Seto Hiroki, Ogura Ryosuke, Hiraishi Tetsuya, Tsukamoto Yoshihiro, Saito Taiki, Shibuma Satoshi, Shibuya Kohei, Okamoto Kouichirou, Oishi Makoto, Fujii Yukihiko
Departments of1Neurosurgery and.
2Translational Research, Brain Research Institute, Niigata University, Niigata, Japan.
J Neurosurg Case Lessons. 2023 Mar 20;5(12). doi: 10.3171/CASE2318.
Cerebellopontine angle (CPA) lipoma-associated hemifacial spasm (HFS) is rare. As the removal of CPA lipomas has a high risk of worsening the neurological symptoms, surgical exploration is warranted only in selected patients. Preoperative identification of the lipoma affected site of the facial nerve, and offending artery are crucial for patient selection and successful microvascular decompression (MVD).
Presurgical simulation using three-dimensional (3D) multifusion imaging showed a tiny CPA lipoma wedged between the facial and auditory nerves, as well as an affected facial nerve by the anterior inferior cerebellar artery (AICA) at the cisternal segment. Although a recurrent perforating artery from the AICA anchored the AICA to the lipoma, successful MVD was achieved without lipoma removal.
The presurgical simulation using 3D multifusion imaging could identify the CPA lipoma, affected site of the facial nerve, and offending artery. It was helpful for patient selection and successful MVD.
小脑脑桥角（CPA）脂肪瘤相关的面肌痉挛（HFS）较为罕见。由于切除CPA脂肪瘤具有使神经症状恶化的高风险，仅在特定患者中才需要进行手术探查。术前识别面神经的脂肪瘤累及部位以及责任动脉对于患者选择和成功的微血管减压术（MVD）至关重要。
使用三维（3D）多融合成像进行术前模拟显示，一个微小的CPA脂肪瘤楔入面神经和听神经之间，并且在脑池段小脑前下动脉（AICA）压迫面神经。尽管来自AICA的一支反复分支的穿支动脉将AICA固定于脂肪瘤，但未切除脂肪瘤仍成功完成了MVD。
使用3D多融合成像进行术前模拟能够识别CPA脂肪瘤、面神经累及部位以及责任动脉。这有助于患者选择和成功实施MVD。
