临床研究脑桥显微血管减压术治疗特发性半面痉挛及其机理探讨

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1、临床研究脑桥显微血管减床术治疗特发性半而痉挛及其机理探讨屮华耳鼻咽喉科杂志1998年第6期第0卷临床研究作者：张开文单位：510602广州解放军第458医院耳鼻咽喉科关键词：面神经；面神经疾病；解剖学；局部：神经外科手术；神经解剖学【摘要】目的进一步探讨特发性半而痉挛(idiopathichemifacialspasm,IHFS)的病因、发病机理及手术方法。方法对8个(16侧)经甲醛固定的脑桥行矢、冠状而常规冰冻切片、染色，观测脑桥内而神经核的位置及而神经纤维行走方向、方位。对25例IHFS而神经入脑段(roote

2、xitzoneREZ)无血管压迫者做了脑桥显微血管减压术。结果血神经核距脑桥腹侧表血距离为12.0〜12.5mm,距中线为6.0mm,距脑桥腹外侧表血为7.5~9.0mm；而神经纤维在距脑桥岀口部4.0mm之内这一段，距脑桥表而为1.0〜2.0mm,平均1.65mm。25例1HFS术中见血管圧迫部位在REZ前上方4mm之内脑桥衣血，床迫血管为小脑前下动脉及其分支。8例术后症状即消失，17例于1周内消失，随访6个月〜5年未见复发。结论IHFS病因主要为血管压迫，而REZ无血管压迫者面神经核功能异常可能为原因之一，RE

3、Z前上方脑干表而有血管压迫者，脑桥显微血管减压术治疗有效。MicrovasculardecompressionofponsforidiopathichemifacialspasmandexplorationofitsmechanismZhangKaiwen.458thHospitalofPLA,Guangzhou510602【Abstract］ObjectiveTofurtherexplorethecause,mechanismandsurgicaltreatmentofidiopathichem

4、ifacialspasm(IHFS).MethodsRoutinesagittalandcoronalcryoslicesof8(16sides)ponsweremade・ThesectionswerestainedwithLuxolfastblueandNisslstains.Thelocationofthefacialnucleusandpathwayoffacialneurofibersintheponswereobserved.Twenty-fivepatientswithIHFSwhosefacialne

5、rverootexitzone(REZ)wasnotcompressedbyvesselsunderwentmicrovasculardecompressionofpons.ResultsThedistancesfromthefacialnucleustotheventralsurfaceofpons,themedianline,andtheventroexteriorsurfacewere12・()~12.5mm,6.0mm,and7.5~9.0mmrespectively.Thedistancefromthef

6、acialneurofibersintheponstothesurfaceoftheponswas1.0to2.0mm,withanaverageof1.65mm.Thevascularcompressionwasatthesurfaceofpons,within4nunanterosuperiortotheREZin25IHFSpatients・Thecompressingvesselsweretheanteriorinferiorcerebellararteriesandtheirbranches.Theres

7、ultsofdecompressionin25patientswithIHFSwereasfollows:spasmimmediatelydisappearedin8patients,andwithinoneweekin17patients.Norecurrencewasfoundduringafollow-upperiodfrom6monthsto5years.ConclusionThemaincauseofIHFSwasvasculai*compression,butthepositionofcompressi

8、onisnotnecessarilyalwaysattherEZ.The“short・circuiting，theorycanonlyexplainthecaseswithvascularcompressionattheRE乙ButincaseswhodonothavevascularcompressionattheREZ,theremightbedysfu