治疗伴有椎动脉夹层动脉瘤的面肌痉挛需行微血管减压术联合血管内夹闭：病例报告并文献复习。
Treatment for Hemifacial Spasm Associated with a Dissecting Vertebral Artery Aneurysm Requiring Microvascular Decompression in Addition to Endovascular Trapping: A Case Report with Literature Review.
机构信息
Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
出版信息
J Neurol Surg A Cent Eur Neurosurg. 2022 Jul;83(4):377-382. doi: 10.1055/s-0040-1721681. Epub 2021 Mar 9.
BACKGROUND
The treatment protocol for hemifacial spasm (HFS) associated with dissecting vertebral artery aneurysm (DVAA) has not been established.
CASE DESCRIPTION
A-42-year-old man with left HFS underwent endovascular trapping for a DVAA that was identified on brain imaging. Although the dissecting segment was treated successfully, the HFS persisted for 3 months, and subsequently microvascular decompression (MVD) was needed. The posteroinferior cerebellar artery (PICA) was found to be interposed between the root exit zone of the facial nerve and DVAA during surgery. After pulling out the PICA, the HFS ceased immediately.
CONCLUSION
HFS associated with DVAA should be considered carefully before formulating a treatment strategy. Moreover, the cause of pulsatile compression may not be visible on brain imaging, and MVD surgery may be indicated in such cases.
背景
与椎动脉夹层动脉瘤（DVAA）相关的面肌痉挛（HFS）的治疗方案尚未建立。
病例描述
一位 42 岁男性，因左侧 HFS 接受了 DVAA 的血管内夹闭治疗，该动脉瘤在脑部成像中被发现。尽管夹层节段治疗成功，但 HFS 持续了 3 个月，随后需要微血管减压术（MVD）。术中发现小脑后下动脉（PICA）位于面神经神经根出颅区和 DVAA 之间。在拉出 PICA 后，HFS 立即停止。
结论
在制定治疗策略之前，应仔细考虑与 DVAA 相关的 HFS。此外，搏动性压迫的原因在脑部成像上可能不可见，在这种情况下可能需要 MVD 手术。
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