显微血管减压治疗三叉神经痛和面肌痉挛的临床分析

目的总结显微血管减压术治疗三叉神经痛和面肌痉挛的手术体会,分析疗效和术后并发症。方法回顾性分析2011年4月至2018年6月20例行显微血管减压术治疗的三叉神经痛和面肌痉挛患者的临床资料。从骨窗显露与神经血管保护、责任血管辨识与手术策略、疗效及术后并发症等方面进行总结分析。结果本组病例手术早期的总体治愈率为95%,其中三叉神经痛患者术后治愈8例,面肌痉挛患者术后即刻治愈10例,延迟痊愈1例,好转1例,严重并发症1例,轻度并发症3例。手术策略和技巧与疗效及并发症相关。结论显微血管减压术是治疗三叉神经痛及面肌痉挛的有效外科方法,个体化选择不同的手术策略对疗效和并发症的发生具有重要意义。     

显微血管减压治疗三叉神经痛和面肌痉挛的近期疗效观察

经后颅窝入路对7例三叉神经痛、5例面肌痉挛行显微血管减压手术治疗。7例三叉神经痛患者中有6例发现三叉神经根为动脉压迫,1例为静脉压迫。7例病人于血管减压后疼痛完全消失,且无任何神经缺陷遗留。5例面肌痉挛患者中4例面神经根有动脉压迫。血管减压后症状都获得明显缓解,1例在面神经根部未发现血管压迫,此例术后疗效不佳。微血管对神经根的压迫是三叉神经痛和面肌痉挛的一种重要病因。显微血管减压治疗这两种疾病的近期疗效甚佳,远期疗效尚待进一步观察。     

三叉神经痛合并面肌痉挛1例并文献复习

目的探讨三叉神经痛合并面肌痉挛的临床特点、诊断方法及手术疗效。方法回顾性分析1例三叉神经痛合并面肌痉挛的临床资料,结合文献复习,总结其临床特点、诊断方法、手术方式及术后疗效。结果患者术前MRI 3D-TOF序列提示右侧三叉神经和面神经根区均有血管影存在,对该例患者在电生理监测下行微血管减压手术,术中发现右侧小脑上动脉是三叉神经痛的责任血管,右侧小脑前下动脉是面肌痉挛的责任血管,术后患者三叉神经痛及面肌痉挛症状均完全消失,随访一年余症状未见复发。结论三叉神经痛合并面肌痉挛一般都是血管源性的,术前MRI检查有助于明确诊断和指导手术,微血管减压术是该病唯一的根治性治疗方法。     

面肌痉挛合并三叉神经痛1例报告并文献复习

目的探讨面肌痉挛合并三叉神经痛的发病机制、治疗方法和预后。方法手术治疗1例右侧面肌痉挛合并三叉神经痛的女性患者,并结合文献分析术中所见、手术疗效及随访结果。结果此病例右侧三叉神经痛、面肌痉挛是由粗大移位椎动脉压迫所致,行显微血管减压术后病人三叉神经痛、面肌痉挛消失,无并发症。结论同侧三叉神经痛合并面肌痉挛少见,粗大移位的椎动脉通常是导致面肌痉挛合并三叉神经痛的直接或间接责任血管,微血管减压术是有效的治疗方法。     

椎基底动脉扩张延长症所致三叉神经痛及面肌痉挛的微血管减压手术策略及临床分析

目的探讨椎基底动脉扩张延长症所致三叉神经痛及面肌痉挛的微血管减压术中采用悬吊法的手术技巧及疗效。方法回顾分析中国科学技术大学附属第一医院(安徽省立医院)2015年6月至2018年2月160例椎基底动脉扩张延长症所致的三叉神经痛及面肌痉挛患者的临床资料,总结悬吊法在不同责任血管类型减压中的操作技巧,分析临床疗效。结果椎基底动脉扩张延长症所致三叉神经痛及面肌痉挛的病例中,椎基底动脉很少作为单支责任血管压迫神经,常伴有一支或多支血管压迫,术中结合悬吊法进行了责任血管的充分减压,三叉神经痛的手术有效率为93%,面肌痉挛的手术有效率98.2%,术后疗效及并发症较其他非椎基底动脉相关的微血管减压术无明显差异。结论对于复杂血管压迫类型,术中采用悬吊法可以充分减压,为微血管减压提供一种新的安全、有效的手术方法。     

