemifacial spasm (presumably caused by vascular compression of the ipsilateral facial nerve), and 4 (2%) had hereditary hemifacial spasm. Secondary causes were found in 40 patients (19%) and included Bell's palsy (n = 23, 11%), facial nerve injury (n = 13, 6%), demyelination (n = 2), and brain vascular insults (n = 2). There were an additional 38 patients (18%) with hemifacial spasm mimickers classified as psychogenic, tics, dystonia, myoclonus, and hemimasticatory spasm. We concluded that although most cases of hemifacial spasm are idiopathic and probably caused by vascular compression of the facial nerve, other etiologies should be considered in the differential diagnosis, particularly if there are atypical features. © 2011 Movement Disorder Society     

提高颅神经显微血管减压术疗效的临床研究(附1950例报告)

目的探讨微血管减压术治疗三叉神经痛、面肌痉挛、舌咽神经痛方法的改进措施和提高治疗效果的临床经验.方法自1984年12月至2004年6月采用微血管减压术治疗1950例颅神经血管压迫综合征病例,其中三叉神经痛1 515例,面肌痉挛400例,舌咽神经痛35例.结果全部病例术中均发现有明确的压迫血管,总有效1 886例,有效率为96.7%,无死亡病例.由于显微外科技术的应用及手术技巧的提高,并发症发生率由8年前的10.55%下降到近8年的2.88%.结论显微血管减压术是三叉神经痛、面肌痉挛和舌咽神经痛最有效的治疗方法.术中颅神经根部的显露、责任血管的识别及减压材料的放置等是影响手术效果的关键.提高微血管减压术的治愈率、减少并发症及复发率有多方面因素值得考虑.     

A case of paroxysmal tinnitus and nystagmus accompanied by facial spasm

Trigeminal neuralgia and facial spasm are usually caused by cross vascular compression of the trigeminal root entry zone and facial nerve exit zone. A similar mechanism is believed to affect the acoustic nerve as well, giving rise to tinnitus and nystagmus. We present one case of paroxysmal tinnitus and nystagmus, accompanied by facial spasm, and discuss the mechanism and the significance of the neurotological examination.     

微血管减压治疗颅神经血管压迫综合症（附1470例报告）

目的：探讨用微血管减压术治疗三叉神经痛,面肌痉挛、舌咽神经痛等神经血管压迫综合征治疗方法改进措施和提高治疗效果的临床经验,方法：系统回顾1984年至1999年我们采用微血管减压术治疗神经血管压迫综合征证病例1470例,其中三叉神经痛1120例,面肌痉挛320例,舌咽神经痛30例。结果：总有效1421例,有效率96.7%,本组无死亡。并发症发生率由5年前5.6%下降到近5年的1.6%。结论：提高微血管减压术的治愈率、减少并发症有多方面因素值得考虑。     

Melkersson-Rosenthal syndrome as a rare cause of recurrent facial nerve palsy

Melkersson-Rosenthal syndrome is a rare cause of recurrent facial nerve palsy. The syndrome is classically characterized by a triad of signs consisting of facial edema, recurrent peripheral facial nerve paralysis, and congenital fissured tongue, although it may also present in a mono- or oligosymptomatic form. The paper presents a 24-year-old woman with right-sided peripheral facial nerve palsy and a history of left-sided episodes of facial nerve palsy. Magnetic resonance angiography of the cerebral vessels suggested compression of the right seventh and eighth cranial nerves by a vascular loop. The authors describe the patient with a complete picture of Melkersson-Rosenthal syndrome and discuss the diagnosing process and treatment.     

