150例锁孔手术治疗颅神经疾病的护理体会

颅神经疾病包括三叉神经痛、舌咽神经痛及面肌痉挛等。南京大学医学院附属鼓楼医院神经外科2003年10月-2005年11月采取锁孔技术、微血管减压手术治疗各类颅神经疾病150例,均取得良好效果,现将护理体会介绍如下。     

颅神经疾病微血管减压术患者的围手术期护理

应用微血管减压(microvascular decompression,MVD)手术治疗三叉神经痛、面肌痉挛和舌咽神经痛等药物难治性颅神经疾病以来,MVD具有微创、安全、疗效佳特点,一方面复发率低、并发症少,另一方面还可保留颅神经功能[1].我院2006年10月-2008年6月共完成各种颅神经疾病MVD手术1458例,现报道如下.     

颅神经疾病微血管减压术患者的围手术期护理

应用微血管减压（microvascular decompression,MVD）手术治疗三叉神经痛、面肌痉挛和舌咽神经痛等药物难治性颅神经疾病以来,MVD具有微创、安全、疗效佳特点,一方面复发率低、并发症少,另一方面还可保留颅神经功能。我院2006年10月一2008年6月共完成各种颅神经疾病MVD手术1458例,现报道如下。     

微血管减压术治疗颅神经疾病的护理

目的总结微血管减压术治疗颅神经疾病手术前后的临床观察及护理体会。方法对123例行微血管减压术的颅神经疾病患者术前进行心理辅导,术后加强对病情观察及护理。结果本组无1例死亡及其它严重并发症发生,72例三叉神经痛患者中治愈69例,无效3例经行三叉神经半月节微球囊压迫术治愈;47例面肌痉挛患者中,44例治愈、2例好转;4例舌咽神经痛患者全部治愈。结论有效的治疗及护理措施,可减少术后并发症的发生。     

三叉神经痛患者微血管减压术并发症的观察与护理

<正>三叉神经痛(trigeminal neuralgia,TN)是以面部三叉神经分布区域内反复发作的剧烈放电样疼痛为特征的一类疼痛。1929年,Dandy[1]首先提出三叉神经受压可能是三叉神经痛的原因。至20世纪70年代,Jannet-ta等[2]开创了经枕下入路微血管减压术(microvascular decompression,MVD)并大为推广。近年来,微血管减压术是神经外科治疗药物难治性三叉神经痛、面肌痉挛和舌咽神经痛等颅神经疾病最有效的手术治疗方     

微血管减压术治疗颅神经疾病术后常见并发症的护理

微血管减压术是目前治疗颅神经疾病的有效方法。我院2000年10月-2004年5月对275例的颅神经疾病患者采取微血管减压手术治疗。由于手术区位于桥小脑旁,手术视野小且深,术中容易损伤神经及周围血管[1],术后密切观察病情变化,早期发现并发症,及时防范处理至关重要,现将术后常见并发症及护理报道如下。临床资料1.一般资料。本组275例中,男109例,女166例,年龄20~78岁,平均年龄46.4岁。其中原发性三叉神经痛153例,偏侧面肌痉挛114例,舌咽神经痛6例,痉挛性斜颈2例。均为其他治疗方法无效或服药过敏和毒副作用明显的难治性患者。2.手术方法。所有患…     

经后颅凹显微神经血管减压术的护理

过去,对三叉神经痛、面肌痉挛和舌咽神经痛应用保守或手术治疗,疗效不佳。既往的手术是以麻木代替疼痛或从面瘫代替痉挛等神经缺失症存在。七十年代Jannetta应用显微外科技术,行经后颅凹显微神经血管减压术治疗,具有损伤小、痛苦少、恢复快、不留麻木及面瘫等优点。目前已成为世界上治疗     

显微血管减压术的配合体会

随着医学科学不断地进步,显微外科手术在国内近几年发展迅速,我院应用显微血管减压术治疗原发性三叉神经痛,面肌痉挛,舌咽神经痛等疾病具有效果可靠,副作用小等优点,因此越来越被承认和普及,该种手术因切口小,术野狭窄,解剖位置危险,对手     

