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Brain and Nerve No to Shinkei Volume 42, Issue 2 （February 1990）

Brain and Nerve 脳と神経 42巻2号（1990年2月発行）

Japanese English

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原著

手術合併症としての顔面神経，前庭神経麻痺その発生機序に関する実験的検討 POSTOPERATIVE FACIAL AND VESTIBULAR NERVE PALSY : EXPERIMENTAL STUDY OF ITS PATHOPHYSIOLOGICAL MECHANISMS 関谷徹治 ¹ , 岡部慎一 ¹ , 畑山徹 ¹ , 岩淵隆 ¹ , 滝口雅博 ² Tetsuji Sekiya ¹ , Shinichi Okabe ¹ , Toru Hatayama ¹ , Takashi Iwabuchi ¹ , Masahiro Takiguchi ² ¹弘前大学医学部脳神経外科 ²弘前大学救急部 ¹Department of Neurological Surgery, Hirosaki University School of Medicine ²Department of Critical Care Medicine, Hirosaki University School of Medicine キーワード： cerebellopontine angle , facial nerve , vestibular nerve , avulsion injury , nerve injury Keyword: cerebellopontine angle , facial nerve , vestibular nerve , avulsion injury , nerve injury pp.113-119

発行日 1990年2月1日 Published Date 1990/2/1

DOI https://doi.org/10.11477/mf.1406900012

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Abstract 文献概要
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　臨床的に経験される小脳橋角部手術後の顔面神経，前庭神経麻痺の発生機序を検討するために動物実験を行った。聴性脳幹反応のモニタリングのもとで，ヒトの手術同様の小脳圧排をイヌの小脳橋角部で行い術後の変化を組織学的に検討した。その結果，前庭神経損傷は神経幹が尾側から頭側に偏位移動する時に引き起こされやすく，しばしば顔面神経の損傷も伴なうことが分かった。前庭神経の損傷は内耳道底における引き抜き損傷（avulsion injury）の形で起こっていた。顔面神経は直接の術野から離れた顔面神経管内のpreganglionic portionで損傷されることがはじめて明らかとなった。これらの神経幹の偏位の方向と神経損傷の起こり方の相関関係は内耳道底および側頭骨内における各神経の解剖学的位置関係の特殊性から説明できる。

The 7th and 8th cranial nerves were shifted in the cerebellopontine (CP) angle of dogs by cerebel-lar retractions that were similar to those perform-ed in humans with monitoring of auditory evoked brainstem responses (ABR). Postoperatively, the vestibular, facial nerves, and brainstem were his-tologically examined.

Cuadal-to-rostral shifts of the nerves could in-duce vestibular and/or facial nerve damages. The most vulnerable portion of the vestibular nerve was located between the vestibular ganglions andthe area vestibularis-the most lateral end of the internal auditory canal. This indicated that due to traction force derived from surgical interven-tions, the nerves and vessels were avulsed at the fundus of the internal auditory canal. The vesti-bular nerve may be potentially injured more easily and frequently than the cochlear and facial nerves in retromastoid craniectomies with lateral decu-bitus position in humans.

Direct injuries of the facial nerves in the CP angles were not observed in this study. It was elucidated that the facial nerve was usually in-jured in the facial canal proximal to the geniculate ganglion due to traction force derived from mani-pulations in the CP angle. It is likely that as facial nerve edema progresses postoperatively, the facial nerve is gradually compressed within the narrow labyrinthine portion of the facial canal. This may be the cause of delayed postoperative facial nerve palsy.

The importance to recognize how not only coch-lear but also vestibular and facial nerve are in-jured by the usual manipulations in the CP angle is stressed.