Bauman Megan M, Carlstrom Lucas P, Link Michael J
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.
Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, United States.
J Neurol Surg Rep. 2024 Feb 12;85(1):e23-e24. doi: 10.1055/a-2244-1143. eCollection 2024 Jan.
Hemifacial spasm is a neuromuscular disorder caused by compression of the facial nerve at the nerve root entry zone, often due to ectatic or aberrant vasculature. Pathologic compression of the nerve-brainstem interface results in involuntary, paroxysmal contractions of ipsilateral facial muscles that may cause considerable impairments in quality of life. For those with severe symptoms, have positive imaging demonstrating vascular compression, or who fail other management modalities, 1 2 3 4 microvascular decompression offers potential definitive treatment. 5 6 Traditionally, nonabsorbable packing agent is used to pack between the nerve and offending vascular structure. However, for large and more complex arterial structures, simple nonabsorbable padding is often not sufficient. In this operative video, we demonstrate microvascular decompression for intractable hemifacial spasm in a 52-year-old female using a specialized sling tacked to the petrous dura for management of a large, ectatic vertebral artery. Following a standard left retrosigmoid craniotomy, an atheromatous ectatic vertebral artery was identified. We fashioned a bovine pericardium sling around the vessel and used a permanent aneurysm clip to secure it to an incision portion of petrous dura. We subsequently identified potential additional facial nerve root compression by anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA) branches, which were elevated and secured using Teflon felt packing. Following elevation of all three vessels, the lateral spread response resolved. At 2 weeks postoperatively, the patient reported substantial relief in her hemifacial spasms and endorsed highly improved quality of life.
面肌痉挛是一种神经肌肉疾病，由面神经在神经根进入区受压引起，通常是由于血管扩张或走行异常。神经-脑干界面的病理性压迫导致同侧面部肌肉不自主、阵发性收缩，这可能会对生活质量造成相当大的损害。对于症状严重、影像学检查显示有血管压迫阳性结果或其他治疗方式无效的患者，微血管减压术提供了潜在的确定性治疗方法。传统上，使用不可吸收的填塞剂填充在神经和肇事血管结构之间。然而，对于大的和更复杂的动脉结构，单纯的不可吸收填塞往往是不够的。在这个手术视频中，我们展示了对一名52岁女性难治性面肌痉挛进行微血管减压术的过程，使用一种专门的吊带固定在岩骨硬脑膜上，以处理一条大的、扩张的椎动脉。在进行标准的左乙状窦后开颅术后，发现了一条动脉粥样硬化性扩张的椎动脉。我们在血管周围制作了一个牛心包吊带，并用一个永久性动脉瘤夹将其固定在岩骨硬脑膜的一个切口部分。随后，我们发现小脑前下动脉（AICA）和小脑后下动脉（PICA）分支可能对面神经根部造成额外压迫，将这些分支抬起并用特氟龙毡垫固定。在抬起所有三条血管后，侧面扩散反应消失。术后2周，患者报告其面肌痉挛症状大幅缓解，并认可生活质量有了显著改善。