后颅凹微血管减压术后护理体会

我院应用后颅凹微血管减压术治疗三叉神经痛、舌咽神经痛、面肌抽搐共25例，现就该护理体会报告如下。1临床资料本组男19例，女6例，年龄19－64岁，平均43岁。其中三叉神经痛18例，面肌抽搐6例，舌咽神经痛1例。术后痊愈23例，三叉神经痛症状好转2例，至今无一例复发。2手术及术后特点开颅探查后松解粘连包裹神经根的蛛网膜，悬吊压迫神经根的血管或以涤纶片坝塞于神经与血管之间，解除对神经根的压迫，使症状缓解或消失。该手术操作区域位于后颅凹，易损伤神经和血管，故要求手术技巧精细，止血彻底。术后为了避免因渗血过多积存，出现颅脑…     

微血管减压术治疗三叉神经痛及舌咽神经痛1150例报告

目的:探讨用微血管减压术治疗三叉神经痛、舌咽神经痛等神经血管压迫综合症治疗方法的改进措施和提高治疗效果的临床经验。方法:系统回顾1984年6月至1999年12月我们采用微血管减压术治疗神经血管压迫综合症病例1150例,其中三叉神经痛1120例,舌咽神经痛30例。结果:有效1112例,有效率为96.7％,本组无死亡。并发症发生率由5年前5.6％下降到近5年的1.6％。结论:提高微血管减压术的治愈率和减少并发症,有多方面因素值得考虑。     

采用显微血管减压术治疗三叉神经痛

目的：总结近年采用显微血管减压手术治疗三叉神经痛的方法和结果，以期进一步提高手术治愈率。方法：回顾分析从1994年1月至2003年12月进行后颅窝手术探查的21例原发性三叉神经痛患者。19例行显微血管减压术。有1例术中采用脑室镜协助观察。结果：在头颅磁共振扫描上，有11例可见疼痛一侧的桥脑旁有异常血管影。术中发现三叉神经出脑干处有血管压迫者19例(动脉血管压迫16例，静脉血管压迫3例)。19例中，术后早期疼痛完全缓解17例。结论：显微血管减压术是治疗原发性三叉神经痛的安全和有效的方法。     

Vascular compression as a potential cause of occipital neuralgia: a case report

Vascular compression is a well-established cause of cranial nerve neuralgic syndromes. A unique case is presented that demonstrates that vascular compression may be a possible cause of occipital neuralgia. A 48-year-old woman with refractory left occipital neuralgia revealed on magnetic resonance imaging and computed tomographic imaging of the upper cervical spine an atypically low loop of the left posterior inferior cerebellar artery (PICA), clearly indenting the dorsal upper cervical roots. During surgery, the PICA loop was interdigitated with the C1 and C2 dorsal roots. Microvascular decompression alone has never been described for occipital neuralgia, despite the strong clinical correlation in this case. Therefore, both sectioning the dorsal roots of C2 and microvascular decompression of the PICA loop were performed. Postoperatively, the patient experienced complete cure of her neuralgia. Vascular compression as a cause of refractory occipital neuralgia should be considered when assessing surgical options.     

微血管减压术治疗三叉神经痛的疗效及其并发症的预防与处理

目的探讨微血管减压术治疗三叉神经痛的疗效及其并发症的预防与处理策略。方法采用微血管减压术治疗93例三叉神经痛患者,对其临床疗效及术后并发症等临床资料进行回顾性分析。结果 93例中89例术后疼痛症状消失,有效率为95.70%。术后并发症的发生情况：皮下积液4例,脑脊液漏1例,听力下降3例,耳鸣3例,面神经功能障碍4例,手术无效4例,死亡1例。结论微血管减压术治疗三叉神经痛是一种十分成熟的技术,规范手术的各种操作和积极应用监测技术能够尽量避免各种并发症的发生,显著提高手术的安全性。     

原发性三叉神经痛的显微外科治疗

目的 :探讨原发性三叉神经痛的显微外科治疗及其疗效。方法 :根据术中探查有无明确的血管压迫三叉神经 ,分别采用显微血管减压术或感觉根部分切断术。 132例病人中 95例行血管减压术 ;37例行感觉根切断术。结果 :无手术死亡病例。随访 6个月 15年 ,治愈或好转 130例 ,有效率为     

20例原发性舌咽神经痛患者临床特点及疗效分析

目的:观察原发性舌咽神经痛患者的临床特点和疗效.方法:对20例原发性舌咽神经痛的患者进行临床特点及疗效的分析总结.结果:20例患者中女性11例(55%),发病年龄>60岁者16例(80%),病程>3月的患者17例(85%),左侧16例(80%),20例(100%)患者均存在耳心痛.治疗前患者视觉模拟量表(VAS)平均值为6.9±2.2,治疗后降低为3.2±1.3.药物治疗(卡马西平联合加巴喷丁)的有效率为45%,药物联合舌咽神经阻滞治疗的有效率为85%,治疗总有效率为90%,1例患者治疗期间完全无效.治疗后3月、6月、1年的有效率分别为72.2%、33.3%、16.7%.结论:原发性舌咽神经痛老年人好发,左侧多见,药物联合舌咽神经阻滞治疗有效率可达85%.     

