舌咽神经根切断术治疗舌咽神经痛12例疗效分析

目的 :评价乙状窦后径路舌咽神经根切断术治疗舌咽神经痛的效果。方法 :进行乙状窦后径路舌咽神经根切断术治疗舌咽神经痛 12例 ,对其中 3例伴有同侧三叉神经痛者 ,同时进行了三叉神经根显微血管减压术。结果 :所有 12例患者术后舌咽神经痛立即消失 ,3例伴有三叉神经痛者术后疼痛也消失 ,追踪 3个月～ 6a,无疼痛复发。结论 :乙状窦后径路舌咽神经根切断术是治疗舌咽神经痛安全而有效的方法     

Can fifth nerve mapping guide rhizotomy for recurrent trigeminal neuralgia? Case report

IntroductionMicrovascular decompression (MVD) is usually considered the first-line treatment for trigeminal neuralgia (TN) when medical treatments fail. Recurrence is rare and best treatment option is controversial. MVD was proposed as a feasible and effective technique for recurrent TN by many authors. Nevertheless, in a substantial number of cases, not any impingement or deterioration are found intraoperatively and partial selective rhizotomy is then advised. The rhizotomy site is mostly guided by anatomical landmarks, but variations due to scarring and adhesions are common pitfalls in these second surgeries. Intraoperative monitoring is infrequently used during MVD for trigeminal neuralgia. We describe the use of nerve mapping in a case of recurrence, revealing an unexpected rootlet distribution and thus safely guiding partial rhizotomy.Clinical presentationA 53-year-old woman had suffered from bilateral trigeminal neuralgia for 10 years. Symptoms began on the right side. MVD resolved her symptoms but, after a few months, she developed left TN which persisted after left MVD, radiofrequency and radiosurgery. She was referred to our center for a second MVD on the left side. Intraoperative inspection detected no relevant findings, and nerve mapping followed by partial selective rhizotomy was performed. Complete pain relief was achieved. There were no complications.ConclusionRhizotomy is seldom employed for refractory trigeminal neuralgia. The effects of previous treatments can jeopardize anatomical landmarks. Nerve mapping seems a promising tool to improve results.     

跳跃式椎板切除选择性脊神经后根切断治疗脑瘫性下肢痉挛9例

目的：探讨跳跃式椎板切除选择性脊神经后根切断治疗下肢痉挛性脑瘫的应用与疗效。方法我们对9例下肢痉挛性脑瘫患儿采取跳跃式、限制性椎板切除,仅切除L3、L5椎板,保留L4椎板和棘突;为L2、L3、L5、S1（或含S2）后根分束,在神经肌电图监测下选择性切断脊神经后根。结果9例患儿手术顺利,经随访9～24个月,肌张力均有下降,疗效显著;无脊柱畸形等远期并发症。结论跳跃式、限制性椎板切除选择性脊神经后根切断术治疗下肢痉挛性脑瘫具有一定的可行性,术中应注意选择合适的麻醉深度以及神经肌电监测。     

The efficacy of conventional radiofrequency denervation in patients with chronic low back pain originating from the facet joints: a meta-analysis of randomized controlled trials

Background Context

Radiofrequency denervation is commonly used for the treatment of chronic facet joint pain that has been refractory to more conservative treatments, although the evidence supporting this treatment has been controversial.

Electrophysiologically guided versus non-electrophysiologically guided selective dorsal rhizotomy for spastic cerebral palsy: a comparison of outcomes

