双侧椎动脉相关面肌痉挛的手术疗效分析  

Surgical outcomes of hemifacial spasm associated with bilateral vertebral artery compression

作　　者：王晶 种玉龙 戴宇翔 陆天宇 倪红斌 梁维邦 WANG Jing;CHONG Yu-long;DAI Yu-xiang;LU Tian-yu;NI Hong-bin;LIANG Wei-bang(Department of Neurosurgery,Nanjing Drum Tower Hospital,Nanjing 210008,China)

机构地区：[1]南京鼓楼医院神经外科,南京210008

出　　处：《中国临床神经外科杂志》2022年第10期805-808,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨双侧椎动脉(BVAs)相关面肌痉挛(HFS)的临床特征及显微血管减压术(MVD)的疗效。方法回顾性分析2018年1~12月收治的首次行MVD治疗的362例HFS的临床资料。结果362例中,BVAs相关HFS有16例。责任血管的分布:BVAs合并小脑前下动脉(AICA)有14例,BVAs合并小脑后下动脉(PICA)有1例,BVA合并AICA与PICA有1例。10例(62.5%)BVAs在后组颅神经水平向腹侧无移位空间,8例(50%)对侧椎动脉直径比同侧粗大。术后即刻治愈率为93.6%(15/16),随访2年治愈率为87.5%(14/16)。结论BVAs相关HFS临床较少见,往往联合AICA或PICA压迫面神经出脑干区,多表现为对侧椎动脉冗长扩张,且在后组颅神经处无移位空间。因血管类型复杂,可采用联合减压方法,疗效较好。术前影像学评估及熟练掌握神经血管解剖特点是手术成功的关键。Objective To investigate the characteristics and surgical outcomes of hemifacial spasm(HFS)associated with bilateral vertebral artery(BVA)compression.Methods The clinical data of 362 patients with HFS who underwent microvascular decompression(MVD)from January 2018 to December 2018 were analyzed retrospectively.Results Of 362 patients with HFS,16 patients were BVAs related HFS.The offending arteries including BVAs plus AICA occurred in 14 patients,BVAs plus PICA in 1,and BVAs plus AICA and PICA in 1.In 10 patients(62.5%),there was no movable space to the ventral side on the posterior cranial nerves level.In 8 patients(50%),the contralateral vertebral artery of the symptomatic side was more ectatic,dolichoectatic and tougher than the ipsilateral vertebral artery.The immediate postoperative cure rate was 93.6%(15/16),and the 2-year follow-up cure rate was 87.5%(14/16).Conclusions HFS associated with BVA compression is rare in clinic.The offending arteries usually include BVAs combined with AICA or PICA.Due to the complex type of offending arteries,combined decompression is recommended to achieve good outcomes.Preoperative imaging evaluation and proficiency in neurovascular anatomical characteristics are the key to successful surgery.

关 键 词：面肌痉挛 显微血管减压术 双侧椎动脉 疗效 

分 类 号：R745.12[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]