显微血管减压及神经松解手术治疗颅神经疾病1956例

目的 探讨显微血管减压及神经松解手术治疗颅神经疾病的方法及经验。方法 总结自1986至2005年12月以来局麻下共实施显微血管减压及神经松解手术治疗颅神经疾病1956例，其中三叉神经痛1465例，面肌痉挛428例，舌咽神经痛63例。患者平均年龄62．5岁，病史3至37年不等。介绍了显微血管减压及神经松解手术技巧及术中寻找责任血管及部分神经根切断的注意事项。结果 手术确定了1462例三叉神经痛、428例面肌痉挛和51例舌咽神经痛患者的压迫责任血管，并以teflon垫棉置于其间；对1876例局部蛛网膜和颅神经间的粘连行神经松解手术；对45例行神经根部分切断。手术效果满意。术后总有效率100％。31例复发，其中23例行二次手术治疗后病愈。结论 显微血管减压及神经松解手术是治疗颅神经疾病的有效手段，疗效确切。     

微血管减压术治疗面肌痉挛96例分析

目的探讨微血管减压术治疗面肌痉挛的责任血管、手术疗效以及手术策略。方法回顾性分析采用微血管减压术的96例面肌痉挛病人的临床资料。结果本组术中均能见到血管压迫面神经根出脑干处,均为动脉血管压迫。术后68例症状完全缓解,26例明显减轻,2例手术无效;其中有1例复发。结论微血管减压术是面肌痉挛的有效治疗方法,熟练的显微外科技术,术中责任血管的识别以及减压棉片的放置是影响手术疗效的关键。     

探讨显微血管减压术治疗面肌痉挛的最佳操作技巧

目的探讨面肌痉挛患者采用显微血管减压术的手术方式及治疗效果。方法选取50例患有面肌痉挛的患者作为本次研究的对象,对所有患者的资料进行回顾性分析,所有患者采用显微血管减压术进行治疗,在术中应用面肌诱发肌电图进行监测。结果所有患者均有血管压迫面神经,均属于动脉压迫,随访仅1例复发。结论采用显微血管减压术对面肌痉挛患者具有显著治疗效果和安全性。     

内镜辅助的神经微血管减压术(附31例报告)

目的 探讨内镜辅助的神经微血管减压术的方法和技术要点.方法 2008年1月～2009年12月间共治疗原发性三叉神经痛17例,面肌痉挛12例,原发性三叉神经痛合并面肌痉挛2例,手术采用枕下小切口乙状窦后入路,在内镜下辅助下行神经微血管减压术,对临床资料和治疗结果进行回顾性分析.结果 31例患者术中均发现责任血管压迫并予分离、减压.本组患者无死亡,术后1例出现蛛网膜下腔出血,1例发生颅内感染,经治疗后痊愈.术后随访5个月～2年,症状完全缓解28例,症状减轻3例,无复发.结论 在神经微血管减压术应用内镜,有助于分辨责任血管,减压彻底,具有微创、安全的优点.     

显微手术治疗面肌痉挛合并三叉神经痛（附7例分析）

目的探讨显微手术治疗面肌痉挛合并三叉神经痛的疗效。方法回顾性分析7例面肌痉挛合并三叉神经痛病人的手术经验。均在磁共振检查后行微血管减压治疗,观察术后疗效。结果MRI及术中均见面神经责任血管为小脑前下动脉6例,椎动脉1例;三叉神经责任血管为椎动脉4例,小脑上动脉3例。行微血管减压后,三叉神经痛症状均立即消失;面肌痉挛术后立即消失5例,术后3个月内完全消失2例。结论术前MRI检查可明确诊断并指导手术;微血管减压可有效治疗原发性面肌痉挛合并三叉神经痛。     

显微血管减压术治疗面肌痉挛51例临床分析

目的 探讨显微血管减压术治疗特发性面肌痉挛疗效.方法 回顾分析显微血管减压术治疗51例面肌痉挛的临床资料,术中确认责任血管并减压.结果 本组均能见到面神经出脑干处有动脉血管压迫,其中AICA26例(51.0%),PICA16例(31.3%),VA4例(7.8%),复合型5例(9.8%).43例(84.4%)术后症状完全缓解,8例术后减轻(15.6%).其中4例(7.8%)3周内停止抽搐,3例(5.8%)3月后抽搐停止,1例(2%)一直未完全缓解.随访1年以上,复发1例(2.0%).结论 显微血管减压是面肌痉挛的首选方法,术中确认责任血管,充分减压和防止副损伤是手术成功的关键.     

