显微血管减压手术治疗舌咽神经痛远期疗效分析

目的评价显微血管减压手术治疗舌咽神经痛（glossopharyngeal neuralgia,GN）的远期疗效,提高治疗效果。方法观察并分析我科自2001年1月到2011年10月收治的19例接受显微血管减压手术的舌咽神经痛患者的相关资料。所有患者均行地卡因实验明确诊断,影像学提示血管对舌咽神经存在不同程度的压迫。手术采取经乙状窦后-幕下入路行微血管减压术,术后对其进行疗效随访。结果所有患者术后早期疗效明显,随访时间1．5～12．5年,平均5．6年。随访过程中1例出现复发,1例疼痛程度及次数较术前明显缓解。本组1例患者术后出现轻度声音嘶哑和吞咽困难,1例出现脑脊液漏,经处理后均痊愈。结论显微血管减压手术是治疗舌咽神经痛的一种安全、有效的方法,影像学诊断对判断神经-血管压迫有重要意义。显微血管减压手术远期效果良好。     

显微血管减压治疗舌咽神经痛术后声音嘶哑原因分析及预防

目的评价显微血管减压治疗舌咽神经痛手术后声音嘶哑的发生因素,分析此类并发症的原因并以预防。方法回顾性分析我科自2001年1月到2015年1月收治的32例接受显微血管减压手术的舌咽神经痛患者相关资料。所有患者地卡因实验明确诊断,且行影像学检查提示局部血管对神经存在不同程度的压迫。术后对发生声音嘶哑患者随访并分析术中可能因素。结果随访时间1.5年~12.5年,平均5.6年,本组患者28例疼痛消失,4例缓解,随访中1例复发。本组4例患者术后出现声音嘶哑及吞咽困难,随访提示1例痊愈,3例仅轻度缓解,责任血管均为粗大椎动脉。结论显微血管减压手术是治疗舌咽神经痛的有效方法,本术式可发生神经损伤致声音嘶哑,减压方式的正确选择可避免此类并发症发生。     

显微血管减压术治疗舌咽神经痛(2例报告并文献复习)

目的 探讨显微血管减压术治疗舌咽神经痛的手术技巧、疗效及并发症。方法 回顾性分析2例舌咽神经痛的临床特点、手术过程及术后随访结果，并结合相关文献资料进行分析。结果 2例患者均具有典型的舌咽神经痛症状，术前头部MRI 3D-TOF检查提示舌咽神经根部有动脉压迫，行显微血管减压术后疼痛即刻消失，术后随访1年以上无复发。结论 显微血管减压术是治疗舌咽神经痛的一种有效方法，熟悉局部解剖及变异，娴熟、规范的显微操作，正确合理选择适宜的术式，另外加上术中电生理监测的应用，术后并发症是可控和可接受的。     

原发性舌咽神经痛的显微神经外科治疗

目的探讨舌咽神经痛的发病机制、不同临床术式选择及疗效、并发症之间的关系。方法对22例舌咽神经痛的病人,采用枕下乙状窦后入路,进行手术探查,选择性对14例病人进行微血管减压,8例进行舌咽神经根、迷走神经根上部1～2根丝切断术。结果 3例微血管减压术术后的病人出现短暂性声音嘶哑、饮水呛咳,6个月内好转消失;1例一直有咽喉部不适;8例神经根切断的病人术后均有声音嘶哑、饮水呛咳症状,4例6个月后症状减轻。术毕疼痛均消失,平均随访5年以上无复发。结论根据责任血管能否移开,神经根能否充分游离减压情况,选择性进行微血管减压以及舌咽神经根、迷走神经根丝切断术是治疗舌咽神经痛安全、有效的治疗方法。     

颅神经血管压迫综合征手术治疗的探讨

目的总结采用微血管减压术治疗原发性三叉神经痛、面肌痉挛和舌咽神经痛等颅神经血管压迫综合征的临床治疗经验。方法系统回顾2006年1月至2009年3月采用微血管减压术治疗颅神经血管压迫综合征患者256例,其中三叉神经痛134例,面肌痉挛117例,舌咽神经痛5例。结果三叉神经痛患者手术有效率为94.8%,面肌痉挛患者为96.6%,5例舌咽神经痛患者术后症状均消失。本组术后发生轻度不良反应者15例,占5.9%;发生较重并发症6例,占2.3%,没有死亡病例。术后有效的患者中,168例获得随访,平均随访36个月,复发12例,复发率为7.1%。结论微血管减压术是治疗颅神经血管压迫综合征的有效方法,良好的外科手术技能可有效地降低术后并发症的发生。     

