迷走神经根内副交感神经纤维的位置：病例报告和文献复习,Stereotactic and Functional Neurosurgery

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迷走神经根内副交感神经纤维的位置：病例报告和文献复习
Stereotactic and Functional Neurosurgery ( IF 1.9 ) Pub Date : 2022-12-29 , DOI: 10.1159/000528094
Aisha Alkubaisi _{1,

2} , Charles C J Dong ₁ , Christopher R Honey ₁

Affiliation

迷走神经具有运动、感觉和副交感神经成分。了解神经的内部解剖结构、其变化以及与舌咽神经的关系对于神经外科医生对下颅神经减压至关重要。我们提出了一个病例报告，展示了副交感神经纤维在迷走神经根内的位置。一名 47 岁的女性因药物难治性左侧舌咽神经痛 1 年病史和左侧半喉咽痉挛病史就诊。磁共振成像显示她的左小脑后下动脉扭曲了受影响左侧的下颅神经。患者同意对下颅神经进行微血管减压，并可能切断迷走神经的舌咽根和上感觉根。在手术过程中，对迷走神经最尾根的电刺激引发了严重的心动过缓。更多的延髓细根都没有类似的副交感神经反应。据我们所知，该病例首次证明了人类迷走神经根内心脏副交感神经纤维的位置。这种对迷走神经根分布的纯感觉（大部分是头侧）、运动/感觉（更多是尾侧）和副交感神经（大部分是尾侧）纤维的新认识可能会导致对迷走神经根病的更好理解和诊断。大约20%的舌咽神经痛患者也有阵发性咳嗽。这可能是由于第 IX 脑神经与具有纯感觉纤维（介导肺部痒感）的头侧迷走神经根的解剖学并置。一部分舌咽神经痛患者有神经痛诱发的晕厥。自从 Riley 于 1942 年首次描述这种罕见病症“迷走神经-舌咽神经痛”以来，其病因一直存在争议。我们的病例支持这样一种理论，即这种神经痛引起的心动过缓是通过脑干反射性介导的，具有第 IX 区的传入冲动和第 X 脑神经的传出冲动。舌咽神经痛与半喉咽痉挛的罕见同时发生（如本例所示）可能是由于第 IXth 神经与更多的迷走神经根接近，迷走神经根具有对喉咙的运动（可能还有感觉）供应。最后，如果存在与其副交感神经纤维受压相关的迷走神经根病，人们会认为它位于迷走神经的最尾根。
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The Location of the Parasympathetic Fibres within the Vagus Nerve Rootlets: A Case Report and a Review of the Literature

The vagus nerve has motor, sensory, and parasympathetic components. Understanding the nerve’s internal anatomy, its variations, and relationship to the glossopharyngeal nerve are crucial for neurosurgeons decompressing the lower cranial nerves. We present a case report demonstrating the location of the parasympathetic fibres within the vagus nerve rootlets. A 47-year-old woman presented with a 1-year history of medically refractory left-sided glossopharyngeal neuralgia and a more recent history of left-sided hemi-laryngopharyngeal spasm. magnetic resonance imaging showed her left posterior inferior cerebellar artery distorting the lower cranial nerves on the affected left side. The patient consented to microvascular decompression of the lower cranial nerves with possible sectioning of the glossopharyngeal and upper sensory rootlets of the vagus nerve. During surgery, electrical stimulation of the most caudal rootlet of the vagus nerve triggered profound bradycardia. None of the more rostral rootlets had a similar parasympathetic response. This case is the first demonstration, to our knowledge, of the location of the cardiac parasympathetic fibres within the human vagus nerve rootlets. This new understanding of the vagus nerve rootlets’ distribution of pure sensory (most rostral), motor/sensory (more caudal), and parasympathetic (most caudal) fibres may lead to a better understanding and diagnosis of the vagal rhizopathies. Approximately 20% of patients with glossopharyngeal neuralgia also have paroxysmal cough. This could be due to the anatomical juxtaposition of the IXth cranial nerve with the rostral vagal rootlets with pure sensory fibres (which mediate a tickling sensation in the lungs). A subgroup of patients with glossopharyngeal neuralgia have neuralgia-induced syncope. The cause of this rare condition, “vago-glossopharyngeal neuralgia,” has been debated since it was first described by Riley in 1942. Our case supports the theory that this neuralgia-induced bradycardia is reflexively mediated through the brainstem with afferent impulses in the IXth and efferent impulses in the Xth cranial nerve. The rarer co-occurrence of glossopharyngeal neuralgia with hemi-laryngopharyngeal spasm (as seen in this case) may be explained by the proximity of the IXth nerve with the more caudal vagus rootlets which have motor (and probably sensory) supply to the throat. Finally, if there is a vagal rhizopathy related to compression of its parasympathetic fibres, one would expect it to be at the most caudal rootlet of the vagus nerve.
Stereotact Funct Neurosurg

更新日期：2022-12-29

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