An easy adjustable method of ectatic vertebrobasilar artery transposition for microvascular decompression

Background

Microvascular decompression (MVD) of trigeminal neuralgia (TN) or hemifacial spasm (HFS) caused by an elongated, tortuous or enlarged vertebral or basilar artery has a higher rate of incomplete cure.

Objective

We used an easily applied and adjustable method of vertebrobasilar artery transposition and fixation to improve the immediate surgical outcome of MVD of TN or HFS due to compression by an ectatic vertebrobasilar artery system.

Methods

Vertebral or basilar artery transposition was performed using the vascular sling with a strip of unabsorbable dural tape. The vertebrobasilar artery-sling complex was then fixed to the dura over the petrous bone by aneurysm clip through the dural bridge. The direction and angle of traction on the vertebrobasilar artery was adjustable using different lengths of clip or the horizontal level of the dural bridge.

Results

The sling and clip fixation method has been applied in 7 cases of MVD associated with vertebral or basilar artery compression. All 3 patients with TN and one with HFS had total remission of symptoms right after the procedure; one patient was completely free of spasm within 1 week after MVD and one had achieved 80% improvement of spasm in his last clinical visit 3 months after MVD. There was no major surgical complication in these 7 patients. Surprisingly, refractory hypertension was unexpectedly cured in one patient with TN following the procedure.

Conclusion

The vertebrobasilar artery transposition and fixation method used in the present study provided surgeons an easy and adjustable way to perform MVD safely and effectively.     

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.     

神经内镜在三叉神经痛和面肌痉挛手术中的应用

目的 探讨神经内镜在三叉神经痛和而肌痉挛手术中的辅助作用。方法 在显微血管减压术中使用神经内镜，观察神经根进出脑干部位及局部血管的分布和走行情况，确认压迫血管；在实施减压后观察神经根松解情况、垫棉的位置和压迫血管移位后的状态。结果 60例三叉神经痛病例中，56例术后疼痛消失，4例疼痛减轻；40例面肌痉挛病例中，37例术后痉挛消失，3例减轻。平均随访3．2年无一例复发。结论 显微血管减压术中辅助使用神经内镜，能提高手术治疗效果，减少并发症发生。     

枕下乙状窦后入路手术治疗三叉神经痛的术式选择

目的探讨枕下乙状窦入路手术治疗三叉神经痛术中手术方式的选择。方法对39例原发性三叉神经痛患者的临床资料进行回顾性分析。其中31例患者术中有明确的血管压迫,仅行微血管减压术(MVD)手术;6例患者血管压迫不明显,行MVD+三叉神经梳理术(TNC);3例患者行三叉神经感觉根部分离断术(PSR),1例患者行二次手术。对患者术后的疗效及并发症进行分析。结果 31例行MVD手术患者,术后疼痛立即完全缓解26例,延迟缓解2例,无效3例,总有效率90.6%。6例行MVD+TNC的患者和3例行PSR手术的患者术后疼痛均立即缓解。结论为提高手术治疗三叉神经痛的治愈率,应根据术中不同情况决定不同的手术方式。对于老年人及不能耐受第二次手术的患者,更应积极行PSR手术。     

异常椎基底动脉压迫致三叉神经痛的临床特点及显微手术治疗（附16例分析）

目的 探讨异常椎基底动脉压迫所致原发性三叉神经痛（ITN）的临床特点、可能发病机制及微血管减压术治疗效果。方法 回顾性分析2010年1月至2015年6月收治的16例术中证实的异常椎基底动脉压迫所致ITN患者的临床资料。结果 16例患者术后随访３个月至２年,14例术后1 d疼痛立即消失且随访无复发,1例术后3个月随访时疼痛完全消失,1例术后3个月随访时疼痛较术前缓解。结论 异常椎基底动脉压迫所致的ITN多见于老年患者,多伴有高血压、脑卒中病史;术前3D-TOF-MRA有助于明确责任血管及制定适宜的手术方案,术中针对不同的病因行不同的细节处理,充分松解三叉神经入脑干区及环池段周围蛛网膜有助于避免遗漏责任血管;围手术期应控制血压平稳,防治血管痉挛,防治急性卒中事件。     

A clinical analysis on microvascular decompression surgery in a series of 3000 cases

Objective

Despite the microvascular decompression (MVD) has become a definitive treatment for trigeminal neuralgia (TN) and hemifacial spasm (HFS), not all of the patients have been cured completely so far and this sort of operation is still with risk because of the critical operative area. In order to refine this surgery, we investigated thousands MVDs.