显微血管减压术治疗三叉神经痛术后复发的因素和再手术治疗方法总结

目的 探讨显微血管减压术治疗三叉神经痛术后复发的因素以及再手术治疗方法。方法 纳入本院收治的三叉神经痛显微血管减压术后复发患者17例,对患者的手术资料进行临床回顾性研究; 所有再手术患者术中均辅助性应用神经内镜,其中14例患者实施显微血管减压术,1例患者实施单纯蛛网膜松解术,1例患者实施三叉神经感觉根部分切断术,l例患者实施显微血管减压术联合三叉神经感觉根部分切断术; 术后对患者进行随访,观察患者的恢复情况。结果 17例三叉神经痛术后复发再手术者平均进行了28.3个月的临床随访,随访再手术临床治疗有效率为94.12%。术后有1例患者出现面部麻木,有1例患者出现轻度面瘫。结论 影响三叉神经痛患者实施显微血管减压术后复发的情况较多,但血管压迫是其发生的一个主要病因。再手术仍以显微血管减压术为首选,通过联合神经内镜符合有利于提高手术的疗效及安全性。     

原发性舌咽神经痛的临床特点及手术治疗

目的 探讨原发性舌咽神经痛的临床特点,以及显微血管减压术、神经根部分切断术的治疗方法及疗效。方法 2008年6月至2016年5月采用枕下乙状窦后入路手术治疗原发性舌咽神经痛17例,其中单纯血管减压13例,单纯舌咽神经根切断2例,舌咽神经根联合迷走神经根第一支切断1例,舌咽神经根联合迷走神经根第一、二支切断1例。结果 术中探查发现小脑后下动脉参与压迫神经14例,单纯为小脑前下动脉2例,未发现责任血管1例。术后所有病人疼痛均消失。术后出现并发症14例,无饮水呛咳、声音嘶哑、面瘫、听力下降。术后随访14~36个月,平均29个月,疼痛均未复发。结论 经枕下乙状窦后入路手术是治疗原发性舌咽神经痛安全、有效的方法,手术方式应根据致病原因、责任血管情况及迷走神经根丝的粗细多寡等决定。     

微血管减压术100例临床研究

目的总结微血管减压术治疗三叉神经痛、面肌痉挛及舌咽神经痛的经验。方法回顾分析2007年6月至2009年11月作者完成100例微血管减压术和随访结果。结果三叉神经痛51例,术后满意率达96.1%,包括完全治愈46例(90.2%),显效3例(5.9%),无效2例(3.9%);所有病人均有随访,时间1～25月,复发3例。面肌痉挛44例,治愈42例(95.5%,包括抽搐术后立即消失35例,延迟痊愈7例),2例无效(4.5%);随访:无复发。舌咽神经痛5例,术后完全治愈4例,仍存在轻微疼痛1例。随访:1年后复发1例,2年后加重再次手术治愈。1例术后存在轻微疼痛3月后加重。结论微血管减压术是治疗三叉神经痛面肌痉挛及舌咽神经痛最有效的方法,适当的体位和骨窗,熟练的显露和垫隔技术是手术成功的关键。     

家族性原发性颅神经疾病一例报告并文献复习

目的 报告家族性原发性颅神经疾病1例,并对其病因学及治疗学进行探讨. 方法1例家族性原发性颅神经疾病,调查其三代共有5例原发性颅神经疾病患者,包括了三叉神经痛、面肌痉挛、舌咽神经痛等7侧(根)颅神经病变,其中3例采用手术治疗.结果 患者A,右三叉神经痛发病10年后行右三叉神经周围支撕脱术,术后疼痛好转,随访10年至患者去世未再发生严重发作.患者B,右三叉神经痛发病10年后行右三叉神经根显微血管减压术及感觉根选择性部分切断术,术后疼痛消失,随访14年未复发;5年前出现左三叉神经痛,2004年10月行左三叉神经根显微血管减压术,术后疼痛消失,随访44个月未复发.患者C,右舌咽神经痛10年,曾行显微血管减压术及舌咽神经根、迷走神经根丝选择性部分切断术等3次手术,前2次手术无效,第3次手术后有效,半年后出现右三叉神经痛,行右三叉神经根显微血管减压术后治愈.患者D,左面肌痉挛7年,未手术.患者E,右三叉神经痛1年,未手术.结论 家族性原发性颅神经疾病罕见.原发性颅神经疾病出现家族性泛发病例可能与后颅窝容积小、后循环解剖变异、颅神经高易感性、血管迂曲硬化延长等异常发生率高有关,可用颅神经进或出脑干区血管压迫学说解释其病因.颅神经根显微血管减压术可作为首选外科治疗方法.     

