Department of Neurosurgery, University of South Florida, Tampa, Florida, USA.
Department of Neurosurgery, University of South Florida, Tampa, Florida, USA.
World Neurosurg. 2019 Dec;132:134. doi: 10.1016/j.wneu.2019.08.109. Epub 2019 Aug 28.
Hemifacial spasm is a cranial nerve compression syndrome caused by impingement on the facial nerve most frequently by the anterior inferior cerebellar artery or the posterior inferior cerebellar artery. It can be treated with microvascular decompression (MVD) to separate the nerve from the offending artery. Rarely, a large-caliber vessel such as a dolichoectatic vertebrobasilar system may be implicated, requiring more than an MVD. One technique involves placing a sling around the offending vessel to decompress the facial nerve. We find our "neck-tie" technique to be unique and present it in this detailed video. A 36-year-old-woman presented with a 3-month history of severe left hemifacial spasm refractory to medical management. Imaging demonstrated compression of the left facial nerve and its root entry zone by a dolichoectatic vertebrobasilar complex and anterior inferior cerebellar artery. A left retrosigmoid craniotomy was performed. A Dacron sling was placed around the offending vertebral artery in a "neck-tie" fashion. This sling was used to displace the vertebral artery off of the facial nerve and the sling was then sutured in its final position to the petrous dura. In addition, MVD was performed around the facial nerve's root entry zone. Following sling placement and MVD, neuromonitoring demonstrated absence of abnormal motor responses. Postoperative course was uneventful, she remained neurologically intact, and she remained free of symptoms at 6 months' follow-up. This video highlights the decision making for selecting the appropriate case of hemifacial spasm for sling decompression, the key technical nuances, and complication avoidance in these challenging cases.
面肌痉挛是一种颅神经压迫综合征，由面神经受到小脑前下动脉或小脑后下动脉的压迫引起。微血管减压术（MVD）可用于治疗面肌痉挛，通过分离神经和肇事动脉来治疗。极少数情况下，较大口径的血管，如扩张的椎基底动脉系统，可能会涉及其中，需要进行不止一次的 MVD。一种技术是用吊索环绕肇事血管，以对面神经进行减压。我们发现我们的“颈带”技术是独特的，并在这个详细的视频中展示它。一位 36 岁女性因左侧面肌痉挛，病史 3 个月，药物治疗无效而就诊。影像学检查显示左侧面神经及其神经根入口区受到扩张的椎基底动脉复合体和小脑前下动脉的压迫。行左侧乙状窦后入路开颅术。用 Dacron 吊带以“颈带”的方式环绕肇事椎动脉。该吊带用于将椎动脉从面神经上移开，然后将吊带缝合在其最终位置的岩骨硬脑膜上。此外，还在面神经神经根入口区周围进行了 MVD。吊带放置和 MVD 后，神经监测显示无异常运动反应。术后过程顺利，患者神经功能完整，6 个月随访时无症状。这个视频突出了选择适当的面肌痉挛病例进行吊带减压的决策过程、关键技术细节以及这些具有挑战性病例中的并发症预防。
