Marianayagam Neelan J, Qureshi Hanya M, Vasandani Sagar, Vetsa Shaurey, Jalal Muhammad, Wu Kun, Moliterno Jennifer
1Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut; and.
2Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut.
J Neurosurg Case Lessons. 2022 Jul 18;4(3):CASE22176. doi: 10.3171/CASE22176.
Hyperactive cranial neuropathies refractory to medical management can often be debilitating to patients. While microvascular decompression (MVD) surgery can provide relief to such patients when an aberrant vessel is compressing the root entry zone (REZ) of the nerve, the arteries of elderly patients over 65 years of age can be less amenable to manipulation because of calcifications and other morphological changes. A dolichoectatic vertebral artery (DVA), in fact, can lead to multiple cranial neuropathies; therefore, a strategy for MVDs in elderly patients is useful.
A 76-year-old man presented with medically refractory trigeminal neuralgia (TN) and hemifacial spasm (HFS). A DVA was the conflicting vessel at the left REZs of the trigeminal and facial nerves. The authors performed a retrosigmoid craniotomy for MVD of the DVA with Teflon padding at both REZs in approximately 1 hour of operative time. The patient was free of facial pain and spasm immediately after surgery and at follow-up.
The authors described the case of an elderly patient with both TN and HFS caused by compression of a DVA. Simultaneous MVD with Teflon padding at both REZs provided symptomatic relief with limited surgical time. This can be a particularly useful and straightforward surgical strategy in the elderly population.
药物治疗难治的多动性颅神经病变常常会使患者虚弱无力。当异常血管压迫神经的神经根入区（REZ）时，微血管减压（MVD）手术可为这类患者提供缓解，但65岁以上老年患者的动脉由于钙化和其他形态学改变，可能不太适合进行手术操作。事实上，扩张延长型椎动脉（DVA）可导致多种颅神经病变；因此，针对老年患者的MVD策略是有用的。
一名76岁男性患者患有药物治疗难治的三叉神经痛（TN）和半面痉挛（HFS）。在三叉神经和面神经的左侧REZ处，DVA是冲突血管。作者进行了乙状窦后开颅手术，对DVA进行MVD，并在两个REZ处使用聚四氟乙烯垫片，手术时间约1小时。术后及随访时患者面部疼痛和痉挛消失。
作者描述了一例由DVA压迫导致TN和HFS的老年患者病例。在两个REZ处同时进行MVD并使用聚四氟乙烯垫片，在有限的手术时间内缓解了症状。这在老年人群中可能是一种特别有用且直接的手术策略。
