Oizumi Taro, Ohira Takayuki, Kawase Takeshi
Department of Neurosurgery, Ise Keio Hospital, Keio University, Ise city, Mie, Japan.
Keio J Med. 2003 Sep;52(3):189-97. doi: 10.2302/kjm.52.189.
The relations between angiographic manifestations and operative findings of hemifacial spasm were studied in 70 cases between 1988 and 2001. Vertebral angiography was performed, and Towne, straight AP, and lateral projections were routinely examined. The dominant anterior inferior cerebellar artery (AICA) directly compressed the facial nerve root exit zone in 26 cases, the dominant posterior inferior cerebellar artery (PICA) in 20, the AICA in 13, the PICA in 2, and the vertebral artery (VA) in 9. Compression by multiple vessels was observed in 11 cases. Anatomical variations of the affected AICA and PICA were classified into 3 groups according to their origins and distributions of blood supply: normal distribution of AICA and PICA in 18%, common trunk anomaly with dominant AICA (basilar artery origin) in 48% and common trunk anomaly with dominant PICA (vertebral artery origin) in 34%. Analyses of the angiograms revealed significantly increased numbers of common trunk anomalies compared with cases with normal angiograms. In 18 of the 20 cases of unilateral common trunk anomalies, facial nerves were compressed by the dominant artery. Preoperative vertebral angiograms may clarify the offending vessels and their sites in most hemifacial spasm cases, thus increasing the safety of surgical interventions.
1988年至2001年间，对70例面肌痉挛患者的血管造影表现与手术结果之间的关系进行了研究。进行了椎动脉造影，并常规检查汤氏位、正位及侧位投照。26例中优势小脑前下动脉（AICA）直接压迫面神经根部出脑干区，20例中优势小脑后下动脉（PICA）压迫，13例中AICA压迫，2例中PICA压迫，9例中椎动脉（VA）压迫。11例观察到多支血管压迫。根据AICA和PICA的起源及血供分布，将受累的AICA和PICA的解剖变异分为3组：AICA和PICA正常分布占18%，优势AICA（基底动脉起源）的共干异常占48%，优势PICA（椎动脉起源）的共干异常占34%。血管造影分析显示与血管造影正常的病例相比，共干异常的数量显著增加。在20例单侧共干异常病例中的18例，面神经被优势动脉压迫。术前椎动脉造影可在大多数面肌痉挛病例中明确肇事血管及其部位，从而提高手术干预的安全性。
