CAJ | 학술논문

目的研究桥小脑角区(CPA)面神经微血管束的显微解剖,总结面神经微血管减压术(MVD)手术资料.方法显微解剖成人尸头标本10例20侧(男性6例,女性4例),模拟枕下乙状窦后锁孔入路手术操作过程,对CPA区面神经及其毗邻神经血管等结构进行观察和测量；回顾性分析400例面神经MVD手术资料.研究面神经微血管束的组成与变异,并将解剖标本与手术资料进行对比分析.结果尸头解剖:面神经桥小脑池段与毗邻血管发生压迫或接触9侧( 9/20),其中:小脑前下动脉(AICA)5侧,小脑后下动脉(PICA)2侧,椎动脉1侧,多支血管1侧；手术资料:半侧面肌痉挛(HFS)的责任血管绝大多数位于桥脑延髓沟,其中AICA 265例(66.25％)；PICA 69例(17.25％)；椎-基底动脉11例(2.75％)；多支血管45例(11.25％).结论对桥小脑角区面神经微血管束,尤其是桥脑延髓沟段显微解剖结构的深入认识,是术中进行充分探查并明确责任血管,保证面神经MVD手术成功的关键.
목적 연구교소뇌각구(CPA)면신경미혈관속적현미해부,총결면신경미혈관감압술(MVD)수술자료.방법 현미해부성인시두표본10례20측(남성6례,녀성4례),모의침하을상두후쇄공입로수술조작과정,대CPA구면신경급기비린신경혈관등결구진행관찰화측량；회고성분석400례면신경MVD수술자료.연구면신경미혈관속적조성여변이,병장해부표본여수술자료진행대비분석.결과 시두해부:면신경교소뇌지단여비린혈관발생압박혹접촉9측( 9/20),기중:소뇌전하동맥(AICA)5측,소뇌후하동맥(PICA)2측,추동맥1측,다지혈관1측；수술자료:반측면기경련(HFS)적책임혈관절대다수위우교뇌연수구,기중AICA 265례(66.25％)；PICA 69례(17.25％)；추-기저동맥11례(2.75％)；다지혈관45례(11.25％).결론 대교소뇌각구면신경미혈관속,우기시교뇌연수구단현미해부결구적심입인식,시술중진행충분탐사병명학책임혈관,보증면신경MVD수술성공적관건.
Objective To study the microsurgical anatomy of facial neural microvascular bundle in Cerebellopontine angle (CPA) and to summarize surgery materials of facial nerve microvascular decompression (MVD).Methods Microdissection was performed in 10 adults cadaveric heads through the key hole restrosigmoid approach with totally 20 sides (6 male,4 female).CPA area segment of facial nerve and its adjacent structures were observed and analyzed.Four hundred cases of facial nerve MVD surgical data were retrospectively analyzed.The composition and variation of facial neural microvascular bundle were studied.Anatomical specimens and surgical materials were analyzed.Results Cadaveric heads anatomy:the number of facial nerve oppressed or touched by the blood vessel around were 9 sides(9/20) in the CPA area( AICA 5 sides,PICA 2 sides,VA 1 side,multivessel 1 side).Surgery materials:the culprit blood vessel of hemifacial spasm located medulla oblongata trench [ the anterior inferior cerebellar artery (265 cases,66.25％ ),posterior inferior cerebellar artery (69 cases,17.25％ ),vertebral-basal artery ( 11 cases,2.75％ ),multivessel (45 cases,11.25％ ) ]. It located mostly in pontomedullary sulcus.Conclusion Microsurgical anatomy of facial neural microvascular bundle in cerebellopontine angle,especially in pontomedullary sulcus segement is beneficial for the culprit blood vessel in operation and for achieving consistent success in facial nerve microvascular decompression.