Cerebellopontine angle cysticercus and concurrent vascular compression in a case of trigeminal neuralgia

The authors present the case of a 59-year-old woman with an 8 months history of lancinating pain and hyphestesia on the right side of the face along with hearing impairment. She had poor tolerance to carbamazepine. A non-enhancing cystic image was observed at the right cerebellopontine angle on magnetic resonance imaging. The patient underwent surgery. Through a right retromastoid minicraniectomy and under microscopic magnification the VII and VIII cranial nerve complex was found involved by multiple adhesions around a cysticercus. After the cyst was removed a loop of the anteroinferior cerebellar artery was identified compressing the V right nerve at its root entry zone. Decompression was performed by the insertion of a Teflon implant. The postoperative course was uneventful and trigeminal neuralgia (TN) disappeared after surgery. Five previous cases of cranial nerve hyperactive dysfunction syndromes, four of trigeminal neuralgia and one of hemifacial spasm associated to cerebellopontine angle cysticercosis are briefly commented. We suggest that in some of these cases microvascular compression was probably present, and during surgery of cerebellopontine angle cysticercus by either trigeminal neuralgia or hemifacial spasm, vascular compression must be carefully searched and treated when found.     

Vascular compression, hemifacial spasm, and multiple cranial neuropathy

Hemifacial spasm is usually an isolated symptom resulting from facial nerve root compression. Three patients had, in addition, tinnitus, hearing loss, facial sensory loss, diminished gag reflex, dysphagia, and dysarthria. Acoustic reflexes were abnormal, and facial nerve conduction studies showed evidence of ephaptic transmission and ectopic excitation. Brain CT and metrizamide cisternography were normal. Surgical exploration showed compression of cranial nerve roots by posterior inferior cerebellar artery branches. After decompression, symptoms abated, and electrical signs of hemifacial spasm disappeared. Vascular compression of nerve roots in the cerebellopontine recess may cause multiple cranial neuropathy.     

三叉神经痛显微血管减压术中非动脉压迫因素的处理策略

目的探讨三叉神经痛显微血管减压术中非动脉性压迫因素的处理对策,以提高手术效果。方法回顾性分析150例三叉神经痛显微血管减压术术中资料。根据不同的原因,单独或联合采取压迫静脉电凝切断、蛛网膜松解以感觉根纵向梳理术等处理方法。结果岩静脉接触或压迫18例,所有病例均将岩静脉电凝、切断,12例同时进行三叉神经感觉根纵向梳理术。岩静脉接触或压迫合并蛛网膜粘连8例,岩静脉电凝、切断同时行三叉神经颅内段全长蛛网膜粘连松解术。单纯蛛网膜肥厚、粘连5例,全部行三叉神经颅内段全长蛛网膜粘连松解术,同时进行三叉神经感觉根纵向梳理术。既无静脉压迫,也无蛛网膜粘连3例,均行三叉神经感觉根纵向梳理术。术后随访6个月至2年,疼痛消失者32例,2例明显缓解;3例出现面部轻度麻木,半年后消失;1例不全面瘫1年后恢复;1例术侧听力减退,1年后无恢复。结论三叉神经痛显微血管减压术中非动脉性致痛因素处理更为复杂,术中针对不同的原因,单独或联合采用压迫静脉电凝切断、蛛网膜松解、感觉根纵向梳理术,可望取得理想的止痛效果。     

微血管减压术治疗桥小脑角区颅神经压迫综合征的疗效分析

目的 探讨微血管减压术（MVD）治疗桥小脑角区颅神经压迫综合征的疗效。方法 回顾性分析我院2012年1月至2014年2月采用MVD治疗的232例颅神经压迫综合征患者的临床资料,其中三叉神经痛93例,面肌痉挛132例,舌咽神经痛7例。结果 术后症状完全消失197例（三叉神经痛81例,面肌痉挛109例,舌咽神经痛7例）,明显减轻23例（三叉神经痛8例,面肌痉挛15例）,无明显缓解12例（三叉神经痛4例,面肌痉挛8例）。结论 MVD治疗颅神经压迫综合征安全有效,充分的影像学检查、良好的术野暴露、准确的责任血管判断、适当的减压材料放置和细致的显微手术操作可以明显提高手术安全及疗效。     

