微血管减压术治疗三叉神经痛9例围术期护理

目的:探讨微血管减压术(MVD)治疗三叉神经痛患者的围术期护理方法。方法:回顾9例三叉神经痛患者术前、术后的护理资料,进行总结分析。结果:本组6例痊愈,3例明显减轻(其中2例出现手术并发症,经治疗和护理基本缓解,1例有间歇性可忍痛)。出院后随访2~6个月无复发。结论:对MVD治疗三叉神经痛患者给予针对性围术期护理,可提高治愈率,减少并发症发生,提高患者的生活质量。     

颅内微血管减压术治疗三叉神经痛的围术期护理

目的探讨三叉神经痛患者颅内微血管减压术围术期的护理。方法对182例行内镜辅助的微血管减压术的三叉神经痛患者，采用系列护理，包括术前加强心理护理、全面的术前准备，术后严密病情观察、体位护理、饮食护理以及并发症的观察和护理。结果本组患者中疼痛即刻缓解率达95．1％（173例）；伤口Ⅰ期愈合178例，4例因合并脑脊液漏延期愈合。结论术前充分的准备，能给后续治疗奠定基础；术后严密的观察，尤其是注意一些细小的变化，能及时阻止、避免严重并发症的发生。     

微血管减压术治疗原发性三叉神经痛89例术后护理

目的:探讨微血管减压术治疗原发性三叉神经痛(ITN)的术后护理方法。方法:对89例原发性三叉神经痛患者行微血管减压术治疗,做好术后护理、健康教育及并发症护理。结果:本组患者术后疼痛消失78例,术后3个月内疼痛消失8例,术后疼痛减轻3例,无一例严重并发症发生。结论:微血管减压术治疗原发性三叉神经痛效果确切,良好的术后护理可减少并发症发生。     

微血管减压术治疗三叉神经痛患者的围术期护理

目的:探讨三叉神经痛患者行微血管减压术(MVD)围术期护理要点及并发症护理。方法:总结2017年1月1日～2019年1月31日17例微血管减压手术治疗的三叉神经痛(TN)患者的护理要点,积极治疗并发症。结果:17例患者平均住院19 d;出现术后并发症8例,经积极治疗后均治愈;患者疼痛症状均消失。结论:围术期护理为医生及时诊断治疗提供了重要依据,护理人员需要全面掌握三叉神经痛疾病理论基础,熟练掌握操作技能,进而帮助患者改善预后。     

原发性三叉神经痛患者行显微血管减压术的护理

目的总结原发性三叉神经痛患者行显微血管减压治疗的护理要点。方法对62例原发性三叉神经痛患者实施显微血管减压治疗,并做好术前后的护理工作。结果术后治愈52例,好转10例,术后2例发生伤口脑脊液漏,2例发生口唇疱疹,经对症处理后痊愈。结论显微血管减压治疗原发性三叉神经痛,具有较高的治愈率、止痛效果明显、损伤少等优点。术前应做好患者心理护理及疼痛护理,术后密切观察患者病情变化,做好并发症的观察及健康指导,其能减轻患者的痛苦,对患者的康复具有重要意义。     

三叉神经痛合并高血压病人显微血管减压术治疗的护理

目的:探讨显微血管减压术治疗三叉神经痛合并高血压病人的护理体会。方法:分析20例病人行显微血管减压术治疗三叉神经痛合并高血压的护理,主要包括:加强围手术期护理,特别是疼痛正性教育、高血压的护理。术后严密观察生命体征;做好并发症的观察及预防,积极给予对症治疗及处理认为三叉神经痛合并高血压病人术后的病情观察及对症护理至关重要。结果:20例病人手术后均取得满意疗效,不仅疼痛显著缓解,而且高血压得以有效控制。结论:显微血管减压术及科学合理的护理措施对治疗三叉神经痛合并高血压具有良好的效果。     

22例原发性三叉神经痛病人行微血管减压术的术后并发症护理

[目的]总结原发性三叉神经痛病人行微血管减压术后并发症的观察及护理措施.[方法]回顾性分析22例原发性三叉神经痛病人行微血管减压术的临床资料.[结果]本组病人术后并发恶心、呕吐17例,眩晕10例,面部麻木20例,面瘫2例,吞咽障碍1例,口唇疱疹5例,高热2例,经积极对症处理均缓解或痊愈.[结论]加强原发性三叉神经痛病人行微血管减压术后并发症的观察及护理有利于预后.     

微血管减压术治疗三叉神经痛的护理

[目的]总结微血管减压术治疗三叉神经痛的护理措施.[方法]回顾性地分析20例三叉神经痛行微血管减压术病人的临床资料.[结果]本组病人术后疼痛均消失,1例术后第8天出现口角歪斜,经处理后好转出院.[结论]加强三叉神经痛微血管减压术治疗的护理可减少并发症的发生,提高手术成功率.     

