Microanatomy Around the Facial Nerve Pathway for Microvascular Decompression Surgery Investigated with Correlative Light Microscopy and Block-Face Imaging
Microanatomy Around the Facial Nerve Pathway for Microvascular Decompression Surgery Investigated with Correlative Light Microscopy and Block-Face Imaging
复制标题
DOI：
10.1016/j.wneu.2018.06.228
复制
发表时间：
2018-10-01
影响因子：
2
通讯作者：
Yoshimoto, Yuhei
中科院分区：
文献类型：
--
作者：
Iijima, Keiya;Tajika, Yuki;Yoshimoto, Yuhei
背景：面肌痉挛的微血管减压术是在神经根出口区进行的。面神经的更近端段，定义为根新兴区（REmZ），也可能容易受到神经血管压迫。因此，周围的面神经纤维在pontomedullary交界处的显微解剖的详细知识是必不可少的一致成功的microvascular decompression.METHODS：5人脑干从尸体上获得的相关光学显微镜和块面成像，获得任意的二维光镜和三维体积数据从一个单一的标本进行了研究。整个面神经通路，包括髓鞘的过渡，进行了评价内部和外部brainstem.Results：相关的光镜和块面成像显示，脑干内面神经纤维出现在脑干表面深的脑桥延髓沟（REmZ）和coursing沿着脑桥表面之前，从脑桥（根出口区）分离。急性出现的角度显着增加了表面积与中央髓鞘。面神经束在中央髓鞘覆盖的部分形成1束，在髓鞘过渡部分分为2束，在更远的部分又分为多束。REmZ周围的动脉往往锚定的穿支纠缠较低的颅nerves.CONCLUSIONS：面神经纤维是容易出现在脑桥延髓沟的深部脑干表面血管压迫。显微血管减压术的关键步骤是充分解剖下段颅神经至脑干起源，以探查根部出口区和REmZ。
BACKGROUND: Microvascular decompression for hemifacial spasm is performed at the root exit zone. More proximal segments of the facial nerve, defined as the root emerging zone (REmZ), may also be susceptible to neurovascular compression. Consequently, detailed knowledge of the microanatomy around facial nerve fibers at the pontomedullary junction is essential for consistent success of microvascular decompression.METHODS: Five human brainstems obtained from cadavers were investigated using correlative light microscopy and block-face imaging, which obtains arbitrary two-dimensional light microscopic and three-dimensional volume data from a single specimen. The entire facial nerve pathway, including the myelin transition, was evaluated inside and outside the brainstem.RESULTS: Correlative light microscopy and block-face imaging showed the intra-brainstem facial nerve fibers emerging at the brainstem surface deep at the pontomedullary sulcus (REmZ) and coursing along the pontine surface before detaching from the pons (root exit zone). An acute emerging angle significantly increased the surface area with central myelin. The facial nerve bundle formed 1 fasciculus in the portion covered by central myelin but divided into 2 fasciculi in the myelin transitional portion and then into multiple fasciculi more distally. Arteries around the REmZ were often anchored by perforating branches entangled with lower cranial nerves.CONCLUSIONS: Facial nerve fibers are susceptible to vascular compression on emerging onto the deep brainstem surface at the pontomedullary sulcus. The key procedure in microvascular decompression is full dissection of the lower cranial nerves down to the brainstem origin to explore both the root exit zone and the REmZ.