乙状窦后入路显微手术微血管减压治疗原发性三叉神经痛

目的:探讨乙状窦后入路三叉神经根微血管减压术治疗原发性三叉神经痛效果.方法:24例三叉神经痛患者在全麻下行乙状窦后入路三叉神经根微血管减压术.结果:24例患者均发现三叉神经有血管压迫,其中小脑上动脉16例,小脑前上动脉5例,小脑前下动脉2例,静脉1例.18例患者术后症状完全缓解,5例明显改善,1例部分改善.随访2年,1例复发.结论:三叉神经微血管减压术是治疗原发性三叉神经痛的安全有效方法.     

显微血管减压术治疗三叉神经痛的疗效分析

目的　探讨显微血管减压术治疗三叉神经的疗效 ,分析血管受压程度对治疗效果的影响。方法　系统性地回顾分析经显微血管减压术治疗的 3 9例三叉神经痛患者。结果　早期痊愈 3 7例 ( 94 9%) ,部分缓解 1例 ( 2 6%) ,无效 1例 ( 2 6%) ,无手术死亡。但随访 2～ 8年后 ,痊愈 3 3例 ( 84 6%) ,部分缓解 3例 ( 7 7%) ,无效 3例 ( 7 7%) ;复发 4例( 10 8%)。在晚期痊愈的病人中 ,三叉神经受动脉压迫出现明显压迹的 2 9例痊愈 2 7例 ( 93 1%) ,而神经与动脉或静脉接触而无压迹的 10例仅痊愈 6例 ( 60 %) ,二者差异显著 (P <0 0 5 )。结论　显微血管减压术治疗三叉神经痛是一安全有效的方法 ,特别是对神经受动脉压迫而出现明显压迹者效果更佳     

微血管减压术治疗原发性三叉神经痛52例临床分析

目的 探讨原发性三叉神经痛的病因,对微血管减压术(MVD)治疗原发性三叉神经痛的方法 、技术难点、手术效果等进行系统研究分析总结. 方法 采用微血管减压术治疗52例原发性三叉神经痛患者,回顾性分析患者的病例资料. 结果 术中发现有明确责任血管者50例.术后治愈46例(88.46%),缓解5例(9.62%),无效1例(1.92%).随访3-37个月,随访期间无病例复发. 结论 微血管压迫三叉神经根是原发性三叉神经痛的主要病因.MVD治疗原发性三叉神经痛具有疗效肯定、角膜反射和面部感觉完整保留的优点,是原发性三叉神经痛的理想治疗方法 .     

原发性三叉神经痛微血管减压手术探讨

目的 探讨原发性三叉神经痛微血管减压术治疗方法及效果.方法 对32例原发性三叉神经痛患者在显微镜下实施微血管减压术,并讨论其发病机制、手术方法及手术注意事项.结果 术中压迫三叉神经的血管包括小脑上动脉(25例)、小脑前下动脉(6例)和静脉(1例);32例患者术后疼痛完全缓解26例,6例仍有轻微疼痛.术后出现短时期眩晕13例,单纯疱疹者5例,术后面部麻木4例,同侧听力下降2例,无死亡和严重并发症发生,随访无复发病例.结论 微血管减压术是治疗原发性三叉神经痛安全、微创、有效的方法,提高显微外科操作技术,不遗漏责任血管,是提高手术疗效和减少并发症的关键.     

三叉神经根显微血管减压术治疗三叉神经痛87例

目的:探讨显微血管减压术治疗三叉神经痛的价值。方法:回顾分析经显微血管减压术治疗的87例三叉神经痛患者的临床资料,术中见小脑上动脉压迫38例,接触11例;小脑前下动脉压迫19例,接触7例;小脑上动脉和小脑前下动脉同时压迫9例;无名静脉接触3例。伴蛛网膜粘连增厚43例。结果:术后痊愈78例(89.7%),部分缓解7例(8.0%),无效2例(2.3%)。结论:显微血管减压术治疗三叉神经痛疗效显著,尤其对神经受动脉压迫而出现明显压迹者效果更佳。     

微血管减压术治疗非典型三叉神经痛的疗效评价

目的探讨微血管减压手术治疗非典型三叉神经痛的手术疗效。方法自2001年3月至2006年3月,35例非典型三叉神经痛患者术前均经MRTA证实颅内段三叉神经根部存在血管压迫,在我科接受微血管减压手术治疗,回顾性分析患者的临床表现、术中所见和临床疗效。结果本组中累及三叉神经单支者3例(占8.6%),两支或三支者32例(占91.4%)。67.0%的非典型三叉神经痛患者存在多支血管压迫,三叉神经根部上内侧血管压迫占52.6%,上外侧占28.3%,下侧占19.1%。35例患者中有52.5%术后疼痛完全缓解,31.4%部分缓解,而有16.1%的非典型三叉神经痛患者术后疼痛无明显缓解或疼痛复发。结论颅内段三叉神经根部全程充分减压是影响微血管减压术治疗非典型三叉神经痛疗效的重要因素;采用磁共振断层血管成像(magnetic resonance tomographicangiography,MRTA)方法进行术前评估有助于提高患者的预后。     