玻璃体切割术38例围术期护理

目的:探讨玻璃体切割术的围术期护理方法及效果.方法:对38例眼科患者行玻璃体切割术,术前对患者加强健康宣教、进行体位训练,术后加强病情观察,及时发现和处理并发症.结果:本组38例患者均获得解剖学复位,32例患者术后视力提高,5例保持术前视力,1例视力下降.结论:加强围术期护理是手术成功的重要保障.     

乙状窦后锁孔入路三叉神经微血管减压术14例围手术期的护理

目的 探讨乙状窦后锁孔入路三叉神经微血管减压术患者围手术期的护理措施.方法 对14例原发性三叉神经痛微血管减压术患者进行系统术前、术后护理,观察临床护理效果.结果 术后1例出现脑脊液鼻漏;2例颜面部感觉减退,1例听力减退,2例耳鸣,无颅内感染、面瘫、脑脊液切口漏病例.结论 针对术后易出现的并发症早期采取相应的治疗及护理措施有利于促进患者早期康复.     

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。     

显微血管减压术治疗原发性三叉神经痛

目的：探讨原发性三叉神经痛显微外科手术方法和效果。方法：应用三叉神经根显微血管减压术治疗原发性三叉神经痛36例,探讨手术技巧及效果。结果：三叉神经根显微血管减压术治疗原发性三叉神经痛创伤小,手术疗效满意。结论：三叉神经根显微血管减压术是治疗原发性三叉神经痛的较好手术方案。     

针刺联合药物治疗三叉神经痛显微血管减压术后面部麻木的疗效评价

目的:观察针刺联合药物治疗三叉神经痛显微血管减压术后面部麻木的疗效。方法:三叉神经痛显微血管减压术后面部麻木患者72例随机分为药物组和联合组,各36例;药物组给予营养神经、扩血管等综合药物治疗,联合组在药物组综合药物治疗的基础上给予针刺治疗。于治疗前及治疗1疗程后,采用巴罗神经学研究所三叉神经痛分级标准对面部麻木进行临床功能评分测定,同时进行SF-36(生活质量量表)评分。结果:联合组的治疗周期短于药物组(P<0.05);治疗前2组三叉神经功能评分及SF-36量表评分差异无统计学意义(P>0.05);治疗后,2组三叉神经功能评分均低于同组治疗前,且联合组低于药物组(均P<0.05),2组SF-36量表评分高于同组治疗前,且联合组高于药物组(均P<0.05)。结论:针刺结合药物治疗可有效促进三叉神经痛显微血管减压术后面部麻木患者功能恢复,改善患者的生活质量,缩短治疗周期。     

A prospective cost-effectiveness study of trigeminal neuralgia surgery

OBJECTIVES: Approximately 8000 patients with trigeminal neuralgia undergo surgery each year in the United States at an estimated cost exceeding $100 million. We compared 3 commonly performed surgeries (microvascular decompression, glycerol rhizotomy, and stereotactic radiosurgery) to evaluate the relative cost-effectiveness of these operations for patients with idiopathic trigeminal neuralgia. METHODS: Prospective nonrandomized trial at a tertiary referral center from July 1999 to December 2001. One hundred twenty-six consecutive patients underwent 153 operations (microvascular decompression, n=33; glycerol rhizotomy, n=51; stereotactic radiosurgery, n=69). Preoperative characteristics were similar between the groups with respect to sex, pain location, duration of pain, and atypical features. Facial pain outcomes were classified as excellent (no pain, no medications), good (no pain, reduced medications), fair (>50% pain reduction), and poor. The cost per quality adjusted pain-free year was compared between the groups. Mean follow-up was 20.6 months. RESULTS: Patients having microvascular decompression more commonly achieved and maintained an excellent outcome (85% and 78% at 6 and 24 months) compared with glycerol rhizotomy (61% and 55%, P=0.01) and stereotactic radiosurgery (60% and 52%, P<0.01). No difference was detected between glycerol rhizotomy and stereotactic radiosurgery (P=0.61). The cost per quality adjusted pain-free year was $6,342, $8,174, and $8,269 for glycerol rhizotomy, microvascular decompression, and stereotactic radiosurgery, respectively. Reduction in the average cost of morbidity and additional surgeries to zero did not make either microvascular decompression or stereotactic radiosurgery more cost-effective than glycerol rhizotomy. Both microvascular decompression and stereotactic radiosurgery would be more cost-effective than glycerol rhizotomy if the cost of additional surgeries after glycerol rhizotomy increased 79% and 83%, respectively. DISCUSSION: This analysis supports the practice of percutaneous surgeries for older patients with medically unresponsive trigeminal neuralgia. At longer follow-up intervals, microvascular decompression is predicted to be the most cost-effective surgery and should be considered the preferred operation for patients if their risk for general anesthesia is acceptable. More data are needed to assess the role that radiosurgery should play in the management of patients with trigeminal neuralgia.     

