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我的手术方法：原发性面肌痉挛微血管减压术中的联合嵌入-转位技术

How I do it: combined interposition-transposition technique for microvascular decompression in primary hemifacial spasm.

作者信息

Tengattini Francesco, Calbucci Fabio, Borghesi Ignazio, Draghi Riccardo

机构信息

Department of Medical and Surgical Specialties, Division of Neurosurgery, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.

Department of Neurosurgery, Maria Cecilia Hospital, GVM Care&Research, Cotignola, Italy.

出版信息

Acta Neurochir (Wien). 2025 Mar 18;167(1):80. doi: 10.1007/s00701-025-06472-0.

DOI:10.1007/s00701-025-06472-0
PMID:40102276
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11919959/
Abstract

BACKGROUND

Two surgical microvascular decompression techniques to treat primary hemifacial spasm (HFS) are described in literature. The "interposition" uses different materials as "spacers" while the "transposition" consists in suturing the offending vessel to the petrous bone dura mater. In the literature is described a transposition surgery adopting self-adhesive materials reporting promising results.

METHOD

We describe a combination of these two techniques using autologous muscle and Tachosil. The step-by-step surgical principles are described in the article and clarified in a video.

CONCLUSION

This procedure is effective to cure the HFS especially in case of large arteries when interposition only is insufficient.

摘要

背景

文献中描述了两种用于治疗原发性面肌痉挛（HFS）的外科微血管减压技术。“插入法”使用不同材料作为“间隔物”，而“转位法”则是将肇事血管缝合至岩骨硬脑膜。文献中描述了一种采用自粘材料的转位手术，报告显示效果良好。

方法

我们描述了一种结合这两种技术的方法，使用自体肌肉和速即纱。本文详细介绍了逐步的手术原则，并在一段视频中进行了阐释。

结论

该手术方法对于治愈面肌痉挛有效，尤其是在大动脉情况下，仅采用插入法不足以解决问题时。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7225/11919959/1ba56ef0ee49/701_2025_6472_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7225/11919959/4ad3f7b16f1d/701_2025_6472_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7225/11919959/8108ebe0d67f/701_2025_6472_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7225/11919959/eec425a761a0/701_2025_6472_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7225/11919959/581884f91278/701_2025_6472_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7225/11919959/1ba56ef0ee49/701_2025_6472_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7225/11919959/4ad3f7b16f1d/701_2025_6472_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7225/11919959/8108ebe0d67f/701_2025_6472_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7225/11919959/eec425a761a0/701_2025_6472_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7225/11919959/581884f91278/701_2025_6472_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7225/11919959/1ba56ef0ee49/701_2025_6472_Fig5_HTML.jpg

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本文引用的文献

1
Validation of Efficacy and Safety of TachoSil ® Tissue Sealant for Vessel Transposition in Microvascular Decompression.验证 TachoSil ® 组织粘合剂在微血管减压术中血管转位中的疗效和安全性。
Oper Neurosurg (Hagerstown). 2023 Nov 1;25(5):417-425. doi: 10.1227/ons.0000000000000844. Epub 2023 Sep 1.
2
Microvascular Decompression for Hemifacial Spasm Associated with Vertebral Artery: Biomedical Glue-Coated Teflon Sling Transposition Technique.微血管减压术治疗椎动脉相关的半面痉挛：生物医学胶水涂层聚四氟乙烯吊带转位技术
World Neurosurg. 2018 Dec;120:e342-e348. doi: 10.1016/j.wneu.2018.08.073. Epub 2018 Aug 23.
3
Microvascular decompression for hemifacial spasm : Surgical techniques and intraoperative monitoring.
微血管减压术治疗面肌痉挛：手术技术与术中监测
Neurochirurgie. 2018 May;64(2):133-143. doi: 10.1016/j.neuchi.2018.04.003. Epub 2018 May 18.
4
Novel Technical Variations and Increased Adhesive Strength in the "Birdlime" Transposition Technique for Microvascular Decompression.微血管减压术“鸟胶”转位技术中的新型技术变异及增强的黏附力
World Neurosurg. 2018 Aug;116:e460-e468. doi: 10.1016/j.wneu.2018.05.006. Epub 2018 Jun 5.
5
A "sling swing transposition" technique with pedicled dural flap for microvascular decompression in hemifacial spasm.一种带蒂硬脑膜瓣的“吊索摆动转位”技术在面肌痉挛微血管减压术中的应用。
Neurosurgery. 2012 Sep;71(1 Suppl Operative):25-30; discussion 30-1. doi: 10.1227/NEU.0b013e318246aa74.
6
"Double-stick tape" technique for transposition of an offending vessel in microvascular decompression: technical case report.“双胶带”技术在微血管减压术中移位致患血管的应用：技术病例报告。
Neurosurgery. 2011 Jun;68(2 Suppl Operative):377-82; discussion 382. doi: 10.1227/NEU.0b013e318217141c.