显微血管减压术治疗原发性三叉神经痛的临床体会

目的:总结显微血管减压术治疗三叉神经痛的临床经验。方法:回顾性分析2000年6月~2010年9月间采用显微血管减压术治疗的57例三叉神经痛患者的临床表现、术中所见、手术技巧和临床疗效。结果:全部患者临床表现与其术中所见三叉神经受血管压迫有密切关系。57例患者术后随访6个月~5年,41例(72.0%)术后疼痛完全消失,16例(28.0%)术后疼痛明显减轻;6例(10.5%)术后同侧面部有一过性轻度麻木,3例(5.2%)有轻度眼部干涩表现,所有患者无永久性并发症发生。结论:显微血管减压术治疗原发性三叉神经痛效果显著,手术时在三叉神经近脑干区发现责任血管并进行充分分离、松解,实现三叉神经彻底减压是手术成功的关键。     

微血管减压术治疗典型及非典型三叉神经痛的疗效对比研究

目的 探讨微血管减压术治疗典型及非典型三叉神经痛的不同疗效及其可能机制。方法 对比分析2000年-2002年间经微血管减压术治疗的45例典型三叉神经痛患者及17例非典型三叉神经痛患者的临床特征、术中所见和手术疗效。结果 45例典型三叉神经痛患者中，平均病程3．1年，平均发病年龄60．3岁。其中20例(44．4％)患者中疼痛累及三叉神经的单一分支，其余25例(55．6％)疼痛均累及2或3个分支。术中见39例(86．7％)为动脉压迫，6例(13，3％)为动脉和静脉混合压迫。术后疼痛完全缓解44例(97．8％)，明显减轻1例(2．2％)。而在17例非典型三叉神经痛患者中，平均病程8．7年，平均发病年龄55．5岁，疼痛均累及三叉神经的2或3个分支。术中见10例(58．8％)为动脉压迫，7例(41．2％)为动脉和静脉混合压迫。术后疼痛完全缓解5例(294％)，明显减轻10例(58．8％)，无效2例(11．8％)。结论 微血管减压术治疗典型三叉神经痛的疗效明显优于非典型患者，这可能与典型三叉神经痛患者的病程较短、发病年龄较晚、疼痛多呈单支分布、且以动脉压迫为主以及术中能够实现充分降压有关。     

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例发现三叉神经根受小动脉压迫,1例受静脉压迫。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例面神经根受小动脉压迫,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。     

微血管减压术治疗三叉神经痛

目的 探讨三叉神经痛与面肌痉挛的手术方法及治疗效果。方法 本组38例三叉神经癌病人行微血管减压术，术中发现35例有明显血管压迫，在显微镜下显露出三叉神经根桥脑入脑段，注意处理好岩静脉，寻找责任血管后，用涤纶片将责任血管与神经根隔离。其中2例同时有静脉压迫，电凝切断并予神经分离，3例未发现明确责任血管行三叉神经感觉根后外2／3切断。结果 35例症状完全消失，2例三叉神经痛症状缓解，口服止痛药可控制。1例3个月后疼痛复发。结论 微血管减压术是治疗三叉神经痛与面肌痉挛的有效治疗方法。     

静脉阻断试验在微血管减压术治疗三叉神经痛中的应用

目的为了提高静脉性血管压迫所致三叉神经痛的手术疗效和降低并发症,介绍一种处理责任静脉的方法。方法2000年8月~2007年1月间行微血管减压术(MVD)的409例三叉神经痛患者中,责任血管为静脉或动静脉混合压迫的有118例(29%),其中58例为粗大的深部引流静脉,减压前行静脉暂时阻断试验。其中试验阴性者53例,静脉予以切断减压;5例试验阳性者中3例切断,2例分离后减压。结果53例将责任静脉直接切断的患者中,术后51例症状完全缓解,2例明显减轻,但有6例出现不同程度面部麻木。5例试验阳性者中,3例切断后都因严重的小脑肿胀再行后颅窝减压术,死亡1例,另2例行分离后减压的患者术后疼痛获得明显减轻。结论暂时阻断试验可以作为处理粗大责任静脉时的一个参考依据。     

