椎动脉解剖学分型及其在微血管减压术治疗面肌痉挛中的应用

Anatomical classification of vertebral artery and its application in microvascular decompression in the treatment of hemifacial spasm

目的:研究椎动脉解剖学分型与面肌痉挛责任血管的解剖关系,为微血管减压术治疗面肌痉挛提供参考。方法:将椎动脉分为3型,Ⅰ型为居中型,Ⅱ型为单偏侧型,Ⅲ型为双偏侧型。通过成人头颅标本、面肌痉挛患者影像和临床资料对椎动脉解剖学分型以及与面肌痉挛责任血管压迫区域关系进行观测。结果:15例标本中椎动脉解剖分型Ⅰ型6.67%,Ⅱ型80.00%,Ⅲ型13.33%。80例患者中Ⅰ型6.25%,Ⅱ型73.75%,Ⅲ型20.00%;椎动脉偏移侧与患侧一致为80.00%,椎动脉偏移侧与患侧相反为13.75%,组间差异有统计学意义。椎动脉偏移造成面神经受压区域主要集中于面神经实际出脑干点与面神经贴附段。结论:椎动脉解剖分型以Ⅱ型居多,椎动脉偏移侧与面肌痉挛发病侧有显著相关,微血管减压术前应对椎动脉解剖学分型充分评估。

Objective:To study the anatomical relationship between vertebral artery anatomical classification and facial nerve,and to provide reference for microvascular decompression in the treatment of hemifacial spasm.Methods:The vertebral artery was divided into three types:TypeⅠ:medium,TypeⅡ:single lateral,TypeⅢ:double lateral.The relationship between anatomical classification of vertebral artery and responsible vessel area of hemifacial spasm was observed by imaging and clinical data of adult cranial specimens and patients with hemifacial spasm.Results:Among the 15 specimens,6.67%was typeⅠ,80.00%was typeⅡ,and 13.33 were typeⅢ.Among the 80 patients,there were 6.25%typeⅠ,73.75%typeⅡ,and 20.00%typeⅢ.The 80.00%of patients with vertebral artery deviation were consistent with the affected side,and 13.75%of patients with vertebral artery deviation were opposite to the affected side.The difference between groups was statistically significant.The area of facial nerve compression caused by vertebral artery deviation was mainly concentrated in the root exit point(RExP)and attached segment(AS)of facial nerve.Conclusions:The anatomical classification of vertebral artery was mainly typeⅡ,and vertebral artery deviation was significantly correlated with the affected side of hemifacial spasm.Therefore,the anatomical classification of vertebral artery should be fully evaluated before microvascular decompression.