Niijima K H, Yonekawa Y, Kaku Y
Department of Neurosurgery, National Cardiovascular Center.
No Shinkei Geka. 1990 Jun;18(6):577-80.
This report is concerned with a case of right hemifacial spasm (HFS) occurring in a 65-year-old woman, who incidentally had a left internal carotid-ophthalmic artery aneurysm. The aneurysm was successfully treated by clipping its neck. However, spinal drainage had to be performed postoperatively in order to prevent possible cerebrospinal fluid (CSF) rhinorrhea, as the roof of the sphenoid sinus was accidentally opened during the aneurysm surgery. Liquorrhea was observed and stopped on the 5th postoperative day. The drain was then removed only to be reset because CSF rhinorrhea recurred 8 days later, when the HFS began to subside. When the spinal drain was finally removed 9 days later, the HFS was scarcely seen. The HFS was thought to be due to the compression of the right facial nerve by the ipsilateral AICA. The draining of the CSF might have changed the amount and flow of the liquor and consequently the positional relationship among the facial nerve, the AICA and the arachnoid membrane, resulting in neurovascular decompression.
本报告涉及一名65岁女性发生的右侧半面痉挛（HFS）病例，该女性偶然发现患有左侧颈内动脉-眼动脉瘤。通过夹闭动脉瘤颈部成功治疗了该动脉瘤。然而，由于在动脉瘤手术期间蝶窦顶部意外打开，术后必须进行脊髓引流以防止可能的脑脊液（CSF）鼻漏。术后第5天观察到并停止了脑脊液漏。然后移除引流管，但8天后脑脊液鼻漏复发，此时HFS开始缓解，于是重新放置引流管。9天后最终移除脊髓引流管时，HFS几乎消失。HFS被认为是由于同侧小脑前下动脉（AICA）对右侧面神经的压迫所致。脑脊液引流可能改变了脑脊液的量和流动，从而改变了面神经、AICA和蛛网膜之间的位置关系，导致神经血管减压。
