Ekuma Mike E, Goto Tetsuya, Hanaoka Yoshiki, Kanaya Kohei, Horiuchi Tetsuyoshi, Hongo Kazuhiro, Ohaegbulam Samuel C
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Memfys Hospital for Neurosurgery, Enugu, Nigeria.
Surg Neurol Int. 2017 Jun 13;8:114. doi: 10.4103/sni.sni_279_16. eCollection 2017.
Isolated hypoglossal nerve palsy due to mechanical compression by a vascular lesion is rare.
We report the case of a 72-year-old man who presented with a 4-year history of swallowing disturbance and subsequently progressively worsening left-sided tongue atrophy. He was referred to our department by a neurologist due a magnetic resonance imaging detected left vertebral artery compression of the medulla. Neurological examination was unremarkable except for left hypoglossal nerve dysfunction, which presented as left-sided atrophy and impaired movement of the tongue. Three-dimensional computed tomography angiography showed proximal left posterior inferior cerebellar artery (PICA) origin fusiform aneurysm. Microvascular decompression was done through a left transcondylar fossa approach. Intraoperative findings were thickened arachnoid around the lower cranial nerves, fusiform aneurysm of the left PICA at its origin from the left vertebral artery which was severely adherent to and compressing the left hypoglossal nerve rootlets.
The PICA has a very close relationship to the hypoglossal nerve, and its fusiform dilatation could cause isolated hypoglossal nerve dysfunction. Pathological adhesions between hypoglossal rootlets and the PICA aneurysm wall could be a possible contributor in the development and progression of hypoglossal nerve palsy.
血管病变机械压迫导致的孤立性舌下神经麻痹罕见。
我们报告一例72岁男性患者，有4年吞咽障碍病史，随后左侧舌肌萎缩逐渐加重。因磁共振成像检测到左侧椎动脉压迫延髓，神经科医生将其转诊至我科。除左侧舌下神经功能障碍外，神经系统检查无异常，表现为左侧萎缩及舌运动障碍。三维计算机断层血管造影显示左侧小脑后下动脉（PICA）近端起源的梭形动脉瘤。通过左侧髁后窝入路进行微血管减压。术中发现颅底神经周围蛛网膜增厚，左侧PICA从左侧椎动脉起源处的梭形动脉瘤，该动脉瘤与左侧舌下神经根严重粘连并压迫。
PICA与舌下神经关系非常密切，其梭形扩张可导致孤立性舌下神经功能障碍。舌下神经根与PICA动脉瘤壁之间的病理性粘连可能是舌下神经麻痹发生和进展的一个因素。
