面神经血管束显微外科解剖与临床研究  

Microsurgical anatomy and clinical research of facial neurovascular bundle

作　　者：张学基[1] 张崇岳[1] 杨勇[1] 黄宗涛[1] 罗克政[1] 

机构地区：[1]甘肃省中医院神经外科,兰州730050

出　　处：《临床神经外科杂志》2013年第2期69-72,共4页Journal of Clinical Neurosurgery

基　　金：甘肃省科技计划资助项目(1107RJZA180)

摘　　要：目的探讨面神经自脑干发出处至颞骨内侧段及其毗邻结构的显微解剖,为枕下乙状窦后入路面神经微血管减压术(MVD)及桥脑小脑角(CPA)区手术提供显微解剖相关资料。方法对用福尔马林固定的成人尸头标本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方法,显微技术解剖CPA区域面神经及其毗邻神经血管等结构,进行观察和测量;对128例面神经MVD手术资料进行观察、整理和分析。研究面神经血管束的组成与变异,并将解剖标本与手术所见进行对比分析。结果尸头解剖:面神经根与毗邻血管压迫或接触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(VA)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AICA79例(61.72%);PICA21例(16.41%);椎-基底动脉6例(4.69%);多支血管22例(17.18%)。结论面神经血管束,特别是其桥脑延髓沟段的显微外科解剖和术中充分暴露是面神经MVD手术成功的关键。Objective To study the microsurgical anatomy of facial nerve from exit point of brainstem to inside of temporal bone and relationship structure in order to provide anatomic parameters for facial nerve microvacular decompression （MVD） and cerebellar pontine angle （CPA） area operation through retrosigmoid approach. Methods The CPA area segment of facial nerve and its relationship struetures were observed by operative microscope on 10 adults cadaveric heads via the key hole restro sigmoid approach. The data of 128 patients operated by facial nerve MVD were observed and analyzed. Results Cadaveric heads anatomy showed the number of radix nervi facialis that was oppressed or touched by the blood vessel around was 9 side （ 9/20 ）, including anterior inferior cerebellar artery （AICA） 5 side, posterior inferior cerebellar artery （PICA） 2 side, vertebral artery （VA） 1 side and muhivessel 1 side. Operation information showed the culprit blood vessel of hemifaeial spasm was the anterior inferior cerebellar artery （79,61.72%） , posterior inferior cerebeilar artery （21,16.41%） , vertebral artery （ 6,4.69% ） and muhivessel （22,17. 18% ） . It located mostly in pontomedullary sulcus. Conclusion The microsurgieal anatomy of facial neurovascular bundle especially in pontomedullary sulcus segement and its adequately exploration in operation are the key points to achieve consistent success in facial nerve MVD.

关 键 词：小脑桥脑角 显微外科解剖 枕下乙状窦后入路 微血管减压术 半侧面肌痉挛 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学]