Grigoryan Y A, Goncharov M Z, Lazebny V V
Department of Neurosurgery, Russian Medical Academy of Postgraduate Education, Botkin Hospital, Moscow.
Surg Neurol. 2000 May;53(5):493-7; discussion 497. doi: 10.1016/s0090-3019(00)00193-2.
Hemifacial spasm is usually caused by compression of the facial nerve by ipsilateral blood vessels. Compression of the facial nerve root exit zone by a contralateral tortuous vertebral artery is very rare.
This 68-year-old woman presented with left-sided hemifacial spasm and was found to have compression of the left facial nerve by the tortuous vertebrobasilar artery, as revealed by magnetic resonance imaging and magnetic resonance angiography. Retromastoid craniectomy demonstrated compression of the left facial nerve root exit zone by the distal portion of the right vertebral artery. The vertebrobasilar junction and both vertebral arteries were moved laterally from the facial nerve and a muscle implant was interposed between the brainstem and the right vertebral artery.
The patient has remained free of hemifacial spasm for a follow-up period of 27 months.
Compression of the facial nerve by the contralateral tortuous vertebral artery may produce hemifacial spasm. A transposed large vessel can be secured by a sling technique or by interposing a soft implant between the brainstem and the vertebral artery.
面肌痉挛通常由同侧血管对面神经的压迫所致。对侧迂曲椎动脉对面神经根出脑区的压迫极为罕见。
这位68岁女性因左侧面肌痉挛就诊，磁共振成像和磁共振血管造影显示其左侧面神经被迂曲的椎基底动脉压迫。乳突后颅骨切除术显示右侧椎动脉远端压迫左侧面神经根出脑区。将椎基底动脉交界处及双侧椎动脉从面神经侧向移位，并在脑干与右侧椎动脉之间置入一块肌肉植入物。
患者在27个月的随访期内未再出现面肌痉挛。
对侧迂曲椎动脉对面神经的压迫可能导致面肌痉挛。可通过吊带技术或将柔软植入物置于脑干与椎动脉之间的方式来固定移位的大血管。