Methods

Among 3000 consecutive cases of MVDs have been performed in our department, 2601 were those with typical TN or HFS, who were then enrolled in this investigation. They were retrospectively analyzed with emphasis on the correlation between surgical findings and postoperative outcomes. The differences between TN and HFS cases were compared. The strategy of each surgical process of MVD was addressed.

Results

Postoperatively, the pain free or spasm cease occurred immediately in 88.3%. The symptoms improved at some degree in 7.2%. The symptoms unimproved at all in 4.5%. Most of those with poor outcome underwent a redo MVD in the following days. Eventually, their symptoms were then improved in 98.7% of the reoperative patients. The majority reason of the failed surgery was that the neurovascular conflict located beyond REZ or the offending veins were missed for TN, while the exact offending artery (arteriole) was missed for HFS as it located far more medially than expected.

Conclusion

A prompt recognition of the conflict site leads to a successful MVD. To facilitate the approach, the craniotomy should be lateral enough to the sigmoid sinus. The whole intracranial nerve root should be examined and veins or arterioles should not be ignored. For TN, all the vessels contacting the nerve should be detached. For HFS, the exposure should be medial enough to the pontomedullary sulcus.     

微血管减压术治疗青年面肌痉挛的临床分析

目的:本文通过对21例青年面肌痉挛(hemifacialspasm,HFS)手术病例的回顾性分析,总结微血管减压手术治疗青年HFS的特点及术后随访结果。方法:我科自2001年1月-2004年8月共收治HFS患者311例,回顾总结其中21例起病年龄<28岁的青年HFS患者的手术发现以及术后随访结果。结果:本组21例患者均于术中发现存在明确的责任血管压迫面神经REZ区,且责任血管均为动脉。术后症状完全缓解率90.5%。结论:动脉压迫面神经REZ区仍是导致青年HFS发生的最主要原因。微血管减压治疗青年HFS,术后症状完全缓解率高、效果稳定、复发率低。     

绒球下入路微血管减压术治疗面肌痉挛疗效分析

目的 探讨绒球下入路微血管减压术（MVD）治疗面肌痉挛（HFS）的安全性和有效性。方法 回顾性分析2020年7月至2021年6月采用绒球下入路MVD治疗的233例HFS的临床资料。结果 术中发现单一血管压迫166例（71.2%）,其中小脑前下动脉142例;多支血管压迫67例（28.8%）,其中椎动脉参与53例。术后1、3、6、12个月有效率分别为95.3%、94.8%、95.3%、94.8%。术后1年复发率为1.7%。术后发生并发症26例（11.2%）,其中无菌性脑膜炎10例,脑脊液鼻漏3例,迟发性面瘫6例,后组颅神经麻痹4例,听力损伤2例,小脑梗死1例。结论 绒球下入路MVD治疗HFS是一种安全的、有效的手术方法,可充分显露面神经根出脑干区,同时减少对小脑的牵拉,降低听力损伤风险。     

Neuroendoscopy in microvascular decompression for trigeminal neuralgia and hemifacial spasm: Technical note

Abstract

Miocrovascular decompression is an effective treatment for trigeminal neuralgia (TN) and hemifacial spasm (HFS). A complete cure cannot be obtained, and additional adjuncts for extended use of endoscopy are needed. The use of an endoscope combined with the operating microscope can enhance the surgeon’s ability to view deep structures during operation. We study the application of combined microsurgical and endoscopic techniques in 21 cases of HFS and 12 cases of TN. With these techniques the surgeon can explore the ventral aspect of the brainstem and cranial nerves without further retraction, can see the groove caused by compression of the offending artery, and can confirm the proper position of the prosthesis after attachment to the dura by fibrin glue. In HFS the most common offending vessels in 75% of cases were the posterior inferior cerebellar artery (PICA) and anterior inferior cerebellar artery (AICA) and in 25% of cases the vertebral artery (VA). In trigeminal neuralgia the offending vessel in 60% of cases was the superior cerebellar artery (SCA), and in 40% of cases the AICA. The overall success rate was 97% with minimal morbidity 3% (facial palsy) and no mortality. The aim of this work is to study advantages and disadvantages of using endoscopy during microvascular decompression for TN and HFS. [Neural Res 2000; 22: 522-526]