Yamashita K, Okamoto S, Hosotani K, Nakatsu S, Hojo M, Miyamoto K, Matsumoto R
Department of Neurosurgery, Osaka Red Cross Hospital; Osaka, Japan.
Interv Neuroradiol. 1997 Nov 30;3 Suppl 2:32-6. doi: 10.1177/15910199970030S204. Epub 2001 May 15.
There have never been functional studies in the diagnosis of hemifacial spasm caused by neurovascular compression. We used neurointerventional techniques to conduct a functional investigation of the artery responsible for hemifacial spasm in seven patients. A microcatheter was inserted into the various arteries of the posterior circulation under systemic heparinization, and its effect on the spasm was evaluated clinically and electromyographically. In six patients who underwent microvascular decompression surgery, the vessels compressing the root exit zone of the facial nerve were surgically determined, and compared with the result of the procedure. The catheter was inserted into twelve arteries. The spasms were stopped immediately and completely by the insertion of the catheter into seven arteries. Six of them were surgically proven to compress the root exit zone of the facial nerve. The spasm was changed in frequency or in type by the insertion into two arteries. These arteries were also compressing the root exit zone. One artery was located at a more peripheral part of it and the other was running over another artery compressing the root exit zone. The spasms were not affected at all by the insertion into three arteries. These arteries were not observed in the operative field and had no contact with the nerve. Superselective angiograms showedpositional qnd configurational changes of the arteries. There was no arterial spasm and tight catheterization leading to stasis of contrast material within the arteries. There were no complications related to the procedures. Functional relationship between the artery and the spasms was established in all the patients, and one patient refused surgery because the frequency of the spasm was reduced by the procedure. The result of this study may suggest that a functional investigation of hemifacial spasm is feasible and seems useful for selecting good candidates for microvascular decompression surgery.
关于神经血管压迫所致半面痉挛的诊断，此前从未有过功能研究。我们采用神经介入技术对7例半面痉挛患者中引发痉挛的动脉进行了功能研究。在全身肝素化情况下，将微导管插入后循环的各条动脉，并通过临床和肌电图评估其对痉挛的影响。在6例接受微血管减压手术的患者中，通过手术确定压迫面神经根部出口区的血管，并与该操作结果进行比较。导管插入了12条动脉。将导管插入7条动脉后，痉挛立即完全停止。其中6条经手术证实压迫面神经根部出口区。将导管插入2条动脉后，痉挛的频率或类型发生了改变。这些动脉也在压迫根部出口区。一条动脉位于其更外周部分，另一条动脉从压迫根部出口区的另一条动脉上方经过。将导管插入3条动脉后，痉挛完全未受影响。这些动脉在手术视野中未被观察到，且与神经无接触。超选择性血管造影显示动脉的位置和形态发生了变化。未出现动脉痉挛以及因导管插入过紧导致动脉内造影剂淤滞的情况。未发生与操作相关的并发症。在所有患者中均确立了动脉与痉挛之间的功能关系，1例患者因该操作使痉挛频率降低而拒绝手术。本研究结果可能表明，对半面痉挛进行功能研究是可行的，且似乎有助于筛选适合微血管减压手术的患者。
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