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“双胶带”技术在微血管减压术中移位致患血管的应用:技术病例报告。

"Double-stick tape" technique for transposition of an offending vessel in microvascular decompression: technical case report.

机构信息

Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Japan.

出版信息

Neurosurgery. 2011 Jun;68(2 Suppl Operative):377-82; discussion 382. doi: 10.1227/NEU.0b013e318217141c.

DOI:10.1227/NEU.0b013e318217141c
PMID:21389896
Abstract

BACKGROUND AND IMPORTANCE

Severe hemifacial spasm caused by compression by a tortuous vertebral artery (VA) often is encountered and is difficult to treat. We describe a patient with hemifacial spasm caused by compression of the facial nerve by a tortuous VA. A simple and effective transposition approach, a "double-stick tape" technique, to the offending artery using a fibrin tissue-adhesive collagen fleece product (TachoComb) is reported.

CLINICAL PRESENTATION

A 65-year-old woman presented with an 8-year history of right-sided facial spasms, including the orbicularis oculi and orbicularis oris muscles. MRI revealed a tortuous right VA indented into the pontomedullary junction. The right anterior inferior cerebellar artery (AICA) also contacted the proximal portion of the facial nerve. Surgical exploration with standard retrosigmoid craniotomy was performed. The offending VA was dissected away from the pontomedullary junction toward the cranial base. A small piece of TachoComb, with fibrin glue applied on the non-coated side of the fleece to make a "double-stick tape," was then placed on the ventral surface of the VA. Until the glue hardened, the VA was held away from the brainstem onto the dura of the petrous pyramid. After this procedure, AICA transposition was performed. The patient's symptoms were completely resolved immediately after surgery, and she remained asymptomatic at her 1 year follow-up visit.

CONCLUSION

The advantage of our "double-stick tape" technique is the simplicity of the procedure. The present technique is a feasible alternative for the treatment of hemifacial spasm caused by a tortuous VA.

摘要

背景与重要性

由迂曲椎动脉(VA)压迫引起的严重面肌痉挛常难以治疗。我们报告了一例由迂曲 VA 压迫面神经引起的面肌痉挛患者。采用纤维蛋白组织胶胶原绒片(TachoComb)的“双胶带”技术对病变动脉进行简单有效的转位。

临床表现

一名 65 岁女性,右侧面肌痉挛 8 年,包括眼轮匝肌和口轮匝肌。MRI 显示右侧 VA 迂曲,压迹于桥延交界区。右侧小脑前下动脉(AICA)也接触面神经近端。行标准乙状窦后入路开颅探查。将迂曲的 VA 从桥延交界区向颅底解剖游离。将小块 TachoComb 置于 VA 的腹面,纤维蛋白胶涂在绒片的无涂层一侧,制成“双胶带”。在胶变硬之前,VA 被置于脑桥的硬脑膜上。在此操作后,行 AICA 转位。术后患者症状立即完全缓解,1 年随访时无症状。

结论

我们的“双胶带”技术的优点是操作简单。对于由迂曲 VA 引起的面肌痉挛,本技术是一种可行的替代治疗方法。

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