舌咽神经联合迷走神经显微血管减压术治疗舌咽神经痛的疗效分析  

Clinical efficacy of microvascular decompression of glossopharyngeal nerve combined with vagus nerve for patients with primary glossopharyngeal neuralgia

作　　者：王晶 姜成荣 种玉龙 陆天宇 梁维邦 WANG Jing;JIANG Cheng-rong;CHONG Yu-long;LU Tian-yu;LIANG Wei-bang(Department of Neurosurgery,Nanjing Drum Tower Hospital,Nanjing 210008,China)

机构地区：[1]南京鼓楼医院神经外科,南京210008

出　　处：《中国临床神经外科杂志》2024年第1期12-15,18,共5页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨舌咽神经联合迷走神经显微血管减压术(MVD)治疗原发性舌咽神经痛(GPN)的技术要点及疗效。方法回顾性分析2013年1月至2021年10月MVD治疗的50例原发性GPN的临床资料。术前行颅神经3D-TOF-MRA检查及丁卡因试验诊断GPN,术中对舌咽神经、迷走神经进行减压,未行神经根切断术。结果根据术前MRI及术中所见,除1例(2%)外,其余49例可见舌咽神经和(或)迷走神经的根部与血管有接触或压迫,其中椎动脉参与压迫14例(28%),小脑后下动脉和(或)其分支压迫28例(56%),小脑前下动脉6例(12%),静脉1例(2%)。术后即刻治愈47例(94%),明显改善1例,无效2例。术后随访7~105个月,平均(46.7±28.8)个月,中位数48.5个月;1例明显改善,随访55个月无明显改变;1例即刻无效,术后1周延迟治愈;1例即刻治愈术后2个月再次出现疼痛,但程度较术前明显改善;1例术后出现咽部异物感,随访28个月未改善;1例术后出现短暂性吞咽困难,随访6个月症状消失。结论术前影像学检查及丁卡因试验对原发性GPN的诊断非常重要。舌咽神经联合迷走神经MVD是治疗原发性GPN的安全有效的方法,不建议行舌咽神经及迷走神经根切断术。Objective To investigate the surgical techniques and efficacy of microvascular decompression(MVD)of glossopharyngeal nerve combined with vagus nerve for patients with primary glossopharyngeal neuralgia(GPN).Methods The clinical data of 50 patients with primary GPN treated by MVD from January 2013 to October 2021 were retrospectively analyzed.Cranial nerve 3D-TOF-MRA examination and tetracaine test were performed in all the patients before the surgery.Glossopharyngeal nerve and vagus nerve were decompressed,and rhizotomy was not performed in all the patients during the operation.Results According to preoperative MRI and intraoperative findings,except 1 patient(2%),the roots of glossopharyngeal nerve and/or vagus nerve were contact to or compressed by blood vessels in 49 patients,of which the vertebral arteries were responsilble vessels in 14 patients(28%),the posterior inferior cerebellar arteries and/or their branches in 28(56%),the anterior inferior cerebellar arteries in 6(12%),vein in 1(2%).Of 50 patients,47 patients(94%)were cured immediately,1 was significantly improved,and 2 were ineffective after the surgery.The postoperative follow-up ranged from 7 months to 105 months,with an average of(46.7±28.8)months and a median of 48.5 months.One patient with significant improvement immediately after the surgery had no significant change after 55 months of follow-up.One patient who was ineffective immediately after the surgery was cured one week after the surgery.One patient cured immediately after the surgery had pain again 2 months after the surgery,but the degree of pain was significantly improved compared with that before the surgery.One patient had a foreign body sensation in the pharynx after the surgery,which did not improve after 28 months of follow-up.One patient had transient dysphagia after the operation,and the symptoms disappeared 6 months after the operation.Conclusions Preoperative imaging and tetracaine test are very important for the diagnosis of primary GPN.Glossopharyngeal nerve combined with vag

关 键 词：原发性舌咽神经痛 显微血管减压术 疗效 

分 类 号：R745.13[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]