178例原发性三叉神经痛微血管减压手术体会

目的：探讨原发性三叉神经痛微血管减压的手术技巧和总结手术体会。方法：采用乙状窦后锁孔入路对178例原发性三叉神经痛行显微血管减压术治疗,选择Teflon棉为减压垫,根据术中所见压迫血管的类型,分别采用Teflon棉隔离、血管悬吊、血管隔离加感觉根部分切断及神经松解加部分感觉根烧灼等手术方式。其中发现明确血管压迫,尤其压迫处神经变形者单纯行Teflon棉隔离减压;部分责任血管仅与神经接触者,行血管隔离加感觉根部分切断;责任血管为长袢状者行血管悬吊;而未见明确责任血管者行神经松解加部分感觉根烧灼。随访观察其疗效。结果：术中发现三叉神经入脑干区有血管压迫者154例,血管与神经接触密切者19例．未见责任血管但明显蛛网膜增厚者5例。其中动脉责任血管145例,动静脉联合责任血管22例,单纯静脉责任血管6例。单纯行Teflon棉隔离减压155例,减压加部分感觉根切断11例,责任血管悬吊7例,蛛网膜松解加感觉根部分烧灼s侧。术后疼痛立邵消失169例,显著减轻者6例,1周内明显减轻者2例。所有患者术后获3个月～3年随访（平均1．5年）,疼痛消失175例（98．3％）,服用卡马西平片控制满意者2例．疼痛复发如术前1例。结论：微血管减压术是原发性三叉神经痛有效的治疗方法,根据责任血管类型采取适当减压方法是提高三叉神经痛手术有效率及减少复发的关键措施。     

MVD治疗原发性三叉神经痛(附142例报告)

目的探讨微血管减压术治疗原发性三叉神经痛(TN)的手术方法及疗效。方法对142例TN患者行微血管减压术,对临床资料进行回顾性分析。结果术后128例(90%)疼痛消失,9例(6.4%)疼痛明显减轻,手术有效率达96.5%。随访期大于2年的82例患者中,74例疼痛完全消除,5例时有疼痛可药物(卡马西平)控制,3例药物不能有效控制。结论 MVD是治疗TN的有效办法;对责任血管的准确判断及合理处理是微血管减压术成功的关键;良好的显微操作能最大程度降低各种手术并发症。     

3.0T MR 3D-FIESTA序列成像对诊断血管压迫性三叉神经痛的应用价值

探讨3.0T MR 3D-FIESTA序列成像技术对诊断血管压迫性三叉神经痛(TN)的应用价值。应用3.0T MR 3D-FIESTA序列成像技术对本院30例血管压迫性TN患者进行影像学分析及诊断,观察每例患者的诊断结果。结果显示患者经3.0T MR 3D-FIESTA序列成像技术诊断结果与患者后期的微血管减压术(MVD)术中结果相吻合,TN的一侧图像可显示出血管受到压迫,而未出现三叉神经痛的一侧其图像显示出血管未受到压迫,3.0T MR 3D-FIESTA序列成像技术可较为明显地将患者血管的压迫情况及临床症状统一地展示出来。说明3.0T MR 3D-FIESTA序列成像技术可有效辨别血管压迫性TN患者的责任动、静脉与神经的毗邻关系,可显著提高血管压迫性TN诊断的敏感度与准确率,为MVD治疗TN提供更准确的解剖学信息,具有较大的临床应用价值。     

神经内镜辅助手术治疗面部神经痛疗效分析

目的探讨神经内镜辅助下手术治疗面部神经痛的临床价值。方法回顾性分析神经内镜辅助下行微血管减压术(MVD)治疗的23例面部神经痛患者的临床资料,以及术后3个月～2年的随访结果。结果疼痛于手术后即刻完全缓解20例(87.0%),术后7d内缓解3例(13.0%);术后并发症均于3个月后缓解;无死亡及复发病例。结论运用神经内镜辅助手术治疗面部神经痛,可减少单纯显微镜下操作的手术死角,有助于判断责任血管及垫棉的位置,使MVD效果更可靠。     

经皮穿刺球囊压迫半月节治疗微血管减压术后复发性三叉神经痛

目的 探讨经皮穿刺球囊压迫半月节治疗微血管减压术后复发性三叉神经痛患者的临床疗效.方法 回顾性分析笔者医院神经外科于2009年11月～ 2012年8月采用经皮穿刺球囊压迫技术治疗的32例微血管减压术后复发性三叉神经痛患者的临床资料及疗效.结果 术后30例患者（93.4％）疼痛完全消失,1例偶疼痛但不需服用药物,1例疼痛服药可控制,整体有效率96.8％;术后进行18～51个月（平均28个月）的随访,3例轻度复发,2例重度复发,效果满意.术后手术同侧面部麻木31例（96.8％）,咀嚼肌无力19例（59.3％）,面部感觉异常2例（6.25％）,无严重手术并发症.结论 经皮穿刺球囊压迫术是治疗微血管减压术后复发性三叉神经痛的一种安全、有效的手术方法,可作为复发性三叉神经痛一种理想的微创治疗手段.     

