原发性三叉神经痛显微血管减压术中岩上静脉的处理策略  

Management strategies of superior petrosal vein during microvascular decompression for primary trigeminal neuralgia

作　　者：甄雪克[1] 张黎[1] 袁越[1] 于炎冰[1] Zhen Xueke;Zhang Li;Yuan Yue;Yu Yanbing(Beijing ftotitg Department of Neurosurgery,China-Japan Friendship Hospital,Bejing 100029,China)

机构地区：[1]中日友好医院神经外科,北京100029

出　　处：《中华神经外科杂志》2024年第1期50-53,共4页Chinese Journal of Neurosurgery

基　　金：中日友好医院高水平医院临床业务费专项(2022-NHLHCRF-YS-05-01)。

摘　　要：目的探讨原发性三叉神经痛显微血管减压(MVD)术中岩上静脉与三叉神经的位置关系及其相应的处理策略。方法回顾性分析2022年10月至2023年3月中日友好医院神经外科同一术者主刀治疗的69例原发性三叉神经痛患者的临床资料。将岩上静脉与三叉神经的相对位置关系分为3型:Ⅰ型为交叉型,Ⅱ型为伴随型,Ⅲ型为平行型。对于Ⅰ型患者,充分解剖分离岩上静脉与三叉神经和(或)小脑幕之间的蛛网膜,通过此空间进行第一间隙责任血管的减压;对于Ⅱ型患者,需尽可能地将岩上静脉与三叉神经及其神经根进/出脑干区的蛛网膜分离,并置入垫棉隔离;对于Ⅲ型患者,以吸引器将岩上静脉轻轻推开,完整显露第一间隙进行减压。以巴罗神经学研究所(BNI)疼痛分级评估手术疗效。出院后采用门诊和电话的方式随访患者的BNI疼痛分级。结果69例患者中,岩上静脉与三叉神经的位置关系为Ⅰ型者占比为52.2%(36例),Ⅱ型占比为30.4%(21例),Ⅲ型占比为17.4%(12例);MVD术中均完整保留岩上静脉。术后7 d内,患者BNI疼痛分级Ⅰ级68例,Ⅱ级1例。术后无一例发生听力障碍、静脉回流障碍等并发症。69例患者的随访时间[M(Q_(1),Q_(3))]为6(4,7)个月;至末次随访,所有患者的三叉神经痛症状均完全消失(BNI疼痛分级Ⅰ级)。结论根据岩上静脉与三叉神经的不同位置关系采取相应的手术策略,尽可能地完整保留岩上静脉,既可缓解三叉神经痛,又可避免岩上静脉损伤相关并发症的发生。Objective To investigate the relationship between the position of the superior petrosal vein and the trigeminal nerve during microvascular decompression(MVD)for primary trigeminal neuralgia and the corresponding management strategies.Methods The clinical data of 69 patients with primary trigeminal neuralgia treated by the same surgeon at the Department of Neurosurgery,China-Japan Friendship Hospital from October 2022 to March 2023 were retrospectively analyzed.The relative positional relationship between the superior petrous vein and the trigeminal nerve was divided into three types.TypeⅠwas crossed type,typeⅡwas concomitant type,and typeⅢwas parallel type.For typeⅠpatients,the arachnoid membrane between the superior petrosal vein and the trigeminal nerve and/or tentorium cerebellum was fully dissected and separated.The offending vessels in the first space should be decompressive through this space.For typeⅡpatients,the superior petrous vein was separated from the arachnoid membrane of the trigeminal nerve and its nerve root entry/exit zone of the brainstem(REZ)as far as possible,and cotton pad was placed to isolate it.For typeⅢpatients,the superior petrosal vein was gently pushed away with an aspirator,and the first space was completely exposed for decompression.The outcome was assessed by the Barrow Neurological Institute(BNI)pain scale.The BNI classification of patients was followed up by outpatient visits and telephone interviews from discharge to the end of follow-up.ResultsAmong 69 patients,52.2%(36 cases),30.4%(21 cases)and 17.4%(12 cases)were typeⅠ,typeⅡand typeⅢrespectively.The superior petrosal vein was completely preserved during MVD.Within 7 days after operation,there were 68 cases of BNI gradeⅠand 1 case of BNI gradeⅡ.No complications such as hearing disorder or venous drainage disorder occurred after operation.The follow-up time[median(Q_(1),Q_(3))]of 69 patients was 6(4,7)months.At the last follow-up,the symptoms of trigeminal neuralgia were completely disappeared in all patie

关 键 词：三叉神经痛 治疗结果 岩上静脉 显微血管减压术 

分 类 号：R651.3[医药卫生—外科学]