Jiang Xiaofeng, Wu Min, Fu Xianming, Niu Chaoshi, He Fang, Sun Kegui, Zhuang Hongxia
Department of Neurosurgery, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, Hefei, Anhui, China; Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; Anhui Provincial Stereotactic Neurosurgical Institute, Hefei, Anhui, China; Anhui Provincial Key Laboratory of Brain Function and Brain Disease, Hefei, Anhui, China.
Department of Neurosurgery, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, Hefei, Anhui, China; School of Medicine, Shandong University, Jinan, Shandong, China; Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; Anhui Provincial Stereotactic Neurosurgical Institute, Hefei, Anhui, China; Anhui Provincial Key Laboratory of Brain Function and Brain Disease, Hefei, Anhui, China.
World Neurosurg. 2018 Dec;120:e342-e348. doi: 10.1016/j.wneu.2018.08.073. Epub 2018 Aug 23.
Microvascular decompression is the most effective treatment for hemifacial spasm. However, when encountering hemifacial spasm associated with vertebral artery (VA), the procedure is more challenging and requires complicated operation techniques. The authors retrospectively analyzed the clinical characteristics of this group of cases and investigated reasonable transposition procedures for different anatomic classifications.
We retrospectively analyzed 117 cases that underwent their first microvascular decompression for hemifacial spasm between June 2010 and December 2016, which had all associated with vertebral artery compression diagnosed by preoperational radiology examination. The study first classified offending vessels into 3 types according to operative anatomy and designed personalized decompression management according to different forms of neurovascular conflict. Curative effects and complications were assessed.
The offending vessels were artificially divided into 3 types according to both arterial pattern and compression direction: 1) ipsilateral VA plus anterior inferior cerebellar artery compressing the facial nerve from the ventrolateral direction in 72 (61.5%) cases; 2) ipsilateral VA plus posterior inferior cerebellar artery compressing the facial nerve from the caudal-medial direction in 31 (26.5%) cases; 3) bilateral VA compressing the facial nerve in 14 (12.0%) cases. We selected corridors to expose the neurovascular conflict site between the suprafloccular-transhorizontal fissure approach and subtonsillar-transcerebellomedullary fissure approach. The methods of decompression consist of anteromedial and posterolateral transposition by using biomedical glue-coated Teflon sling. Sufficient decompression of the offending vessels was safely performed in all cases. All cases had total relief of symptoms immediately after their operations. Follow-up periods ranged from 16-90 months, and total recovery occurred in 110 cases (94.0%). In 7 cases (6.0%), 90% recovery occurred.
Accuracy and comprehensive recognition of anatomic features of the offending vessels are crucial for the management of hemifacial spasm associated with vertebral artery compression. Appropriate approaches combined with the biomedical glue-coated Teflon sling transposition technique can allow adequate mobilization of the vertebral artery and bring complete postoperative symptom relief for most cases.
微血管减压术是治疗面肌痉挛最有效的方法。然而，当遇到与椎动脉（VA）相关的面肌痉挛时，该手术更具挑战性，需要复杂的操作技术。作者回顾性分析了这组病例的临床特征，并研究了针对不同解剖分类的合理转位手术方法。
我们回顾性分析了2010年6月至2016年12月期间首次接受微血管减压术治疗面肌痉挛的117例病例，这些病例术前影像学检查均诊断为与椎动脉压迫相关。该研究首先根据手术解剖将责任血管分为3型，并根据不同形式的神经血管冲突设计个性化减压处理方法。评估疗效和并发症。
根据动脉形态和压迫方向，将责任血管人为分为3型：1）同侧椎动脉加小脑前下动脉从腹外侧方向压迫面神经72例（61.5%）；2）同侧椎动脉加小脑后下动脉从尾内侧方向压迫面神经31例（26.5%）；3）双侧椎动脉压迫面神经14例（12.0%）。我们选择在绒球上-水平裂入路和扁桃体下-小脑延髓裂入路之间暴露神经血管冲突部位的通道。减压方法包括使用生物医学胶水涂层的特氟龙吊带进行前内侧和后外侧转位。所有病例均安全地对责任血管进行了充分减压。所有病例术后症状立即完全缓解。随访时间为16至90个月，110例（94.0%）完全恢复。7例（6.0%）恢复90%。
准确全面认识责任血管的解剖特征对于处理与椎动脉压迫相关的面肌痉挛至关重要。合适的入路结合生物医学胶水涂层的特氟龙吊带转位技术可使椎动脉充分游离，大多数病例术后症状完全缓解。
