腰大池引流在面肌痉挛显微血管减压术中的作用  

Clinical observation of lumbar cerebrospinal fluid drainage in microvascular decompression

作　　者：冯清林[1] 范仕兵[1] 赵锐[1] 吴瑶 李冀[1] 冉住国[1] 刘明冬[1] FENG Qinglin;FAN Shibing;ZHAO Rui;WU Yao;LI Ji;RAN Zhuguo;LIU Mingdong(Department of Neurosurgery,Three Gorges Central Hospital,Chongqing 404000,China)

机构地区：[1]重庆三峡中心医院神经外科,重庆404000

出　　处：《中国实用神经疾病杂志》2018年第14期1525-1529,共5页Chinese Journal of Practical Nervous Diseases

基　　金：重庆市卫生计生委医学科研项目面上项目(2016MSXM121)

摘　　要：目的探讨腰大池置管引流释放脑脊液在显微血管减压术(MVD)中缩短责任血管显露时间、预防小脑挫伤及岩静脉破裂出血的作用。方法回顾分析109例行显微血管减压术治疗的面肌痉挛病例资料。术中行腰大池置引流患者(实验组)56例,术中未行腰大池引流者(对照组)53例,比较2组责任血管显露时间,术中、术后小脑挫裂伤及岩静脉属支出血发生率。结果实验组责任血管显露时间<10min 48例(85.71%),对照组16例(30.18%);术中发生小脑挫裂伤对照组3例(5.66%),实验组1例(1.78%);术后复查头颅CT示小脑挫裂伤对照组2例(3.77%),实验组无术后小脑挫裂伤。对照组术中可见由于释放CSF牵拉造成岩静脉属支出血2例(3.77%),术后对侧幕上远隔部位硬膜下出血1例(1.88%);实验组术中、术后均未见出血,且未见明显腰大池置管相关并发症。结论术中腰大池引流可控制脑脊液释放量及释放时间,可避免术中释放脑脊液过程中由于操作不当引发的小脑挫裂伤,亦可避免由于过快、过多的脑脊液丢失导致的远隔部位出血,同时减少MVD手术相关并发症,缩短手术时间。Objective To explore the role of lumbar cerebrospinal fluid drainage in microvascular decompression （MVD）for shortening the exposure time of responsible vessels,the effect of preventing cerebellar contusion and the hemorrhage of petrosal vein. Methods We analyzed The clinical data of 109 patients of hemifacial spasm undergoing MVD retrospectively,56 specimens were classified into the experimental group in which a lumbar subarachnoid catheter was placed during surgery,53 specimens were classified into the control group in which the lumbar subarachnoid catheter was not placed,then we compared the time of exposing the responsible vessels and the incidence rates of cerebellar contusion and the hemorrhage of petrosal vein branches. Results The exposure time of responsible vessels less than 10 minutes occurred in 16 patients（30.18%）and 48 patients（85.71%）of the experimental group.Intraoperative cerebellar hemorrhage occurred in 3 patients （5.66%）of the control group and one patient （1.78%）of the experimental group.Postoperative head CT revealed that cerebellar contusion was seen in 2 patients （3.77%）in the control group and no one in the experimental group.Intraoperative petrosal vein hemorrhage due to CSF released was seen in 3 patients （3.77%）and 1 patient （1.88%）occurred the postoperative subdural hemorrhage at the contralateral distal supratentorial part in the control group.No intraoperative and postoperative hemorrhage and other evident lumbar catheter placement associated complications were seen in the experimental group. Conclusion CSF drainage during MVD surgery of hemifacial spasm can slowly release CSF,which can avoid distal hemorrhage due to too fast release of CSF,meanwhile,prevent cerebellar contusion resulting from inadequate operation during releasing CSF and reduce MVD associated complications,short the exposure time of responsible vessels.

关 键 词：面肌痉挛 腰大池引流 显微血管减压术 并发症 小脑挫伤 岩静脉属支出血 远隔部位出血 

分 类 号：R745.11[医药卫生—神经病学与精神病学]