Is the root entry/exit zone important in microvascular compression syndromes?
Is the root entry/exit zone important in microvascular compression syndromes?
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DOI：
10.1097/00006123-200208000-00023
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发表时间：
2002-08-01
期刊：
影响因子：
4.8
通讯作者：
De Ridder, L
中科院分区：
文献类型：
--
作者：
De Ridder, D;Moller, A;De Ridder, L
OBJECTIVE.微血管压迫综合征，如三叉神经痛、面肌痉挛和致残性位置性眩晕，涉及动脉或静脉压迫颅神经。颅神经由中枢神经系统（CNS）段和周围神经系统（PNS）段组成，它们被根入口/出口区（REZ）分开。虽然血管压迫可发生在沿颅神经的沿着任何点，但通常认为只有受影响颅神经的REZ处的血管接触才能引起症状。根据个人的手术经验，我们认为，血管压迫中枢神经系统段单独引起的症状。这对今后微血管压迫综合征，特别是耳蜗前庭压迫综合征的诊断和治疗具有重要的影响。方法：解剖学研究，4例尸检标本和1例手术活检的前庭蜗神经进行了显微镜和超微结构，分析CNS和PNS段之间的结构差异。在临床研究中，5例临床表现为耳蜗前庭压迫综合征的患者在CNS节段而非REZ水平接受显微手术减压治疗。1例患者4年后因复发症状再次手术，并在该阶段进行了4 mm前庭神经切除术。我们进行了流行病学分析，以证明三叉神经痛，面肌痉挛，舌咽神经痛的已知发病率相关的长度各自的CNS segments.RESULTS：PNS和CNS节段之间的组织学差异表明，PNS节段更耐压缩，这是证实了神经生理数据从术中监测后颅窝手术和实验研究。我们发现了一个明确的流行病学之间的相关性的长度不同的脑神经中枢神经系统段，微血管压迫综合征的发病率。成功减压的中枢神经系统段的患者没有压缩在REZ的前庭蜗神经禁用位置性眩晕提供了临床支持这一hypothes.CONCLUSION：我们提出的证据支持这一假设，即血管压迫综合征产生血管接触沿着的中枢神经系统段的颅神经。
OBJECTIVE. Microvascular compression syndromes such as trigeminal neuralgia hemifacial spasm, and disabling positional vertigo involve an artery or vein compressing a cranial nerve. A cranial nerve is composed of a central nervous, system (CNS) segment and a peripheral nervous system (PNS) segment separated by the root entry/exit zone (REZ). Although vascular compression can occur at any point along the cranial nerve, it has been generally assumed that only vascular contact at the REZ of the affected cranial nerve can cause symptoms. On the basis of personal surgical experience, we propose that vascular compression of the CNS segment alone causes symptoms. This has important repercussions for the future diagnosis and treatment of microvascular compression syndromes, especially the cochleovestibular compression syndrome.METHODS: For the anatomic study, four autopsy specimens and one surgical biopsy of the vestibulocochlear nerve were microscopically and ultramicroscopically, analyzed for structural differences between the CNS and PNS segments. For the clinical study, five patients with the clinical picture of cochleovestibular compression, syndrome were treated by microsurgical decompression at the level of the CNS segment and not the REZ. One patient underwent reoperation for recurrent symptoms 4 years later, and a 4-mm vestibular neurectomy was performed at that stage. We performed an epidemiological analysis to demonstrate that the known incidences of trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia are related to the length of their respective CNS segments.RESULTS: Histological differences between the PNS and CNS segments suggest that PNS segment is more resistant to compression, This was confirmed by neurophysiological data from intraoperative monitoring in posterior fossa surgery and experimental studies. We found a clear epidemiological correlation between the length of the CNS segment which differed among cranial nerves, and the incidence of the microvascular compression syndrome. Successful decompression of the CNS segment in patients without compression at the REZ of the vestibulocochlear nerve for disabling positional vertigo provides clinical support for this hypothesis.CONCLUSION: The evidence we present supports the hypothesis that vascular compression syndromes arise from vascular contact along the CNS segment of the cranial nerves.