面神经根解剖变异与原发性面肌痉挛

Anatomical variation of the facial nerve root in cerebellopontine angle and idiopathic hemifacial spasm

目的探讨桥小脑角面神经根解剖变异与原发性面肌痉挛的关系。方法回顾性分析2000年10月～2006年6月采用显微血管减压术(MVD)治疗的787例面肌痉挛病例的临床资料。其中5例(0.6%)术中探查时发现面神经根存在解剖变异,面神经根出脑干区距离听神经根进脑干区均大于10 mm。均成功行MVD治疗,其中2例采用责任动脉悬吊法。结果5例病人术后面肌痉挛均立即消失。分别随访2、7、14、50、63个月,均无复发。术后并发症:中度面瘫1例,随访期间恢复为轻度;展神经麻痹致复视2例,随访期间恢复正常1例,好转1例。结论桥小脑角面神经根出脑干区异位至距离听神经根进脑干区大于10mm者罕见,动脉性血管压迫仍然是此类病人原发性面肌痉挛的主要病因,采用MVD治疗可获良效。

Objective To study the relationship of anatomical variation of the facial nerve in the cerebellopontine angle to idiopathic hemifacial spasm. Methods Facial nerve anatomical variations were analyzed in 787 patients who underwent microvascular decompression （MVD） for hemifacial spasm （HFS） from October 2000 to June 2006. Anatomical variation of the facial nerve root was found in 5 patients. The distance between the root exit zone （RExZ） of the facial nerve and the root enter zone （REnZ） of the vestibulocochlear nerve was longer than 10 mm. All the 5 patients were successful in MVD, and 2 out of them also received offending artery suspension method. Results HFS disappeared immediately after MVD and no recurrence was seen during follow-up periods （2, 7, 14, 50, 63 months） in all the 5 patients. Postoperative complications included： transient moderate facial paralysis, which turned out to be mild during follow-up, in one patient, and transient abduction paralysis in 2, one of them recovered to normal and the other turned out to be mild during follow-up. Conclusion It is a really rare condition that the distance between the RExZ of the facial nerve and the REnZ of the vestibulocochlear nerve is more than 10 mm. Compression of the artery is still a main reason of HFS. Good efficacy could be expected after MVD.