面肌痉挛MVD入路与中血管神经复合体的解剖学研究

目的研究面肌痉挛微血管减压（MVD）经枕下外侧小脑绒球下方入路与桥小脑角（CPA）区中血管神经复合体的显微解剖学关系。方法应用15例经10％甲醛充分固定并灌有乳胶的国人成人头颅湿标本，经枕下外侧小脑绒球下方入路，在4～25倍手术显微镜下对CPA区中血管神经复合体逐层解剖，观察，测量及照相。同时，临床应用该入路治疗面肌痉挛9例。结果经枕下外侧小脑绒球下方入路可直接从尾侧方小脑绒球与舌咽神经之间的间隙显露面、听神经分离处，能够准确、安全、快捷到达CPA区相应的中血管神经复合体位置，充分暴露术野，达到完全减压效果。结论经枕下外侧小脑绒球下方入路是治疗面肌痉挛安全有效的方法，可以最大限度的减少术中损伤神经致术后颅神经麻痹等并发症。

Anatomical study on the MVD approach for hemifacial spasm and the middle neurovascular complex

Objective To investigate the anatomical study of microvascular decompression （MVD） for hemifacial spasm via the translateral suboccipital infrafloccular approach and the middle neurovascular complex. Methods A total of 15 adult cadaver heads fixed in 10% formalin were used for this study. Ten of them were perfused with red latex through artery and blue latex through vein, to facilitate their definition. The heads were placed in a head holder in a position simulating the translateral suboccipital infrafloccular approach to the cerebellopontine angle （CPA） region. Dissections were performed under 4 to 25 magnification. Special attention was given to the microanatomy related to the middle neurovascular complex in the CPA region. At the same time, 9 patients with hemifacial spasm were treated via translateral suboccipital infralloccular approach. Results Via translateral suboccipital infrafloccular approach, with gentle retraction of the flocculus in a caudorostral direction perpendicular to the vestibulocochlear nerve, the root exit zone of the facial nerve could be easily observed medial to the root zone of vestibulocochlear nerves in the supraolivary. Conclusion The greatest advantage of trans- lateral suboccipital infrafloccular approach lies in reaching the middle neurovascular complex in the CPA accurately with minimal risk of postoperative cranial nerve palsy.