显微血管减压术治疗多根颅神经疾患

目地探讨显微血管减压术治疗同一病人并存多根颅神经疾患病例的疗效。方法采用显微血管减压术治疗同一病人并存多根颅神经疾患病例。包括同侧三叉神经痛合并舌咽神经痛12例,同侧三叉神经痛合并面肌痉挛3例,同侧舌咽神经痛合并面肌痉挛2例,双侧三叉神经痛3例,双侧面肌痉挛2例,双侧舌咽神经痛1例。结果术后总有效率100%,治愈率97.83%(45/46),平均随访30.57个月,治愈率97.83%(45/46),仅1例次三叉神经痛复发,再次手术后治愈。结论显微血管减压术是治疗同一病人并存多根颅神经疾患病例安全有效的显微外科手术方法。     

Endoscopic assistance in microvascular decompression of cranial nerves

Microvascular decompression (MVD) is an effective method for treatment of trigeminal neuralgia (TN), hemifacial spasm (HFS), glossopharyngeal neuralgia (GPN). The aim of this study was to assess the role of endoscopic assistance in MVD for the treatment of cranial neuropathies. Since 2009 till 2011 133 patients with cranial neuropathies were treated by MVD in Burdenko Neurosurgical Institute, Moscow. In 22 patients (11 patients with HFS, 10 patients with TN, 1 with GPN) endoscopic assistance was applied during the MVD. We used minimally invasive retrosigmoid approach in a unilateral position. Cerebellopontine angle was explored by 30-degree or 70-degree telescope to visualize the root entry zone of trigeminal, facial or glossopharyngeal nerves and to locate the neurovascular conflict. In 9 patients with HFS and in 1 patient with TN and in another patient with GPN endoscopy discovered offending vessels that were not visible through the microscope. In all cases endoscope was used to exclude another site of compression and to verify decompression and to identify position of teflon and offending vessel after MVD. Immediately after the surgery excellent outcome was observed in 10 patients with HFS (89%), one patient was reoperated 1.5 years after first operation with positive effect. Relief of pain in early postoperative period was observed in patients with TN and GPN. There were no major complications and postoperative mortality in our series. Endoscopic assistance is very effective and helpful technique in MVD of cranial nerves, especially in cases with HFS. In this study the use of the endoscope allowed to identify the site of compression and to confirm the position of teflon after MVD.     

原发性舌咽神经痛的显微手术治疗（附33例分析）

目的 探讨显微手术治疗原发性舌咽神经痛的手术方式、手术疗效及长期随访结果。方法 2003年5月至2014年7月显微手术治疗原发性舌咽神经痛33例,手术均采用单侧枕下乙状窦后入路,微血管减压术23例,舌咽神经根及迷走神经根上部第1、2根丝切断术3例,微血管减压术+神经根切断术7例。所有患者术后随访10个月至11年,平均5.1年。结果 责任血管为椎动脉5例,为小脑后下动脉18例,为小脑后下动脉合并椎动脉8例,为小脑后下动脉合并小脑前下动脉1例;1例未发现责任血管。33例患者术后即刻疼痛全部消失。5例术后出现暂时性吞咽困难、饮水呛咳、声嘶,3例有阵发性干咳,l例有耳鸣,1例有复视;随访期间,除复视1例外,余9例患者并发症逐渐减轻至消失。结论 显微手术治疗舌咽神经痛是有效、安全的,正确合理选择适宜的术式,在保证疗效的前提下,术后并发症是可控、可接受的。     

