Takano Yuji, Tanaka Yoji, Kaneoka Azumi, Imamura Mayuko, Tamura Kaoru, Maehara Taketoshi
Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan.
NMC Case Rep J. 2024 Dec 3;11:371-375. doi: 10.2176/jns-nmc.2024-0167. eCollection 2024.
Hemifacial spasm (HFS) is a disorder that causes involuntary movements of the ipsilateral facial muscles because of vascular compression of the facial nerve. Microvascular decompression (MVD), a surgical procedure to detach the culprit vessel from the nerve is believed to be the most effective treatment for HFS. Nevertheless, in the rare case in which the vessel penetrates the nerve, positioning the vessel sufficiently far from the nerve is challenging. In this report, a case of right HFS in a 54-year-old man with an anterior inferior cerebellar artery that had penetrated the nerve fiber cleft between the facial nerve and the nervus intermedius is presented. In the present case, the patient achieved relief from spasm, and postoperative facial hemiplegia was prevented by splitting the cleft slightly, gently moving the vessel, and affixing it to the petrous part of the temporal bone. The anatomic relationship between the facial nerve and the offending vessel must be properly understood, which must be carefully manipulated in such "penetration-type" HFS cases.
面肌痉挛（HFS）是一种由于面神经受血管压迫而导致同侧面部肌肉不自主运动的疾病。微血管减压术（MVD）是一种将肇事血管与神经分离的外科手术，被认为是治疗HFS最有效的方法。然而，在极少数情况下，血管会穿透神经，将血管放置在离神经足够远的位置具有挑战性。在本报告中，介绍了一例54岁男性右侧HFS患者，其小脑前下动脉穿透了面神经与中间神经之间的神经纤维裂。在本病例中，通过稍微分开裂、轻轻移动血管并将其固定在颞骨岩部，患者痉挛得到缓解，且预防了术后面部偏瘫。必须正确理解面神经与肇事血管之间的解剖关系，在这种“穿透型”HFS病例中必须小心操作。