An unusual cause of hemifacial spasm

Hemifacial spasm (HFS) is a movement disorder characterized by involuntary paroxysmal chronic contractions of the facial musculature. The usual cause is vascular compression of the seventh cranial nerve, at its exit zone from the brain stem. We report a case of left hemifacial spasm, in a 66-year-old woman, in which the neuroradiological investigation with magnetic resonance imaging showed a hypervascular soft tissue mass arising from the left skull base, in the jugular foramen. This lesion was thought highly likely to be a glomus jugulare tumour. While the usual occurrence of tumour compression causing HFS has been previously recognized, the association of glomus jugulare tumours presenting with HFS has not. The importance of this association is discussed.     

Intracranial microvascular decompression for “cryptogenic” hemifacial spasm,tirgeminal and glossopharyngeal neuralgia,paroxysmal vertigo and tinnitus: II. Clinical study and long-term follow up

20 patients who had undergone microvascular decompression for the treatment of “idiopathic” trigeminal neuralgia (9 cases), hemifacial spasm, (7 cases), glossopharyngeal neuralgia (3 cases) and paroxysmal vertigo and tinnitus (1 case) were followed up for 25 months on average. Permanent relief of symptoms was observed in 19 (95%), with sparing of cranial nerve function. Analysis of the clinical data shows that the patients described in the present series did not differ from those considered to suffer from “idiopathic” cranial nerve dysfunction syndromes. The importance of vascular cross compression as etiological factor in such conditions is stressed and the pathophysiology discussed. The term “cryptogenic” applied to trigeminal neuralgia or hemifacial spasm thus needs revising. Lastly, the indications of microvascular decompression in the treatment of “cryptogenic” cranial nerve dysfunction syndromes are defined.     

微血管减压术对桥小脑角区颅神经疾病合并高血压患者术后血压的影响

目的 探讨微血管减压术（MVD）对桥小脑角区颅神经疾病合并高血压患者术后血压的影响。方法 2010年11月至2013年12月收治桥小脑角区颅神经疾病患者合并高血压患者92例（颅神经疾病位于左侧59例、右侧33例;三叉神经痛14例、面肌痉挛28例、舌咽神经痛50例）,应用乙状窦后入路微血管减压术治疗。结果 92例患者中,术后高血压缓解59例（左侧减压手术53例,右侧减压手术6例）,其中脱离高血压用药34例,均为左侧减压手术患者;术后高血压无明显变化33例。总有效率为64.13%（59/92）,其中左侧减压手术有效率为89.83%（53/59）,右侧减压手术有效率为18.18%（6/33）;左侧减压手术治愈率为57.63%（34/59）。左侧颅神经疾病患者术后血压较术前明显降低（P<0.05）,而右侧颅神经疾病患者术后血压无明显变化（>P>0.05）。结论 对左侧桥小脑角区颅神经疾病患者合并高血压患者,微血管减压术具有一定的降血压效果。     

颅神经血管压迫综合征微血管减压术治疗探讨

目的探讨用微血管减压术治疗三叉神经痛、面肌痉挛、舌咽神经痛等颅神经血管压迫综合征的临床经验。方法系统回顾1999年至2005年我们采用微血管减压术治疗神经血管压迫综合征病例420例，其中三叉神经痛282例，面肌痉挛120例．舌咽神经痛18例。结果总有效406例，有效率96．67％，本组无死亡病例。结论微血管减压术是治疗颅神经血管压迫综合征的有效方法。     

Computed tomographic analysis of hemifacial spasm: narrowing of the posterior fossa as a possible facilitating factor for neurovascular compression.

