摘要
目的微血管减压术是治疗面肌痉挛的有效方法。手术成功的关键是基于对面神经出脑桥区域即桥延沟解剖的精确掌握。我们研究侨延沟在该手术中的重要性。方法对来自于15个大脑标本的30个桥小脑角部分显微镜下观察,结合400例手术中所见,综合探讨桥延沟的重要性。结果将面神经根出桥脑区域分作两部分,一部分称为周围部,另一部分称为脑干部。而后者我们又提出分为两部分,分别为基底部和斜坡部。临床上对周围部的减压术相对容易,而脑干部分因被舌咽神经和迷走神经所掩盖,故术中常被遗漏。大部分责任血管恰恰隐藏于此。有时椎动脉亦走行在此区域。为了避免遗漏面神经脑干部分,应该在术中常规探查桥延沟,而且术中须充分切开舌咽、迷走神经根部的蛛网膜。结论由尸检标本和术中所知,桥延沟的解剖是面神经微血管减压术中的重点,在治疗一侧面肌痉挛中作用重大。
Objective Microvascular decompression is an effective therapy for hemifacial spasm. A complete performance of this surgery is based on the precise comprehension of the anatomic conformations of pontomedullary sulcus around the facial nerves. In this study we report the importance of the pontomedullary sulcus in this surgery. Methods 30 cerebellopontine angle from 15 autopsied brains were inspected under the operative microscope. The operations on 400 cases were investigated to explore the importance of the pontomeduuary sulcus. Results The pontomedullary sulcus was divided into two parts： peripheral part and brain stem. Then the brain stem was subdivided into two parts： basilar part and sloping part. Clinically, it is relatively easier to decompress the peripheral part but brain stem is hidden behind the glossopharyngeal and vagus nerve so that it is easy to be overlooked. Most relevant vessels are located and hidden in this area. To avoid the neglection of the brain stem, we should inspect the pontomedullary sulcus routinely and should cut the arachnoid membrane fully around the roots of the glossopharyngeal and vagus nerves. Conclusion From the findings of the autopsied brain and the surgery, we conclude pontomedullary sulcus is key in microvascullar decompression and thus important in the treatment for hemifacial spasm.
出处
《中华神经医学杂志》
CAS
CSCD
2006年第9期931-933,共3页
Chinese Journal of Neuromedicine
关键词
面肌痉挛
微血管减压
桥延沟
Hemifacial spasm
Microvascullar decompression
Pontomedullary sulcus
