Tokimura Hiroshi, Hirabaru Masashi, Miyajima Seiji, Tajitsu Kenichiro, Yamahata Hitoshi, Sugata Sei, Arita Kazunori
Division of Neurosurgery, Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Sakuragaoka, Kagoshima City, Japan.
Division of Neurosurgery, Department of Neurosurgery, Sendai Shimin Hospital, Satsumasendai, Japan.
J Neurol Surg A Cent Eur Neurosurg. 2014 Mar;75(2):116-9. doi: 10.1055/s-0033-1343981. Epub 2013 Aug 12.
Minimized frontal and frontolateral approaches have been proposed for the clipping of aneurysms and for removal of deep-seated supra- and parasellar lesions. To avoid postoperative facial nerve palsy, anatomical studies have been conducted; however, only one electrophysiological investigation has been reported. We studied the course of the facial nerve in the temporal region and identify the optimal pterional keyhole craniotomy from the perspective of facial nerve protection.
We stimulated the temporal branch of the facial nerve in nine healthy volunteers and identified its course electrophysiologically. Electromyographic (EMG) responses were recorded from the superior orbicularis oculi, corrugator, and frontal muscles. The course of the temporal branch of the facial nerve was identified by tracking the stimulation points that elicited the best EMG responses.
The distances from the tragus to the canthus, the tragus to the point where the facial nerve crosses over the zygomatic arch, the tragus to the first nerve bifurcation, the tragus to the second nerve bifurcation, and from the orbit to the middle rami were 80.8 ± 1.8 mm, 40.2 ± 1.6 mm, 58.1 ± 2.8 mm, 79.1 ± 3.4 mm, and 16.4 ± 0.9 mm, respectively. We found that the temporal branch of the facial nerve innervates each muscle in posterior-anterior direction. Based on these results, we prefer the pterional keyhole approach and incise the skin at a site posterior to the temporal branch of the facial nerve.
已有人提出采用额部和额颞部微创入路夹闭动脉瘤以及切除鞍上和鞍旁深部病变。为避免术后面神经麻痹，已开展了解剖学研究；然而，仅报道过一项电生理研究。我们从面神经保护的角度研究了颞区面神经的走行，并确定了最佳翼点锁孔开颅入路。
我们在9名健康志愿者身上刺激面神经颞支，并通过电生理方法确定其走行。从眼轮匝肌上部、皱眉肌和额肌记录肌电图（EMG）反应。通过追踪引发最佳EMG反应的刺激点来确定面神经颞支的走行。
从耳屏到内眦、耳屏到面神经跨过颧弓处、耳屏到第一神经分支、耳屏到第二神经分支以及从眼眶到中间分支的距离分别为80.8±1.8mm、40.2±1.6mm、58.1±2.8mm、79.1±3.4mm和16.4±0.9mm。我们发现面神经颞支由后向前支配各肌肉。基于这些结果，我们更倾向于翼点锁孔入路，并在面神经颞支后方的部位切开皮肤。
