Ryu H, Yamamoto S, Sugiyama K, Uemura K, Miyamoto T
Department of Neurosurgery, Hamamatsu University School of Medicine, Shizuoka, Japan.
J Neurosurg. 1998 Mar;88(3):605-9. doi: 10.3171/jns.1998.88.3.0605.
It is generally accepted that hemifacial spasm (HFS) and trigeminal neuralgia are caused by compression of the facial nerve (seventh cranial nerve) or the trigeminal nerve (fifth cranial nerve) at the nerve's root exit (or entry) zone (REZ); thus, neurosurgeons generally perform neurovascular decompression at the REZ. Neurosurgeons tend to ignore vascular compression at distal portions of the seventh cranial nerve, even when found incidentally while performing neurovascular decompression at the REZ of that nerve, because compression of distal portions of the seventh cranial nerve has not been regarded as a cause of HFS. Recently the authors treated seven cases of HFS in which compression of the distal portion of the seventh cranial nerve produced symptoms. The anterior inferior cerebellar artery (AICA) was the offending vessel in five of these cases. Great care must be taken not to stretch the internal auditory arteries during manipulation of the AICA because these small arteries are quite vulnerable to surgical manipulation and the patient may experience hearing loss postoperatively. It must be kept in mind that compression of distal portions of the seventh cranial nerve may be responsible for HFS in cases in which neurovascular compression at the REZ is not confirmed intraoperatively and in cases in which neurovascular decompression at the nerve's REZ does not cure HFS. Surgical procedures for decompression of the distal portion of the seventh cranial nerve as well as decompression at the REZ should be performed when a deep vascular groove is noticed at the distal site of compression of the nerve.
一般认为，面肌痉挛（HFS）和三叉神经痛是由面神经（第七对脑神经）或三叉神经（第五对脑神经）在神经根出口（或入口）区（REZ）受压所致；因此，神经外科医生通常在REZ进行神经血管减压术。神经外科医生往往会忽略第七对脑神经远端部分的血管压迫，即使在对该神经的REZ进行神经血管减压术时偶然发现，因为第七对脑神经远端部分的压迫未被视为面肌痉挛的病因。最近，作者治疗了7例由第七对脑神经远端部分受压产生症状的面肌痉挛患者。其中5例患者的责任血管为小脑前下动脉（AICA）。在处理AICA时必须格外小心，不要拉伸内听动脉，因为这些小动脉极易受到手术操作的影响，患者术后可能会出现听力丧失。必须牢记，在术中未确认REZ存在神经血管压迫的情况下，以及在神经REZ进行神经血管减压术未能治愈面肌痉挛的情况下，第七对脑神经远端部分的压迫可能是导致面肌痉挛的原因。当在神经受压远端部位发现深血管沟时，应同时进行第七对脑神经远端部分减压以及REZ减压的手术操作。
