顔面けいれんのＤｏｘｏｒｕｂｉｃｉｎ選択的神経ブロック術

Abstract

Objective: To describe our experience with adriamycin (ADM) selective chemical rhizotomy of facial nerves in a patient with hemifacial spasm (HFS) who refused neuro-vascular decompression surgery. This unique technique was less invasive than intracranial neuro-surgery. It was possible to perform a permanent nerve block under local anesthesia.Case report: The patient, a 73-year-old female, had difficulty opening her left eye due to HFS. After treatment with antiepileptic medicine (carbamazepine) was ineffective, the patient received selective intraneural injections of ADM under local anesthesia. One week after the surgery, the spasms had disappeared completely and slight muscle weakness was observed. No major complications were caused by this procedure and no recurrence of spasms was observed two years after the surgery.Main outcome: It is thought that recurrence of HFS should be observed after simple neurotomy due to re-growth of nerve fibers. However, this did not occur after selective ADM chemical rhizotomy of facial nerves. This method clearly differs from previously used methods of simple neurotomy because simple neurotomy does not cause severe destructive change in the facial motor nucleus.Conclusion: We conclude that selective facial nerve chemical rhizotomy with ADM under local anesthesia may be effective in treating a subgroup of patients with HFS, especially elderly patients and those in high risk groups for general anesthesia and intra cranial neuro-vascular decompression surgery.