Hemifacial spasm can be caused by vascular compression of the facial nerve at the root exit zone from the brainstem. Several case reports suggest that narrowing of the cerebellopontine angle cistern caused by Paget's disease, abnormal elevation of the petrous bone caused by hyperplasia, or contralateral acoustic neurinoma may increase the chance of vascular compression of the facial nerve. Therefore, posterior fossa narrowness has been evaluated in 34 patients with hemifacial spasm by measuring the petrous angle and pons diameter index to elucidate whether narrowing of the posterior fossa can act as a facilitating factor for neurovascular compression. The petrous angle in the hemifacial spasm group was significantly smaller than that in the control group, which consisted of 33 patients with an unruptured supratentorial aneurysm, and the pons diameter index in the hemifacial spasm group was significantly greater than that in the control group. These results indicate that the cerebellopontine angle cistern of patients with hemifacial spasm is narrower resulting in more crowded cranial nerves and vascular structures compared with patients without hemifacial spasm. The narrowness of the cerebellopontine angle cistern may be a possible factor in facilitating neurovascular compression in hemifacial spasm.     

脑神经疾患“血管压迫”病因的放射学诊断研究——磁共振断层成像脑血管造影术的应用

目的:探讨磁共振影像学对“压迫血管”病因诊断的可能性和特征。方法:采用稳定快速进动程序以提供脑实质、脑神经和后颅窝脑血管的高分辨率磁共振成像(MRI),即一种“白血”磁共振断层成像血管显影术(magnetic resonance tomographic angiography,MRTA)。分别检查11例三叉神经痛和21例面肌痉挛,同时10例行后颅窝探查及显微血管减压术(microvascular decompression,MVD),对照和评估MRTA的确诊率。结果:32例单侧三叉神经痛及面肌痉挛的MRTA中,确认患侧有“血管压迫”28例,无血管压迫4例。而正常侧仅见2例“血管接触或压迫”影像。1例三叉神经痛术中发现岩静脉为压迫血管,而MRTA提示无异常,因而未再行增强扫描、10例接受探查术发现有或无压迫血管,与MRTA诊断相符9例。结论:MRTA可作为脑神经疾患的”血管压迫”病因之术前诊断的一种特殊而可靠的检查方法,以便有的放矢地指导此类疾患的治疗。     

Vascular compression of cranial nerves: II: pathophysiology.

The pathophysiology of trigeminal neuralgia, hemifacial spasm and other disorders that can be cured by microvascular decompression of cranial nerves, is reviewed and different hypotheses about its pathophysiology are discussed. It is found that the pathophysiology of these disorders is complex and other factors than vascular compression are necessary to cause symptoms. While the efficacy of the microvascular decompression (MVD) operation is indisputable, it is questionable if the symptoms and signs of these disorders are caused by abnormal neural activity in the respective cranial nerves that result from the compression from a blood vessel. Instead, studies point to hyperactivity and hyperexcitability of the respective nuclei as a cause of the symptoms and signs of these disorders. Results of several studies indicate that irritation of the cranial nerve in question from close contact with a blood vessel may promote such development, and it seems necessary that other factors in addition to the vascular contact must be present in order that such a condition develops.     

显微血管减压及神经松解手术治疗颅神经疾病1956例

目的 探讨显微血管减压及神经松解手术治疗颅神经疾病的方法及经验。方法 总结自1986至2005年12月以来局麻下共实施显微血管减压及神经松解手术治疗颅神经疾病1956例，其中三叉神经痛1465例，面肌痉挛428例，舌咽神经痛63例。患者平均年龄62．5岁，病史3至37年不等。介绍了显微血管减压及神经松解手术技巧及术中寻找责任血管及部分神经根切断的注意事项。结果 手术确定了1462例三叉神经痛、428例面肌痉挛和51例舌咽神经痛患者的压迫责任血管，并以teflon垫棉置于其间；对1876例局部蛛网膜和颅神经间的粘连行神经松解手术；对45例行神经根部分切断。手术效果满意。术后总有效率100％。31例复发，其中23例行二次手术治疗后病愈。结论 显微血管减压及神经松解手术是治疗颅神经疾病的有效手段，疗效确切。