Epidermoid tumour of the posterior fossa causing multiple facial pain a case report

A 53-year-old woman presented with three types of pain. The pains had characteristics of neuralgia of the fifth cranial nerve, ninth cranial nerve, and cluster headache. On further investigation, a tumour in the posterior fossa was observed and histologically shown to be an epidermoid tumour.     

微血管减压术治疗三叉神经痛疗效观察

目的：探讨微血管减压术治疗三叉神经痛的适应症，手术方法，疗效，方法：枕下入路手术治疗三叉神经痛92例，其中77例发现有血管压迫，行微血管减压术，结果：77例中，68例术后疼痛立即消失，3例疼痛减轻，6例无效，40例随访68个月－5a，疼痛复发7例。结论：三叉神经微血管减压术有较肯定疗效，可保留三叉神经功能，但需开颅，有一定风险，有一定的复发率。     

Diagnosis and neurosurgical treatment of glossopharyngeal neuralgia: clinical findings and 3-D visualization of neurovascular compression in 19 consecutive patients

Glossopharyngeal neuralgia is a rare condition with neuralgic sharp pain in the pharyngeal and auricular region. Classical glossopharyngeal neuralgia is caused by neurovascular compression at the root entry zone of the nerve. Regarding the rare occurrence of glossopharyngeal neuralgia, we report clinical data and magnetic resonance imaging (MRI) findings in a case series of 19 patients, of whom 18 underwent surgery. Two patients additionally suffered from trigeminal neuralgia and three from additional symptomatic vagal nerve compression. In all patients, ipsilateral neurovascular compression syndrome of the IX cranial nerve could be shown by high-resolution MRI and image processing, which was confirmed intraoperatively. Additional neurovascular compression of the V cranial nerve was shown in patients suffering from trigeminal neuralgia. Vagal nerve neurovascular compression could be seen in all patients during surgery. Sixteen patients were completely pain free after surgery without need of anticonvulsant treatment. As a consequence of the operation, two patients suffered from transient cerebrospinal fluid hypersecretion as a reaction to Teflon implants. One patient suffered postoperatively from deep vein thrombosis and pulmonary embolism. Six patients showed transient cranial nerve dysfunctions (difficulties in swallowing, vocal cord paresis), but all recovered within 1 week. One patient complained of a gnawing and burning pain in the cervical area. Microvascular decompression is a second-line treatment after failure of standard medical treatment with high success in glossopharyngeal neuralgia. High-resolution MRI and 3D visualization of the brainstem and accompanying vessels as well as the cranial nerves is helpful in identifying neurovascular compression before microvascular decompression procedure.     

Occipital nerve block is effective in craniofacial neuralgias but not in idiopathic persistent facial pain

Occipital nerve block (ONB) has been used in several primary headache syndromes with good results. Information on its effects in facial pain is sparse. In this chart review, the efficacy of ONB using lidocaine and dexamethasone was evaluated in 20 patients with craniofacial pain syndromes comprising 8 patients with trigeminal neuralgia, 6 with trigeminal neuropathic pain, 5 with persistent idiopathic facial pain and 1 with occipital neuralgia. Response was defined as an at least 50% reduction of original pain. Mean response rate was 55% with greatest efficacy in trigeminal (75%) and occipital neuralgia (100%) and less efficacy in trigeminal neuropathic pain (50%) and persistent idiopathic facial pain (20%). The effects lasted for an average of 27 days with sustained benefits for 69, 77 and 107 days in three patients. Side effects were reported in 50%, albeit transient and mild in nature. ONBs are effective in trigeminal pain involving the second and third branch and seem to be most effective in craniofacial neuralgias. They should be considered in facial pain before more invasive approaches, such as thermocoagulation or vascular decompression, are performed, given that side effects are mild and the procedure is minimally invasive.