内窥镜配合显微镜微血管减压治疗三叉神经痛

目的总结采用内窥镜配合显微镜微血管减压术治疗三叉神经痛的临床治疗经验。方法 2008年3月～2011年3月,采用内窥镜配合显微镜微血管减压术治疗三叉神经痛41例。在显微镜下探查三叉神经整个脑池段全程,再以内窥镜观察三叉神经脑干端和Meckel腔内口处,显露压迫或接触神经根的动脉襻或静脉,静脉电凝后切断,动脉襻采用Teflon棉垫隔开。结果术中发现单纯动脉压迫29例,单纯静脉压迫6例,动静脉联合压迫6例。小脑上动脉25例,小脑前下动脉5例,小脑后下动脉3例,基底动脉2例,扭曲、冗长的椎动脉2例,其中2例为2根动脉压迫;岩静脉分支12例。术后疼痛立即消失34例,疼痛延迟缓解5例（术后2周4例,术后1个月1例）,疼痛无明显减轻2例。手术有效率95.1%（39/41）。术后轻度面瘫伴耳鸣1例,面部麻木1例,3周内症状均消失。39例有效者随访6个月～3年,平均21.4月,其中〉12个月31例,无复发。结论微血管减压术是治疗三叉神经痛的有效方法,内窥镜配合显微镜技术可有效降低术后并发症,减少创伤,避免遗漏责任血管。

Endoscopic-assisted Microvascular Decompression for Trigeminal Neuralgia

Objective To summarize our experience in endoscopic-assisted microvascular decompression for trigeminal neuralgia. Methods Since March 2008 to March 2011, we performed endoscopic-assisted mierovascular decompression on totally 41 patients with trigeminal neuralgia. By endoscopy, we explored the cisternal segment of the trigeminal nerve, and then the root entry zone and Meckel＇ s cave to identify the vessels compressing or touching the root of the trigeminal nerve. The vessels were cut by electrocoagulation （veins） or separated with Teflon felt （arteries）. Results Among the patients, the trigeminal nerves were compressed by arteries alone in 29 cases, by veins alone in 6, and by both arteries and veins in the other 6. The involved arteries included the superior cerebellar artery （25 cases） , anterior inferior cerebellar artery （5 cases） , posterior inferior cerebellar artery （3 eases） , basilar artery （2 cases） , and twisted vertebral artery （2 cases） ; in two of these patients, two arteries were involved in two cases. The involved vein was the branch of the petrous vein （ 12 cases）. After the operation, immediate pain extinction was achieved in 34 patients, delayed complete pain alleviation was reported by 5 cases in two weeks （4 patients） or one month （1 patient）, in the other two patients, the pain was not relieved. The effective rate of the procedure was 95.1% （39/41）. Postoperative complications included mild facial paralysis and tinnitus （ 1 case） , and facial numbness （ 1 case） , both the symptoms disappeared in three weeks. The 39 effective cases were followed up for a mean of 21.4 months （6 months to 3 years, 〉 12 months in 31 patients） , during which no patient had recurrence. Conclusions Microvascular decompression is effective for trigeminal neuralgia. We recommend endoscopic-assisted technique to decrease the rate of surgical complications and trauma, and avoid missing any involved arteries.