椎骨動脈の転位が有用であった舌咽神経痛と顔面痙攣との併発例

A Case of Coexistent Glossopharyngeal Neuralgia and Hemifacial Spasm Successfully Treated with Transposition of the Vertebral Artery

Ⅰ．はじめに

　舌咽神経痛は比較的稀な疾患であり，三叉神経痛との合併例はいくつか報告されているが^9,11,22)，顔面痙攣との併発例は極めて稀である．今回われわれは症状や画像所見，またリドカインテストの結果から椎骨動脈（vertebral artery：VA）を責任血管とする舌咽神経痛と診断し，VAのtranspositionによる微小血管減圧術（microvascular decompression：MVD）を施行後，速やかに症状の消失が得られた1手術例を経験したため，文献的考察を加えて報告する．

　A case of coexistent glossopharyngeal neuralgia and hemifacial spasm was treated by transposition of the vertebral artery. A 60-year-old man was referred to our hospital due to pain in the left posterior part of the tongue that was difficult to control with oral medication at a local hospital. The diagnosis was left glossopharyngeal neuralgia based on the symptoms, imaging findings, and lidocaine test results. Moreover, the patient had left hemifacial spasm. Microvascular decompression was performed, which confirmed that the vertebral artery was compressing the lower cranial nerve and the posterior inferior cerebellar artery was compressing the root exit zone of the facial nerve. The vertebral artery and posterior inferior cerebellar artery were transposed using TachoSil^®. After the surgery, both glossopharyngeal neuralgia and hemifacial spasm disappeared, and the patient was discharged.