Background  The perceived need for electrophysiological guidance (EPG) during selective dorsal rhizotomy (SDR) has limited the frequency with which SDR is performed. The need for EPG during SDR has been questioned. At our institution, of >200 children with SDR for spastic cerebral palsy, 22 children underwent SDR without EPG using clinical guidance (no EPG group). Electrophysiological stimulation was used to distinguish dorsal from ventral roots. The remainder had SDR with EPG. The purpose of this study was to compare outcomes between the groups having SDR with and without EPG. Methods  The 22 patients in the no EPG group were matched with 22 controls in whom EPG was used, with respect to Gross Motor Function Classification System score (GMFCS) and age. The 12-month outcomes with respect to motor function score, hip adductor spasticity (Ashworth), hip abduction range of motion (ROM), quadriceps power [Medical Research Council (MRC)], WeeFIM, Quality of Upper Extremities Skills Test (QUEST), and incidence of complications were compared. Results  There were no statistically significant differences preoperatively with respect to GMFCS, age, gross motor function, Ashworth or MRC scores, joint ROM, WeeFIM, or QUEST. At 1 year after SDR, there were no differences between the groups in the incidence of complications or outcome measures. Percentage of dorsal roots cut was similar, but the duration of surgery was significantly shorter in the no EPG group. Conclusions  There was no advantage of doing SDR with EPG compared to no EPG. SDR can reasonably be done in centers where EPG is not available, but electrophysiological stimulation to distinguish dorsal from ventral roots may be useful in avoiding complications.     

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。     

Heterotopic neurons in human spinal nerve roots: what is their clinical significance?

Summary The significance of heterotopic nerve cells in human spinal nerve roots was studied. Heterotopia was a consistent finding in 230 routine necropsy series (neuropathologically normal) and 16 spinal cord malformation cases, the incidence ranging between 2.1% and 10.9%. It was more frequently found in the cervical posterior roots than in the anterior roots or in other segmental levels. The heterotopia was not increased in dysraphic anomalies. Aberrant sensory nerve cells in the posterior roots and aberrant motor cells in the anterior roots were morphologically ascertained. The clinical significance of the sensory function of the heterotopia in the anterior roots is discussed and compared with previous experimental data.     

舌咽神经痛显微外科手术治疗后的远期疗效

目的 探讨舌咽神经痛的有效手术方法及远期疗效。方法 １９８６年至１９９８年间对２１例舌咽神经痛患者进行了外科手术治疗,其中显微血管减压术５例,血管减压术同时行舌咽神经根及迷走神经根上部１～２根丝切断术４例,舌咽神经根及迷走神经根上部１～２根丝切断术１２例。结果 ２１例患者术后疼痛全部消失,３例出现偶发性干,其中１例伴轻度声嘶及吞咽功能障碍。全部病例平均随访时间为７．２年,疼痛无１例复发。结论 显微     

Functional assessment following selective posterior rhizotomy in spastic cerebral palsy

This study used the Pediatric Evaluation of Disability Inventory as a functional assessment tool for children with spastic cerebral palsy undergoing selective posterior rhizotomy. Sixteen patients were followed for 3–12 months following surgery. Improvement in self-care, mobility, and social functional skills were found. Overall, the patients required less caregiver assistance and needed fewer modifications for self-care. The results suggest that selective posterior rhizotomy improves the quality of life in children with spastic cerebral palsy.     

Effect of dorsal rhizotomy on postural tremor in the monkey

Summary Rhizotomy of the dorsal roots of the upper limb in lesioned monkeys with lesioned-induced and harmaline-induced tremor caused complete anaesthesia and akinesia of the corresponding limb, which only showed purposeless movements. The rate and rhythm of postural tremor and the reciprocality of the bursts in opposite muscles were not affected by the rhizotomy; the incidence of tremor episodes was greater in some animals. Rhizotomy apparently interfered with the amplitude of the bursts which, at times, was less regular in the deafferented limb. In four out of six animals the rhizotomy involved the blood supply of the dorsal part of the lateral column. This caused a degeneration of the corresponding lateral corticospinal and dorsal spinocerebellar tracts, producing a weakness of the ipsilateral lower limb which gradually improved. Faster bursts (12–13/sec) were also noted on the EMG in response to harmaline in monkeys with cerebellar lesions.These findings suggest that the influence transmitted through the spinal dorsal roots does not play an important role in initiating postural tremor. The rate and rhythm of tremor episodes are uninfluenced by impulses transmitted through the dorsal roots which, however, apparently exert a stabilizing effect on the amplitude of the bursts.Visiting Scientist of the Medical Research Council of Canada. Dr. Ohye is on leave of absence from the Department of Neurosurgery, Faculty of Medicine, University of Tokyo.Holder of a Fellowship from the Medical Research Council of Canada.Holder of a Fellowship from the Quebec Medical Research Council.