脳神経減圧術におけるtranspositionの優位性—文献的考察を含めて

Microvascular Decompression:The Superiority of Transposition

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・Interposition手術は，時間とともにprosthesisの硬化や線維化が進むことや，慢性炎症などの長期的な合併症を引き起こすリスクが指摘されている．

・Transposition手術は，interposition手術の限界を克服し，三叉神経痛と顔面痙攣の効果的な治療法として認識されている．

・一部の複雑なケース（例：太い血管，short perforatorの存在など）ではinterpositionが選択され，効果と安全性が検証されている．

＊本論文中、［Video］マークのある図につきましては、関連する動画を見ることができます（公開期間：2027年2月まで）。

　In this feature article, we underscore the advantages of Transposition over Interposition in the management of trigeminal neuralgia and hemifacial spasm. Interposition, while effective, has raised concerns owing to long-term complications associated with the use of artificial materials, such as Teflon and silicone sponges. Transposition, on the other hand, mitigates these issues, showcasing adaptability to a range of anatomical and pathological conditions and affirming its standing as a safer and more effective treatment alternative.

　Each technique has distinct applications that are governed by the patient's specific anatomical and pathological needs. While Transposition is emerging as a favored option, Interposition remains relevant in specific cases, underscoring the necessity for a personalized approach to neurovascular decompression.

　In offering a comprehensive overview, this article is not just an academic exercise, but also a practical resource. A nuanced exploration of these surgical interventions is meant to provide readers with actionable insights, blending the current findings with real-world applicability. The goal is to foster a deeper understanding and aid practitioners in making informed decisions that are finely attuned to each patient's unique needs and conditions, ensuring optimal outcomes, while prioritizing safety and effectiveness.