Neurosurgical therapy of facial neuralgias

INTRODUCTION: Neuralgias of the face, especially trigeminal neuralgia and glossopharyngeal neuralgia are indications for surgical interventions after failed medical therapy. In contrast to other forms of headache or atypical facial pain, where surgical measures are considered to be contraindicated, percutaneous procedures or microvascular decompression are able to produce immediate and longstanding pain relief. Careful preoperative evaluation is essential to confirm the clinical diagnosis and to rule out other causes as multiple sclerosis or tumors afflicting the cranial nerves. The following study will summarize the common surgical techniques and their role considering a mechanism-based therapy as well as document long-term results of these measures. METHODS: Between 1977 and 1997 316 thermo-controlled radiofrequency trigeminal rhizotomies (TK) and 379 microvascular decompressions (MVD) were performed in our hospital to treat trigeminal neuralgia; additional 6 MVDs for glossopharyngeal neuralgia and one MVD of the intermediate facial nerve were carried out. Questionnaires were sent out to all patients still living in 1981, 1982, 1992 and 1998. For all other patients, interviews with relatives or the general practitioners were conducted. A retrospective analysis of postoperative pain relief was performed using Kaplan-Meier curves at the latest follow-up. Additionally 80 patients underwent careful quantitative sensory testing with Von-Frey-hairs. RESULTS: 225 patients who underwent microvascular decompression and 206 with radiofrequency trigeminal rhizotomies were further analyzed. There was a 50% risk for pain recurrence two years after radiofrequency rhizotomy. On the other hand 64% of patients who underwent microvascular decompression remained painfree 20 years postoperatively. Patients with microvascular decompression without sensory deficit were painfree significantly longer than patients with postoperative hypesthesia. DISCUSSION: Etiology and pathogenesis of facial neuralgias are far from understood despite several hypotheses. Based on current models there is no explanation for the immediate pain relief especially after microvascular decompression. Some authors even discuss surgical trauma as the only cause for postoperative pain relief.     

椎动脉复合体压迫类型三叉神经痛微血管减压术后近期疗效分析

目的:探讨椎动脉复合体压迫导致的三叉神经痛患者微血管减压术后的近期疗效。方法:椎动脉复合体压迫类型的三叉神经痛患者(复合体组,n=13例)采用微血管减压治疗。非椎动脉复合体压迫导致的三叉神经痛(非复合体组,n=25例)采用直接旷置小脑上动脉进行治疗。两组术后2月进行疗效比较。结果:复合体组术后2月治愈10例,好转2例,无效1例;而非复合体组治愈22例,好转3例,无效0例。椎动脉复合体压迫类型的三叉神经痛的近期疗效低于非椎动脉复合体压迫类型的三叉神经痛,两组对比有统计学差异(P<0.05)。结论:椎动脉复合体压迫类型的三叉神经痛近期疗效低,其特殊的压迫类型或许是疗效低的原因。     

Studies on the operative outcomes and mechanisms of microvascular decompression in treating typical and atypical trigeminal neuralgia

OBJECTIVE: To evaluate the operative outcomes and mechanisms of microvascular decompression in treating typical and atypical trigeminal neuralgia. METHODS: A group of 45 patients with typical trigeminal neuralgia and 17 patients with atypical trigeminal neuralgia treated by micro-vascular decompression from 2000 to 2002 were reviewed, including their clinical presentations, operative findings, and outcomes. RESULTS: Of 45 patients with typical trigeminal neuralgia, the mean duration was 3.1 years, and the mean age of pain onset was 60.3 years. Single trigeminal division was involved in 20 patients (44.4%), and 2 or 3 divisions were involved in the other 25 patients (55.6%). During the operation, artery compression was found in 39 patients (86.7%), and the combined artery and venous compression was found in 6 patients (13.3%). Postoperatively, complete pain relief was achieved in 44 patients (97.8%), and significant pain relief was achieved in 1 patient (2.2%). As for 17 patients with atypical trigeminal neuralgia, the mean duration and the mean age of pain onset was 8.7 years and 55.5 years, respectively. Two or 3 trigeminal divisions were involved in all of these patients. During operation, artery compression occurred in 10 patients (58.8%), and the combined artery and venous compression was found in 7 patients (41.2%). Postoperatively, complete pain relief was achieved in 5 patients (29.4%), and partial pain relief was achieved in 10 patients (58.8%), and 2 patients showed no response to microvascular decompression. CONCLUSIONS: The operative outcome of microvascular decompression in patients with typical trigeminal neuralgia was better than that of patients with atypical trigeminal neuralgia, which perhaps related to short duration, late onset of pain, limited distribution, artery compression, and complete operative decompression.     

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.     

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。