神经内镜下微血管减压术治疗三叉神经痛  

Treatment of trigeminal neuralgia by endoscopic microvascular decompression surgery

作　　者：赵可[1] 徐兆水[1] 唐乔[1] 张卫平[1] 唐林卡[1] 陈玲[1] 高雁 龚剑卿[1] 

机构地区：[1]解放军第一八一医院耳鼻咽喉头颈外科,广西桂林541002 [2]北京空军司令部门诊部,北京100843

出　　处：《中国耳鼻咽喉头颈外科》2012年第10期555-557,共3页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的总结3年多来在神经内镜下微血管减压术治疗三叉神经痛(trigeminal neuralgia,TN)58例的经验体会。方法经乙状窦后进路在神经内镜下进入桥小脑角区,检查三叉神经根及周围区域有无异常血管或其他病灶压迫情况,对责任血管进行分移减压或神经感觉支部分切断、垫片、分解粘连、切除肿瘤等治疗。结果 58例TN者术中发现三叉神经根有责任血管压迫者55例(94.83%),部分为多动脉或动静脉双重压迫;在血管压迫的同时伴有蛛网膜粘连者19例,3例为单纯的重度蛛网膜粘连。术后均痊愈出院,随访1～4年(平均2.6年)56例,其中2例术侧耳鸣伴听力下降,6例面部浅感觉减退。无疼痛复发者。结论神经内镜的全景化,高分辨率视野有助于准确判定三叉神经的责任血管,可检查手术显微镜难以窥见的盲区。准确判断分移减压是否彻底,垫片位置是否合适,有助于提高疗效,减少并发症。OBJECTIVE To summarize the experiences of 58 cases of trigeminal neuralgia（TN） cured by endoscopic microvascular decompression surgery（MVD）in 3 years.METHODS The cerebellopontine angle was entered by neuroendoscope via retrosigmoid approach.Check the trigeminal nerve root and the surrounding area to find out abnormal vessels or oppressed position.The responsible vascular was moved aside and sensory nerves were partly cut off,separated by gasket.Adhesions were broke down and tumor removed if necessary.RESULTS The trigeminal nerve roots were oppressed by responsible vascular in 55 cases of TN（94.83%）,some of which were several arteries or both artery and vein;3 cases with serious adhesions;19 cases were both oppressed and adhered.All cases were cured after surgery.56 cases were followed up with 1-4 years（mean 2.6 years）and no recurrence was found.2 cases got tinnitus and hearing loss,6 cases got decreased facial sensation.CONCLUSION Endoscopic panorama and high-resolution vision helps accurately determine the responsible vessel for the trigeminal nerve,get a glimpse of the blind area of operating microscope.Accurate determination of complete decompression and suitable gasket help improve efficacy and reduce complications.

关 键 词：神经内窥镜检查 显微外科手术 三叉神经痛 

分 类 号：R651.3[医药卫生—外科学]