Abstract: Objective To investigate the significance of the classification of vertebral artery in vertebral artery related hemifacial spasm,explore the strategies of microvascular decompression,improve the therapeutic effects and reduce the complications.Methods A retrospective study was performed to analyze the clinical data of 109 cases with microvascular decompression for vertebral artery related hemifacial spasm in our hospital.In these cases,the vertebral arteries were classified into four types by its movable space.Based on the surgical practice,the influence of the classification of vertebral artery on decompression process was evaluated and the security and difficulty of operation was analyzed.The surgical strategies were summed up according to the different four types of vertebral arteries.Results The microvascular decompression surgery for hemifacial spasm with vertebral artery was a safe and effective method.In 60.55% of cases,the vertebral artery can be moved ventrally at the level of posterior cranial nerves;In 23.85% of cases,the vertebral artery can only be moved at the facial nerve level;In 0.92% of cases,there was no movable space at the level of posterior cranial nerves and the facial nerve,which made the operation difficult;In 14.68% of the cases,the bilateral vertery arteries were highly deviated to one side,which made the offending vessels complex and difficult to recognize,so the relative position of the bilateral vertebral arteries should be changed firstly,in order to win the decompression space.Conclusion The classification of the vertebral arteries is significant in microvascular decompression for vertebral artery related hemifacial spasm,which can improve the operative outcome and reduce the incidence of postoperative complications.

Key words: Hemifacial spasm, Vertery artery, Microvascular decompression

摘要： 目的 探讨椎动脉相关面肌痉挛显微血管减压术的治疗策略,提出椎动脉的外科手术分型,探讨椎动脉分型在椎动脉相关面肌痉挛术中的意义,提高手术疗效,降低并发症。方法 回顾性分析我院109例椎动脉相关面肌痉挛的临床资料,根据椎动脉有无可移位空间,将椎动脉分为4型,分析其对手术难度的影响。并根据4型不同情况,制定不同的手术策略,探讨其在显微血管减压术中的意义。结果 显微血管减压术治疗椎动脉相关面肌痉挛是安全有效的方法。60.55%的情况下,椎动脉可在后组颅神经水平向腹侧移位;23.85%的情况下,椎动脉在后组颅神经水平无向腹侧移位空间,仅可在面神经水平向腹侧移位椎动脉;而0.92%的情况下,椎动脉无论在后组颅神经水平,还是在面神经水平均无向腹侧移动的空间,手术难度较大;14.68%的情况下,双侧椎动脉高度偏曲至一侧,术区血管复杂,术中需要改变双椎动脉相对位置关系,才能赢得减压空间。结论 椎动脉分型在椎动脉相关面肌痉挛显微血管减压术中有非常重要的意义,可提高手术疗效,减少并发症的发生。

关键词: 面肌痉挛, 椎动脉, 显微血管减压术