经鼻内镜手术治疗原发性三叉神经上颌支痛的初步观察

目的 探讨经鼻内镜蝶腭孔入路到达翼腭窝圆孔手术治疗三叉神经上颌支痛的可行性及优缺点.方法 选择原发性三叉神经上颌支痛患者15例,病程7个月～20年,中位病程4年;其中伴有眼支疼痛者8例,伴有下颌支疼痛者2例,三支均疼痛者1例.设计鼻内镜下微创手术方法 ,经鼻腔蝶腭孔入路,进入翼腭窝,探查圆孔,在上颌神经出圆孔的位置作高频电切或射频热凝处理.根据Brisman的术后评价方法 ,对比手术前后症状的改善,观察并发症的发生情况.结果 术后随访时间6～16个月,中位随访时间13个月.15例患者中治愈13例,有效2例.1例患者术后7个月出现眶上神经疼痛,再次行眶上神经射频热凝术,症状缓解.术中及术后均无严重并发症发生,1例患者术后出现麻痹性疼痛,随访1个月后症状消失.与术前相比,所有患者均无鼻或眼的主观不适症状.结论鼻内镜下经鼻腔蝶腭孔入路行原发性三叉神经上颌支痛微创手术,手术进路较直接,解剖距离短,视野清,创伤小,不易出现严重并发症,手术初步疗效肯定.

Surgery for primary trigeminal maxillary neuralgia under transnasal endoscope

Objective To explore the feasibility of endoscopic surgery for primary trigeminal neuralgia, and to evaluate its advantages and disadvantages. Methods Fifteen patients diagnosed as primary trigeminal neuralgia were included in this study. All of them had maxillary neuralgia, concurrently with 8 ophthalmic neuralgia and 2 mandibular neuralgia. The median course of disease was 4 years. The surgeries were performed by transnasal endoscope, through sphenopalatine foramen, into the pterygpalatine fossa, to find rotundum foramen, and then coagulated and cut the maxillary nerve. Pest-operative evaluation was done based on Brisman R's way. The pest-operative improvement of symptom was compared with preoperative symptom, and the complications of this operation were observed. Results The follow-up time was 6 months to 16 months, with the median time of 13 months. Thirteen patients were cured, 2 patients had effective outcome. Seven months after operation, 1 patient appeared supraorbital neuralgia. After the radiofrequency operation, the pain was improved. All of the patients had no serious complications and no subjective discomfort of nose and eyes. Condusions The surgery for primary maxillary neuralgia under transnasal endoscope had a direct way to rotundum foramen, with clear operative vision. It is a minimally invasive surgery, it can minimize the serious complications. The primary curative effect is confirmed.