Suzuki I, Sasaki A, Yanagibashi K, Tsuchida T, Hayakawa I, Kobayashi T
No Shinkei Geka. 1978 Dec;6(12):1207-12.
Surgical treatment of hemifacial spasm associated with tortuous vertebrobasilar system was reported. A patient was 63-year-old female, who first experienced mild and intermittent muscle twitching around her left eye twenty years prior to admission. Five years later, the twitching extended to all the facial muscles on the left side. She was treated with facial nerve block, which resulted in facial palsy for about one year. Because of recurrence of the hemifacial spasm, she was admitted to the Neurosurgical Department of Bokuto Municipal Hospital on October 12, 1977. Neurological examination revealed no abnormalities except for left hemifacial spasm with slight muscular weakness. Electromyogram showed severe twitching and synkinesis of all the muscles of facial expression. Vertebral angiogram on the left side disclosed pronounced elongation of the vertebral and basilar arteries, which extended into the left cerebellopontine angle. Compression of the facial nerve root exit zone at the brainstem by the vertebral artery was considered to be the cause of the hemifacial spasm. Suboccipital craniectomy was carried out on November 29, 1977. The vertebral artery extended into the cerebellopontine angle, and adhered to the facial nerve. After mobilization of the vertebral artery from the facial nerve, a small prosthesis of non-absorbable spongy material (Teflon felt) was interposed between the vertebral artery and brainstem. Postoperatively, the hemifacial spasm disappeared, but the facial palsy, which had been observed preoperatively probably due to previous facial nerve block and long-standing hemifacial spasm, remained. The function of the acoustic nerve was preserved. Recently vascular compression of the facial nerve root exit zone has been reported as a major cause of hemifacial spasm, but such abnormal vessels are rarely demonstrated angiographically.
报道了与迂曲椎基底系统相关的半面痉挛的外科治疗。患者为63岁女性，入院前20年首次出现左眼周围轻度间歇性肌肉抽搐。5年后，抽搐扩展至左侧所有面部肌肉。她接受了面神经阻滞治疗，导致面瘫约1年。由于半面痉挛复发，她于1977年10月12日入住博多市立医院神经外科。神经检查除左侧半面痉挛伴轻度肌肉无力外无异常。肌电图显示所有面部表情肌严重抽搐和联带运动。左侧椎动脉造影显示椎动脉和基底动脉明显伸长，延伸至左侧小脑脑桥角。椎动脉对脑干面神经根出脑区的压迫被认为是半面痉挛的病因。1977年11月29日进行了枕下颅骨切除术。椎动脉延伸至小脑脑桥角，并与面神经粘连。将椎动脉从面神经游离后，在椎动脉与脑干之间置入一小块不可吸收海绵材料（特氟龙毡）假体。术后，半面痉挛消失，但术前可能由于先前的面神经阻滞和长期半面痉挛而观察到的面瘫仍然存在。听神经功能得以保留。最近，面神经根出脑区的血管压迫已被报道为半面痉挛的主要原因，但这种异常血管在血管造影中很少显示。