面肌痉挛微血管减压再手术病例的选择与疗效

目的探讨微血管减压(microvascular decompression,MVD)手术治疗面肌痉挛手术失败或复发再手术病例的选择和疗效。方法 2001年11月至2010年5月期间,在首次手术失败或复发的面肌痉挛患者中,根据其要求手术的愿望,结合术前影像学和首次手术录像、记录等资料综合判断后,选择了8例首次手术失败和20例术后复发患者进行MVD再手术治疗。结果经过平均34月的随访,仅1例患者术后症状无明显改善。其余27例(96.4%)患者术后症状缓解程度达75%以上,其中21例(75.0%)术后症状完全消失。24例(85.7%)患者术后自我疗效评价达到"优"和"良"。所有患者术后无严重病残和死亡发生,仅一例术后发生HBS 3级面瘫。结论选择合适的病人、恰当的手术时机、耐心仔细的显微操作,是面肌痉挛微血管减压再手术取得良好疗效的保证。     

Microvascular decompression for hemifacial spasm: postoperative neurologic follow-up and evaluation of life quality

Microvascular decompression (MVD) is an effective and safe treatment in hemifacial spasm (HFS). Postoperative evaluations are usually made by neurosurgeons. Follow-up studies performed by neurologists and postoperative quality of life (QoL) investigations are lacking. All 25 HFS patients operated with MVD in our centre between 2000 and 2004 were evaluated with the recently validated HFS-7 scheme, extended with the item 'sleep disturbance due to HFS' (HFS-8). The patients underwent a careful neurological examination median 3 years after the operation. The evaluation focused on clinical aspects, changes in blood pressure and time until observable effect of MVD. The evaluation of HFS-7 questionnaire and the extended form (HFS-8) showed significant improvement in QoL after MVD. Neurological outcome was in almost all cases excellent or good. Eleven (44%) patients had no neurological deficits at all. Only one patient had serious complications with ipsilateral facial palsy, deafness, balance problems and vertigo. The other patients had minor neurological findings or symptoms. Eighteen (72%) patients experienced early effect within 3 months after MVD; seven (28%) patients had late effect between 6 and 14 months. Median age of the patients with late effect (62.6 years) was significantly higher than in those with early effect (52.7 years).     

Percutaneous balloon compression for persistent or recurrent trigeminal neuralgia after microvascular decompression: personal experience of 28 patients

The objective of this study is to investigate the long-term effects of percutaneous balloon compression (PBC) for treating persistent or recurrent trigeminal neuralgia (TN) after microvascular decompression (MVD). The clinical features, surgical findings, outcomes, and complications of 28 patients underwent PBC for TN in Nanjing Drum Tower Hospital between April 2011 and March 2015 were analyzed retrospectively. All the patients had received MVD before but they did not get cured or the symptom relapsed during follow-up. Twenty-six patients (92.9%) experienced immediate pain relief; one patient (3.6%) improved but still had occasional pain. The other one (3.6%) had no pain relief and repeat PBC was performed with complete resolution of the symptom. With a mean follow-up of 39.9 months, ranging from 24 to 65 months after surgery, 24 (85.7%) patients remained pain-free; three patients (11.1%) had a relapse. Surgical complications included facial numbness in 27 patients (96.4%), masseter muscle weakness in 10 patients (35.7%), and diplopia secondary to abducens nerve palsy in one patient (3.6%). None of the patients had serious surgical morbidities. PBC is a minimally invasive, safe, and effective treatment for trigeminal neuralgia, especially suitable for patients with persistent or recurrent TN after MVD.     

显微血管减压术治疗三叉神经痛和面肌痉挛的技术差别(附37例报告)

目的为了提高手术安全性和疗效,减少术后并发症,探讨显微血管减压术治疗三叉神经痛和面肌痉挛的方法和技术细节差别。方法回顾性分析37例显微血管减压术手术患者,其中三叉神经痛15例,面肌痉挛22例,分析术中体位,切口,骨窗,责任血管压迫等细节,观察二者术后疗效。结果三叉神经痛患者术后疼痛立即完全缓解14例,1例延迟缓解。所有面肌痉挛患者痉挛症状术后即刻消失,无严重并发症。随访半年~2年,1例三叉神经痛患者复发,所有面肌痉挛患者未见复发。结论显微血管减压术是治疗三叉神经痛和面肌痉挛的有效治疗方法,但在术中体位、切口、骨窗、责任血管压迫等具体操作细节方面有细微差别,了解这些差别有助于增加手术安全性,取得更好的疗效。     

