顔面けいれんHemifacial Spasm

片側顔面痙攣の治療は、ボトックス局所注射、根治手術の2通りがあります。
通常は細い動脈が顔面神経に接触することが原因ですが、まれに太い血管、脳腫瘍が接触している場合があります。
正確な治療を行うために3D診断を事前に行います。
Treatment choice consists of two methods. For patients against surgery, Botox injection will be the first choice. However, the effect diminishes within 3 months and requires repeat injections. On the other hand, microvascular decompression can lead to complete cure. 3D imaging of the nerve and vessels is very helpful to understand the specific patient conditions which contributes to safer and effective surgery.

ボトックス局所注射
Botox Injection

痙攣の激しい部位にごく少量の薬液を皮下注射します。約3ヶ月間の効果が期待できますが、症状は必ず再発します。不快な顔面痙攣の症状を一時的に抑えるのには有効です。2~3回続けてもよくならない場合は根治術を検討するのが一般的です。
Injection with a tiny needle can reduce the pain during the procedure. The amount of Botox injected is determined by the severity of facial spasm in each patient. The effect continues for about 3 months. Too many repeated injections are not recommended as mixed spasm and palsy status may make MVD result complicated.

根治手術(微小血管減圧術)
Microvascular Decompression for Hemifacial Spasm

三叉神経痛で確立した3D診断を顔面痙攣にも応用し、鍵穴手術で手術を行います。典型的な場合は小切開、数時間での手術が可能です。従来から行われていたスポンジを神経と血管の間にはさむ方法ではなく、血管を完全に神経から離すことにより、治癒率を上げて、再発率を下げることが可能です。
MR and CT imaging with 3D reconstruction are used to diagnose the cause of hemifacial spasm, which is usually an artery compressing the facial nerve, but may be due to other causes of compression.
Microvascular decompression for hemifacial spasm is performed through a key hole with small skin incision. Transposition techniques (sling or bridge technique) is used instead of the interposition technique to avoid failure and recurrence.

case01.Typical Hemifacial Spasm

This beautiful lady came from Hawaii, USA.
She suffered from hemifacial spasm on the right side for 9 years and was forced to quit her career as a school teacher due to HFS.
The 3D imaging revealed the anterior inferior cerebellar artery compressing the root entry zone of the facial nerve. This 3D imaging contributed to her successful MVD.


case02.Typical Hemifacial Spasm

This patient came from Hong Kong. The responsible artery was not identified in other hospitals. MRI taken at Koto Memorial Hospital identified the culprit vessel with 3D imaging. The artery was transposed using bridge technique through a keyhole craniotomy. Her HFS completely subsided immediately after MVD. (This presentation is varid for the end of 2021)


case03.Re-do Surgery

He is a physician in Nevada, USA, and suffered from hemifacial spasm on the left side for 5 years.
His first MVD was performed in Pittsburgh, Pennsylvania, which failed to improve the HFS. His HFS worsened after the first surgery.
3D imaging created at Koto Memorial Hospital disclosed a massive Teflon (green object in 3D video) inserted between the facial nerve and the responsible artery. The surgery was performed to remove the excess Teflon (white material in OP video) to obtain sufficient decompression of the nerve. His HFS disappeared immediately after the surgery.

Pre - operative 3D imaging

The Teflon felt was removed


case04.Hemifacial Spasm: Vertebrobasilar Artery

67 F
Hemifacial spasm on the left side for the last 12 years.
Surgery at other hospitals failed to relieve her facial spasm.
We precisely evaluated using 3D imaging and performed microvascular decompression, resulting in successful relief of her symptom.
These large vessels require meticulous decompression technique.


case05.Ocular Neuromyotonia

62 F
Paroxysmal diplopia when stressed or speaking with others, lasting ~10-20 sec. Neurological finding revealed paroxysmal downward deviation of the left eye when the spell occurs. 3D imaging showed the left oculomotor nerve pinched by two different arteries. Microvascular decompression transposed these arteries, leading to resolution of her symptom.


井上卓郎 外来/診察予約Contact Us

tel.0749-45-3177

subaru@gammaknife-c.jp

外来診察Outpatient Clinics

※以下は予約不要です。※Reservation is not required.

湖東記念病院
Koto Memorial HospitalWebSite
金曜日
Friday
午前
a.m.
東近江総合医療センター
Higashiomi General Medical Care CenterWebSite
火曜日
Tuesday
午前
a.m.
学研都市病院
Gakkentoshi HospitalWebSite
第3土曜日
Third Saturday
午前
a.m.

手術を行う病院Surgical Services

湖東記念病院
Koto Memorial HospitalWebSite
日本、滋賀
Shiga, Japan
京都岡本記念病院
Kyoto Okamoto Memorial HospitalWebSite
日本、京都
Kyoto, Japan
蘇生会総合病院
Soseikai General HospitalWebSite
日本、京都
Kyoto, Japan
Andalusia HospitalWebSite Alexandria, Egypt
National Brain Center HospitalWebSite Jakarta, Indonesia
ページトップへ