选择性舌咽、迷走神经根丝切断术治疗舌咽神经痛  

Microneurosurgical rhizotomy of glossopharyngeal root and vagus rootlets for the treatment of idiopathic glossopharyngeal neuralgia

作　　者：张黎[1] 于炎冰[1] 徐晓利[1] 马延山[2] 

机构地区：[1]卫生部中日友好医院神经外科,北京100029 [2]北京市丰台医院神经外科,北京100071

出　　处：《中华神经外科疾病研究杂志》2006年第2期159-162,共4页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的 探讨选择性舌咽神经根、迷走神经根丝切断术治疗原发性舌咽神经痛的解剖基础、临床术式选择及疗效。方法 1986年5月至2005年7月对50例舌咽神经痛患者进行了显微神经外科手术治疗，均采用枕下乙状窦后锁孔入路，其中显微血管减压术17例，舌咽神经根、迷走神经根上部1-2根丝切断术16例，显微血管减压术同时加行舌咽神经根、迷走神经根上部1～2根丝切断术17例；2004年3月至2005年3月在113例面肌痉挛和5例舌咽神经痛病例显微手术中探查观察舌咽神经根与迷走神经根丝的解剖关系类型。结果 33例行选择性舌咽神经根、迷走神经根丝切断术的患者100％术后即刻疼痛全部消失，其中3l例获平均6．3年的随访，随访期间治愈率为100％。疼痛无1例复发。并发症包括：5例出现吞咽困难、饮水呛咳、声嘶，3例有阵发性干咳，耳鸣1例。化脓性脑膜炎1例，无菌性脑膜炎1例。118例显微手术中探查观察发现舌咽神经根与迷走神经根丝的解剖关系有5种类型。结论 选择性舌咽神经根、迷走神经根丝切断术治疗舌咽神经痛是有效、安全的；可以根据术中探查舌咽神经根与迷走神经根丝的解剖关系类型来进行术式选择。Objective To study the anatomical basis, clinical operative choices and curative rate of microneurosurgical rhizotomy of glossopharyngeal root and vagus rootlets for treatment of idiopathic glnssopharyngeal neuralgia. Methods A total of 50 idiopathic glossopharyngeal neuralgia patients were treated by microneurosurgical methods from May 1986 to July 2005 The microneurosurgical methods included： miemvascular decompression （MVD） （ 17 cases）, rhizotomy （R） of glossopharyngeal nerve root and upper 1 - 2 rootlets of vagal nerve root （ 16 cases）, and MVD ＋ R （17 cases）. From March 2004 to March 2005, the anatomical relationship between glnssopharyngeal nerve root and rootlets of vagal nerve was studied during exploration in microneurosurgical operations for 113 cases of hemifacial spasm and 5 cases of glossopharyngeal neuralgia. Results The disappearance of pain was found in 100% patients （33 cases） right after the operation. Thirty-ane patients were followed-up for 6. 3 years in average. The follow-up curative rate was 100%. There was no recurrence of pain during the follow-up period. The postoperative complications included： dysphagia, bucking and coughing episodes （5 cases）, coughing episodes （3 cases）, tinnitus （1 case ）, suppurative meningitis （1 case ）, aseptic meningitis （1 case ）. Five different types of anatomical relationship between glnssopharyngeal nerve root and rootlets of vagal nerve were found during exploration in microneurosurgical operations. Conclusion Rhizotomy is an effective and safe microneurosurgical method for the treatment of idiopathic glnssopharyngeal neuralgia. The clinical operative choices should be made according to the anatomical relationship types between glnssopharyngeal nerve root and rootlets of vagal nerve.

关 键 词：舌咽神经痛 显微神经外科手术 

分 类 号：R745.11[医药卫生—神经病学与精神病学]