3D-TOF-MRA成像对微血管减压术术前诊断的价值

目的观察三维时间飞越法磁共振血管成像(3D-TOF-MRA)结合MR重建技术对微血管减压手术(MVD)的价值。方法对11例三叉神经痛,17例面肌痉挛,1例复发性舌咽神经痛,1例三叉神经痛合并面肌痉挛患者采用MVD治疗。术前应用3D-TOF-MRA结合MR重建技术进行检查,寻找和判别责任血管,以指导临床手术。结果术前3D-TOF-MRA检查30例中,28例证实有明显的责任血管,并在术中得到证实;2例三叉神经痛患者3D-TOF-MRA检查、未发现责任血管,其中1例术中发现为三叉神经出脑干区腹侧受到基底动脉明显压迫,另外1例术中可见小脑上动脉有多支细小动脉攀附于三叉神经出脑干区,给予MVD+选择性三叉神经感觉根切断术后症状完全缓解。30例患者中,术后完全缓解26例,明显缓解4例。结论 3D-TOF-MRA结合MR重建技术对于微血管减压术术前责任血管的判定及手术设计具有重要的应用价值。     

显微血管减压术治疗三叉神经痛长期疗效研究

目的研究显微血管减压术（microvascular decompression,MVD）治疗三叉神经痛的长期效果。方法回顾性分析482例三叉神经痛病人的临床资料,均接受MVD治疗,随访时间5年以上,电话或门诊随访。结果术后疼痛消失419例,术后即刻疼痛消失率86．9％,部分病人有短暂可逆性并发症,包括疱疹病毒感染、面部麻木、周围性面瘫、耳鸣和听力下降。随访时间5—12年,失访24例;出院时疼痛消失的病人在随访期间复发38例,其中5年内复发24例,5年以上复发14例,复发率9．5％。结论MVD是目前惟一针对三叉神经痛病因进行治疗的手术方式,手术后三叉神经的运动和感觉功能完好保留,其长期疗效良好。     

Prognostic value of intra-operative abnormal muscle response monitoring during microvascular decompression for long-term outcome of hemifacial spasm

The reliability of intra-operative abnormal muscle response (AMR) monitoring as an indicator of post-operative outcome in patients with hemifacial spasm (HFS) is under debate. The primary aim of this study was to evaluate the correlation between intra-operative AMR changes and long-term post-operative outcome. We monitored intra-operative AMR during microvascular decompression (MVD) in consecutive patients with HFS (n = 104). Patients in this study were divided into two groups based on whether their AMR disappeared or persisted following MVD. Ninety patients were followed-up, and the mean duration from surgery to final follow-up examination was 3.7 years. Fourteen patients were lost to follow-up. AMR disappeared during surgery for 80 patients; of these, 74 achieved complete resolution of HFS, five had persistent HFS, and one patient developed a recurrence of HFS. Of the 10 patients with persistent AMR despite effective MVD, eight patients achieved complete resolution, one patient had persistent HFS, and one developed recurrent HFS. The long-term clinical outcome of HFS after MVD did not significantly correlate with intra-operative AMR changes (p = 0.791). Therefore, we suggest that intra-operative AMR monitoring may not be a reliable indicator of long-term post-operative outcome for HFS.     

显微血管减压术治疗原发性面肌痉挛合并原发性三叉神经痛的疗效分析

目的 探讨显微血管减压术（MVD）治疗原发性面肌痉挛（pHFS）合并原发性三叉神经痛（PTN）的疗效。方法 回顾性分析2015~2017年MVD治疗的11例pHFS合并PTN的临床资料。结果 术中发现10例与椎动脉压迫密切相关。11例术后随访2~4年;面部抽搐术后即刻治愈9例,延迟治愈2例;面部疼痛术后即刻治愈10例,明显缓解1例。术后发生后组颅神经损伤1例、听力下降1例,无面瘫、脑脊液漏、颅内出血等并发症。结论 pHFS合并PTN病人责任血管常较复杂,与椎动脉压迫密切相关,MVD治疗安全、有效。