面神经微血管束显微解剖与临床应用研究  

The microsurgical anatomy and clinical research of facial neural microvascular bundle

作　　者：颜抒阳[1] 高宝山[1] 邓东风[1] 张继志[1] 王木春[1] 张绪新[1] 

机构地区：[1]大连大学附属中山医院神经外科,116001

出　　处：《中国医药》2012年第4期471-473,共3页China Medicine

基　　金：辽宁省大连市医学卫生科学研究计划项目（2009-67）：

摘　　要：目的研究桥小脑角区（CPA）面神经微血管束的显微解剖，总结面神经微血管减压术（MVD）手术资料。方法显微解剖成人尸头标本10例20侧（男性6例，女性4例），模拟枕下乙状窦后锁孔入路手术操作过程，对CPA区面神经及其毗邻神经血管等结构进行观察和测量；回顾性分析400例面神经MVD手术资料。研究面神经微血管束的组成与变异，并将解剖标本与手术资料进行对比分析。结果尸头解剖：面神经桥小脑池段与毗邻血管发生压迫或接触9侧（9／20），其中：小脑前下动脉（AICA）5侧，小脑后下动脉（PICA）2侧，椎动脉1侧，多支血管1侧；手术资料：半侧面肌痉挛（HFS）的责任血管绝大多数位于桥脑延髓沟，其中AICA265例（66．25％）；PICA69例（17．25％）；椎一基底动脉11例（2．75％）；多支血管45例（11．25％）。结论对桥小脑角区面神经微血管束，尤其是桥脑延髓沟段显微解剖结构的深入认识，是术中进行充分探查并明确责任血管，保证面神经MVD手术成功的关键。Objective To study the microsurgical anatomy of facial neural microvascular bundle in Cerebellopontine angle （CPA） and to summarize surgery materials of facial nerve microvascular decompression （MVD）. Methods Microdissection was performed in 10 adults cadaveric heads through the key hole restrosigmoid approach with totally 20 sides （6 male, 4 female）. CPA area segment of facial nerve and its adjacent structures were observed and analyzed. Four hundred cases of facial nerve MVD surgical data were retrospectively analyzed. The composition and variation of facial neural microvascular bundle were studied. Anatomical specimens and surgical materials were analyzed. Results Cadaveric heads anatomy： the number of facial nerve oppressed or touched by the blood vessel around were 9 sides（9/20） in the CPA area（ AICA 5 sides,PICA 2 sides,VA 1 side, multivessel 1 side）. Surgery materials ： the culprit blood vessel of hemifacial spasm located medulla oblongata trench [ the anterior inferior cerebellar artery （265 cases, 66. 25% ）, posterior inferior cerebellar artery （69 cases, 17. 25% ）, vertebral-basal arter- y （ 11 cases, 2. 75% ）, multivessel （ 45 cases, 11.25% ） ]. It located mostly in pontomedullary sulcus. Conclusion Microsurgical anatomy of facial neural microvascular bundle in cerebellopontine angle, especially in pontomedullary sulcus segement is beneficial for the culprit blood vessel in operation and for achieving consistent success in facial nerve microvascular decompression.

关 键 词：桥小脑角区 面神经微血管减压术 半侧面肌痉挛 小脑前下动脉 小脑后下动脉 

分 类 号：R322.8[医药卫生—人体解剖和组织胚胎学]