Neurological Surgery 脳神経外科36巻4号

2008年04月発行

総説

神経血管圧迫症候群―特に神経血管減圧術の現況

著者： 松島俊夫¹ 峯田寿裕¹

所属機関： ¹佐賀大学医学部脳神経外科

ページ範囲：P.303 - P.313

Ⅰ．はじめに

　三叉神経痛や片側顔面痙攣に対する後頭蓋窩神経血管減圧術（microvascular decompression procedure：MVD）は，1970年代のJannettaらの報告に始まり^21-23)，本邦でも近藤ら^28,29)，福島¹³⁾や福井ら^11,12)により普及された．その後改良も加えられ，現在では世界中に広く普及した比較的安全な手術法であり，良好な手術成績が報告されている．これらの疾患の多数例の病因が血管による脳神経への圧迫であることを経験的に証明したJannettaは，脳神経の拍動性血管圧迫により発病する疾患を神経血管圧迫症候群として提唱した²²⁾．三叉神経痛と片側顔面痙攣が有名であるが，他に，突発性めまい・耳鳴発作，舌咽神経痛，本態性高血圧症も，第8脳神経，第9脳神経，延髄を血管が圧迫し同様のメカニズムで生じると述べている．加齢とともに硬化を来し屈曲した血管が脳幹部近くで脳神経を圧迫すると，異常な神経回路ができ発病するという考えである．しかし現在では，三叉神経痛の原因としてくも膜炎などによる三叉神経の神経軸の歪みが起因する場合も多々あることがわかってきた．本稿では，これらの疾患群とその治療法，特に外科治療法，神経血管減圧術の各疾患ごとの現況について，われわれの考えと手術法を交え解説する．

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