Radiofrequency thermocoagulation rhizotomy for recurrent trigeminal neuralgia after microvascular decompression

Background  Microvascular decompression (MVD) is a well accepted surgical treatment strategy for trigeminal neuralgia (TN) with satisfying long-term outcome. However, considerable recurrent patients need more effective management. The purpose of this study was to evaluate the effectiveness of radiofrequency thermocoagulation rhizotomy (RTR) on patients with recurrent TN after MVD.

Methods  Totally 62 cases of recurrent TN after MVD undergoing RTR from January 2000 to January 2010 were retrospectively evaluated. Based on surgical procedures undertaken, these 62 cases were classified into two subgroups: group A consisted of 23 cases that underwent traditional RTR by free-hand; group B consisted of 39 cases that underwent RTR under the guidance of virtual reality imaging technique or neuronavigation system. The patients in group A were followed up for 14 to 70 months (mean, 40±4), and those in group B were followed up for 13 to 65 months (mean, 46±7). Kaplan-Meier analyses of the pain-free survival curves were used for the censored survival data, and the log-rank test was used to compare survival curves of the two groups.

Results  All patients in both groups A and B attained immediate pain relief after RTR. Both groups attained good pain relief rate within the first two years of follow-up: 92.3%, 84.6% and 82.6%, 69.6% respectively (P >0.05). After 2 years, the virtual reality or neuronavigation assisted RTR group (group B) demonstrated higher pain relief rates of 82.5%, 76.2% and 68.8% at 3, 4 and 5 years after operation respectively, while those in group A was 57.2%, 49.6%, and 36.4% (P <0.05). Low levels of minor complications were recorded, while neither mortalities nor significant morbidity was documented.

Conclusions  RTR was effective in alleviating the pain of TN cases suffering from unsuccessful MVD management. With the help of virtual reality imaging technique or neuronavigation system, the patients could attain better long-term pain relief.

     

MICROVASCULAR DECOMPRESSION FOR HEMIFACIAL SPASM - TECHNICAL NOTES AND COMPLICATION PREVENTION : EXPERIENCE OF 338 CASES

Objective To summarize our clinical experience of microvascular decompression (MVD)for medically intractable hemifacial spasm(HFS) patients with emphasis on microsurgical manipulation and to improve cure rate and avoid surgical complications. Methods Three hundred and thirty-eight patients with HFS underwent MVD under general anesthesia . With the help of "zero retraction" technique, prosthesis can be properly inserted between offending vessel loop and affected facial nerve REZ in a "rolling ball" fashion under operative microscope. Results Surgical intervention achieved high relief rate of 91 .4% and no major complications, with low recurrence rate of only 3.2% after averaging more than two years' follow-up ( M = 32 months). Conclusion It is possible to approach to the facial nerve REZ with "zero retraction", which is fundamentally important to clear from cranial nerve and cerebellar injury. Skilled microsurgical technique along with correct recognition and mobilization of offending vessels are a must     

Brainstem auditory evoked potential monitoring and neuro-endoscopy: Two tools to ensure hearing preservation and surgical success during microvascular decompression

BackgroundThe effectiveness of microvascular decompression (MVD) has made trigeminal neuralgia (TN), hemifacial spasm (HFS), glossopharyngeal neuralgia, and other cranial nerve rhizopathy diseases treatable by surgery. To ensure hearing preservation and surgical success, we have presented our experience in the application of brainstem auditory evoked potential (BAEP) monitoring and neuro-endoscopy during MVD.MethodsFrom July 2007 to October 2012, a total of 93 patients in our institution received MVD for cranial nerve rhizopathies. Among these patients, 43 had both BAEP monitoring and endoscope-assisted microsurgery for their MVD. None of the patients had undergone previous surgical treatment. Postoperative outcomes were assessed based on the medical records and clinical follow-up.ResultsThis study included 32 women and 11 men. There were 36 HFS cases and seven TN cases, and the median patient age at the time of MVD was 48 years. The median duration of symptoms before MVD was 4.2 years, and the median follow-up duration was 3.5 years (range 1.5 months–5 years). All of the patients had either immediate or delayed complete relief from the symptoms after MVD. One TN patient underwent gamma knife radiosurgery 3 years after MVD, and two HFS cases had recurrent slight spasms, which warranted no further treatment. There was no surgical mortality. The major complications included one HFS patient with delayed and permanent hearing loss and facial palsy, which occurred 1 week after MVD. The surgical success rate was 100%, and the hearing complication rate was 2%.ConclusionThe results of this retrospective study emphasized the importance of BAEP monitoring and neuro-endoscopy during MVD. It is well known that BAEP monitoring can preserve hearing function, and the endoscope offers neurosurgeons a second look to identify the nerve root entry zone and confirms the position of the Teflon felt. These two tools are especially useful in difficult cases.