王焱华++曲凯++常庆勇

DOI：10.16662/j.cnki.1674-0742.2017.09.083

[摘要] 目的 研究面神經根部的显微解剖，为微血管减压术治疗面肌痉挛提供相关资料，结合临床，以提高手术效果。方法 将10例20侧尸头（男性5例，女性5例）模拟枕下乙状窦后入路手术方法进行显微解剖，分别对桥小脑角区面神经根上部及前下部毗邻关系进行观察、测量；收集自2008年7月—2012年8月在大连大学附属中山医院行微血管减压术治疗的面肌痉挛患者208例的病例资料进行回顾性分析，依据就诊时间及手术方式不同，分为A组和B组，分别观察手术效果及术后并发症。 结果 尸头解剖：面神经根部受临近血管压迫或接触时全部位于面神经根前下部，其中小脑前下动脉占71.43%（5/7），小脑后下动脉占14.29%（1/7），椎动脉占14.29%（1/7）。临床资料：A组治愈率为92.77%（77/83），有效率为96.39%（80/83），B组治愈率为91.20%（114/125），有效率为96.00%（120/125）。主要并发症发生率，A组听力减退发生率为7.23%（6/83），术侧听力完全丧失（经营养神经及高压氧等治疗术后半年未恢复）发生率为1.20%（1/83），迟发性面瘫发生率为8.43%（7/83），B组听力减退发生率为0.80%（1/125），术侧听力完全丧失发生率为0.00%（0/125），迟发性面瘫发生率为1.60%（2/125）。结论 微血管减压术为治疗面肌痉挛的有效方法。熟练掌握桥小脑角区面神经根部的显微解剖，对微血管减压术治疗面肌痉挛有重要意义

[关键词] 微血管减压术；面肌痉挛；桥小脑角区；面神经根；显微解剖学

[中图分类号] R74 [文献标识码] A [文章编号] 1674-0742（2017）03（c）-0083-03

Research on Microanatomy and Clinical Treatment of Facial Spasm

WANG Yan-hua1， QU Kai2， CHANG Qing-yong2

1.Department of Brain and Chest Surgery， Shayang Peoples Hospital， Jingmen， Hubei Province， 448200 China；2.Department of Neurology， Affiliated Zhongshan Hospital of Dalian University， Dalian， Liaoning Province， 116001 China

[Abstract] Objective To research the microanatomy of Facial nerve root and provide related data of microvascular decompression surgery treatment for facial spasm in order to improve the operation effect. Methods 20 cadaveric heads in 10 cases （5 female cases and 5 male cases） were given the microanatomy by stimulating the suboccipital retrosigmoid approach， and the upper and front lower part of facial nerve root of cerebellopontine angle area were respectively observed and measured， and the data of 208 cases of patients with facial spasm treated with microvascular decompression from July 2008 to August 2012 were retrospectively analyzed and the patients from Affrliateol Zhongshan Hospital of Dalian University were divided into the group A and group B according to the diagnosis time and operation method， and the operative effect and postoperative complications were respectively observed. Results All facial nerve roots were in the front lower part due to neurovascular contact or compression， anterior inferior cerebellar artery accounted for 71.43%（5/7）， posterior inferior cerebellar artery accounted for 14.29%（1/7）and vertebral artery accounted for 14.29%（1/7） ， and the cure rate and effective rate in the group A and in the group B were respectively 92.77%（77/83）， 96.39%（80/83）and 91.20%（114/125） 96.00%（120/125）， the incidence rates of dysacusis and hearing loss （ no recovery in half a year after trophic nerve and high pressure oxygen ） and delayed facial paralysis in the group A and group B were respectively 7.23%（6/83）， 1.20%（1/83）， 8.43%（7/83） and 0.80%（1/125）， 0.00%（0/125） and 1.60%（2/125）. Conclusion The microvascular decompression is an effective method of treating facial spasm， and having a good master of microanatomy of facial nerve root is of important significance to the treatment of facial spasm using microvascular decompression.

[Key words] Microvascular decompression； Facial spasm； Cerebellopontine angle area； Facial nerve root； Microanatomy

面肌痉挛（hemifacial spasm，HFS），一般指原發性面肌痉挛，是指面神经所支配的面部表情肌发作性、反复性、不自主的抽搐，以单侧多见。目前HFS的发病机制还存在争议，以血管压迫学说为主流学说。……