特发性半面痉挛的影像学研究

Medicalimagingresearchonidiopathichemifacialspasm

为解决特发性半面痉挛的术前影像学检查方法，将椎动脉数字减影（ＤＳＡ）、桥小脑角池充气与椎动脉插管造影ＣＴ同层动态扫描结合起来，自１９８９年起对３６例患者进行检查，全部病例都能清楚地显示面神经自脑干至内听道受动脉血管压迫的情况。责任血管系小脑下后动脉（５５．６％），小脑下前动脉（４４．４％），内听动脉（２５．０％），椎动脉（１１．１％）。３６．１％病例有二条以上责任血管。其对面神经的压迫为１点占２２．２％，２点占３８．９％，３点占２５．０％，伴行压迫占１３．９％。８５．７％的压迫点在面神经出根区，１４．３％在内听道口附近。２４例行显微血管减压术，术中所见与影像学研究结果相符。术后面肌痉挛消失２３例，显著进步１例，无１例死亡。本文报告的影像学检查方法能清晰地显示桥小脑角区的动脉分布及对面神经的压迫情况，对特发性半面痉挛的显微血管减压术及桥小脑角区其他手术有明确的指导意义。

Inordertohaveamedicalimagingexaminationforidiopathichemifacialspasmbeforesurgery,wedesignedanewmethodbyusingvertebroarterialDSAandvertebroarterialCTAbasedonanairedcisternapontis.36patientswereexaminedsince1989andthecompressionofthefacialnervefrombrainstemtoporusacousticusinternuswasshowedclearlyinalthecases.Thearteriesresponsibleforthecompressionwerecerebelarinferiorposterior(55.6%),cerebelarinferioranterior(44.4%),auditoryinternus(25.0%)andvertebroarterial(11.1%).36%ofalthecaseshadmorethanoneresponsiblearteries.22.2%caseshadonlyonecompressionpoint,38.9%hadtwopoints,25.0%had3and13.9%hadmore.85.7%ofthecompressionpointslocatedintherootzoneand14.3%neartheporusacousticusinternus.24casesweretreatedwithdecompressionsurgery,itin-dicatedthatthecompressionconditionsjustmetthemedicalimagingexaminationgresults.Aftersurgerythesymptomdisappearedin23casesandremarkablyreleasedinonecasewithnodeathcase.WebelievedthatthismethodmightbehelpfultoidiopathichemifacialspasmdecompressionsurgeryandothersurgeriesintheCPangle.