[Trigeminal neuralgia and hemifacial spasm associated with vertebrobasilar artery tortuosity].
[Trigeminal neuralgia and hemifacial spasm associated with vertebrobasilar artery tortuosity].
复制标题
DOI：
10.17116/neiro201680144-56
复制
发表时间：
2016-01-01
期刊：
影响因子：
--
通讯作者：
Grigoryan, G Yu
中科院分区：
文献类型：
--
作者：
Grigoryan, Yu A;Sitnikov, A R;Grigoryan, G Yu
背景：三叉神经痛（TN）和面肌痉挛（HFS）患者椎基底动脉（TVBA）弯曲常引起神经血管冲突。在这些情况下，微血管减压（MVD）的实施由于动脉扩张和扩张的僵硬而受到阻碍，并且通常伴有不良结果。三叉神经痛和面肌痉挛合并TVBA的手术策略应明确，以获得良好的效果。材料与方法：268例TN患者和71例HFS患者行MVD。30例（TN 11例，HFS 18例，疼痛性抽动性惊厥1例）发现TVBA为压迫血管。所有患者都接受了MVD治疗，并对临床结果进行了回顾性分析。结果：所有HFS患者和4例TN患者均出现椎动脉压迫，7例TN患者出现基底动脉压迫。21例观察到颅神经根进出区受到小脑血管的额外压迫。TVBA通过剥离血管与脑干之间的蛛网膜粘连而移动，并向外侧缩回。然后，将TVBA从脑干缩回至尾侧方向。这些操作的结果是“自发”的脑神经减压，而无需在动脉和神经根进出区之间放置假体。在所有病例中（除两例外），移位的TVBA使用患者的肌肉和脂肪组织块固定在扩大的动脉和脑干之间，然后应用纤维蛋白胶。1例采用圆柱形硅胶假体。在另一个病例中，通过缝合将筋膜环固定在石质金字塔的硬脑膜上，将TVBA收回。施用MVD后，TN和HFS症状完全消退。有几例短暂性并发症，2例永久性听力丧失。无临床症状复发。结论：MVD是治疗TVBA所致TN和HFS最有效的手术方法。TVBA应从脑干中收回，而不应在神经根进出区放置假体。
BACKGROUND: The tortuous vertebrobasilar artery (TVBA) often causes neurovascular conflicts in patients with trigeminal neuralgia (TN) and hemifacial spasm (HFS). Implementation of microvascular decompression (MVD) in these circumstances is hindered due to stiffness of the enlarged and dilated arteries and is often accompanied by poor outcomes. The surgical strategy in cases of trigeminal neuralgia and hemifacial spasm associated with the TVBA should be clarified in order to achieve good outcomes.MATERIAL AND METHODS: MVD was performed in 268 TN patients and 71 HFS patients. The TVBA as a compressing vessel was identified in 30 cases (11 cases of TN, 18 cases of HFS, and 1 patient with painful tic convulsif). All patients underwent MVD and a retrospective analysis of clinical outcomes.RESULTS: Compression caused by the vertebral artery was found in all HFS patients and 4 TN patients, and compression caused by the basilar artery was observed in 7 TN cases. Additional compression of the cranial nerve root entry/exit zone by cerebellar vessels was observed in 21 cases. The TVBA was mobilized by dissection of arachnoid adhesions between the vessel and the brainstem and retracted laterally. Then, the TVBA was retracted from the brainstem to the caudorostral direction. These manipulations resulted is "spontaneous" decompression of the cranial nerves without placing prostheses between the artery and the nerve root entry/exit zone. In all cases (except two), the displaced TVBA was fixed between the enlarged artery and brainstem using pieces of the patient's muscle and adipose tissues, followed by application of fibrin glue. A cylindrical silicone prosthesis was used in 1 case. In another case, the TVBA was retracted using a fascial loop fixed to the dura mater of the petrous pyramid by means of a suture. After application of MVD, TN and HFS symptoms completely regressed. There were several transient complications and 2 cases of permanent hearing loss. No clinical symptom recurrence was observed.CONCLUSION: MVD is the most effective surgical treatment of TN and HFS caused by the TVBA. The TVBA should be retracted from the brainstem without placing prostheses in the nerve root entry/exit zone.