悬吊法在面肌痉挛显微血管减压术中的应用

The application of the hanging techniques in microvascular decompression of hemifacial spasm caused by the complex vasculature

目的 探讨复杂血管压迫类型所致面肌痉挛显微血管减压术中采取悬吊法进行充分减压的手术技巧及经验.方法 24例术中责任血管为椎动脉联合分支血管,血管粗大,弹性过大;非椎动脉的多支血管压迫,压迫点过多以及有短小穿支血管;动脉袢过长,压迫路径长的病例,单纯利用垫棉不能充分减压,改用垫棉束带围套责任血管后用生物胶将围套粘在硬膜上达到充分减压的目的.结果 术中发现18例椎动脉联合分支血管压迫（椎动脉合并小脑前下动脉1 1例;椎动脉合并小脑后下动脉3例;椎动脉合并小脑前下动脉、后下动脉4例）;4例非椎动脉多血管压迫（小脑前下动脉及后下动脉）;2例动脉袢过长,压迫路径长（小脑前下动脉及内听动脉）,采取悬吊法均彻底减压.随访2年,全部病例抽搐完全消失,未出现并发症.结论 复杂血管压迫类型难以充分减压的情况下,悬吊法可以实现充分减压,安全有效.

Objective To discuss the value of the hanging techniques in microvascular decompression （MVD） of hemifacial spasm （HFS） caused by the complex vasculature.Methods The conflict artery in 24 cases involve 3 types：the first was the large offending vessel with compression much more heavily such as the vertebral artery （VA） combined with the branch vessels;the second was multiple vessels with more compression points or with short and small perforating arteries;the third was an elongated loop of the conflict artery or more compression points between the loop and the nerve.Those complex vasculatures were difficult to be maneuvered in permanent and complete transposition.So a sling piece of Teflon sponge was used to wrap and hang the offending vessel and then the vessel was adhered to the petrous dura with fibrin glue.Results The large heavy compressed conflicting vessel was found in 18 cases：11 cases of VA associated with anterior inferior cerebellar artery （AICA）;3 cases with posterior inferior cerebellar artery（PICA）;4 cases with AICA and PICA.The multiple vessels were found in 4 cases：AICA associated with PICA.An elongated loop was found in 2 cases：AICA combined with the labyrinthine artery.Using the hanging technique,the permanent and complete transposition of the offending vessel was achieved.The mean follow-up period was 2 years.All patients experienced complete spasm resolution without complication.Conclusions In the treatment of HFS by MVD,insufficient decompression might occur with complex vasculature.The hanging technique was a safe and effective method which could provide complete and permanent transposition of the offending artery.