Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China.
J Neurol Neurosurg Psychiatry. 2015 Aug;86(8):865-72. doi: 10.1136/jnnp-2014-308465. Epub 2014 Sep 16.
Hypoglossal-facial nerve (HN-FN) neurorrhaphy is a method commonly used to treat facial palsy when the proximal stump of the injured FN is unavailable. Since the classic HN-FN neurorrhaphy method that needs to section the injured FN is not suitable for incomplete facial palsy, we investigated a modified method that consists of HN-FN 'side'-to-side neurorrhaphy, retaining the remaining or spontaneously regenerated FN axons while preserving hemihypoglossal function.
To improve axonal regeneration, we used for the first time a predegenerated sural autograft for performing HN-FN 'side'-to-side neurorrhaphy followed by postoperative facial exercise. We treated 12 patients who had experienced FN injury for 1-18 months as a result of acoustic tumour removal. All patients experienced facial grade V-VI paralysis according to the House-Brackmann scale, but their FN was anatomically preserved. No spontaneous facial reinnervation was detected before repair.
Although we did not perform fresh nerve grafts and HN-FN 'side'-to-end neurorrhaphy as controls for ethical reasons, the reparative outcomes after nerve reconstruction were remarkable: functional improvements were detected as soon as 3 months after repair, House-Brackmann grade II or III FN functions were achieved in five and four patients, respectively, and there were no apparent signs of synkinesis. The three patients who experienced less satisfactory outcomes had exhibited facial palsy for more than 1 year accompanied by muscle atrophy, consistent with a need for rapid surgical intervention.
Based on fundamental concepts and our experimental results, this new surgical method represents a major advance in the rehabilitation of FN injury.
JS2013-001-02.
当损伤的面神经近端残端无法使用时，舌下-面神经（HN-FN）神经吻合术是一种常用于治疗面瘫的方法。由于需要切断损伤的面神经的经典 HN-FN 神经吻合术不适合不完全性面瘫，我们研究了一种改良方法，即 HN-FN 侧侧吻合术，保留剩余或自发再生的面神经轴突，同时保留舌下神经功能的一半。
为了改善轴突再生，我们首次使用预先退化的腓肠神经自体移植物进行 HN-FN 侧侧吻合术，然后进行术后面部运动。我们治疗了 12 例因听神经瘤切除而导致面神经损伤 1-18 个月的患者。所有患者根据 House-Brackmann 量表均表现为面部 V-VI 级瘫痪，但面神经解剖结构完整，修复前未检测到自发的面部再神经支配。
尽管由于伦理原因我们没有进行新鲜神经移植和 HN-FN 侧端吻合术作为对照，但神经重建后的修复效果显著：修复后 3 个月即可检测到功能改善，5 例和 4 例患者分别达到面神经功能 II 级或 III 级，没有明显的联带运动迹象。3 例修复效果不理想的患者面瘫时间超过 1 年，伴有肌肉萎缩，需要尽快手术干预。
基于基本概念和我们的实验结果，这种新的手术方法代表了面神经损伤康复的重大进展。
JS2013-001-02。
