颅后窝锁孔入路微血管减压术治疗原发性三叉神经痛

目的 总结锁孔入路治疗原发性三叉神经痛的手术技巧及治疗效果.方法 采用锁孔入路微血管减压术治疗原发性三叉神经痛128例,其中三叉神经根人脑干区有明显血管压迫123例,难以明确责任血管5例.结果 术后随访6～48个月,平均32个月.治愈102例,显效16例,有效8例,无效2例.复发4例,经再次行微血管减压术治愈2例.术后出现周围性面瘫3例,同侧听力下降1例,经对症治疗痊愈,无颅内感染及死亡病例.结论 三叉神经微血管减压术可作为治疗原发性三叉神经痛的首选外科方法.     

前庭蜗神经显微血管减压术的初步报告

目的 探讨前庭蜗神经显微血管减压术(MVD)治疗耳鸣、眩晕的疗效.方法 10例耳鸣患者,5例眩晕患者,2例耳鸣伴眩晕的患者,均合并三叉神经痛(TN)或者面肌痉挛(HFS),以上患者均在实施乙状窦后入路手术治疗TN、HFS的同时行前庭蜗神经MVD治疗伴随的耳鸣或眩晕.3例单纯耳鸣患者以及1例单纯眩晕患者均接受乙状窦后入路单纯前庭蜗神经MVD,治疗耳鸣或眩晕.结果 术中均发现有动脉性血管压迫前庭蜗神经.术后即刻疗效:15例耳鸣患者中治愈7例,好转5例,无效3例;8例眩晕患者中治愈4例,好转2例,无效2例.平均随访8个月,随访疗效:15例耳鸣患者中治愈8例,好转4例,无效3例,总有效率80%;8例眩晕患者中治愈4例,好转2例,无效2例,总有效率75%.1例单纯耳鸣患者术后出现患侧听力丧失,随访期间未恢复.结论 血管压迫前庭蜗神经是顽固性耳鸣、致残性眩晕的病因之一;MVD针对有选择的耳鸣、眩晕患者是一种安全、有效的治疗方法.     

微血管减压术治疗面肌痉挛并耳聋、耳鸣

目的探讨微血管减压术治疗面肌痉挛并耳聋、耳呜的临床疗效。方法我科自2000年6月至2006年6月在局麻下对17例面肌痉挛并耳鸣、耳聋的患者施行了微血管减压术。术中分别松解动脉对第Ⅶ、Ⅷ颅神经的压迫，并以Teflon片分隔神经与血管。结果所有患者面肌痉挛均治愈。9例耳聋症状完全缓解，8例耳聋症状明显改善；15例耳呜症状完全缓解，2例耳鸣症状明显改善。结论微血管减压术对由血管压迫引起的面肌痉挛并耳聋、耳鸣患者疗效明确。     

第Ⅷ脑神经切断术治疗面肌痉挛术后继发性顽固眩晕症

目的探讨显微血管减压术后顽固眩晕的合适手术方式。方法回顾性分析6例保守治疗无效的显微血管减压术后继发性顽固性眩晕病人的临床资料,均伴有严重耳鸣及听力下降,行乙状窦后入路第Ⅷ脑神经切断术。手术前后分别观察病人症状改善情况、并发症发生情况,采用生存质量测定量表简表(WHOQOL-BREF)进行评分。结果术后病人眩晕、耳鸣症状均得到有效控制。术后WHOQOL-BREF评分均增高,与术前比较差异有统计学意义(P0.05)。随访6例,时间1~3年,眩晕无复发。结论采用第Ⅷ脑神经切断术治疗面肌痉挛术后继发性顽固眩晕有较好的效果,但病例选择应十分慎重,病例选择条件及远期疗效仍需要进一步观察。     

微血管减压术治疗原发性三叉神经痛84例分析

目的总结微血管减压术治疗三叉神经痛的临床经验。方法回顾性分析采用微血管减压术治疗的84例三叉神经痛患者的临床表现、术中所见、手术疗效及并发症的发生。结果 84例中80例术中发现责任血管压迫,4例无血管压迫而仅见蛛网膜粘连。术后疼痛消失76例,减轻6例,无效2例。术后随访6~62个月,未见一例复发。术后并发症:切口愈合不良13例,脑脊液耳漏1例,面部感觉麻木3例,面瘫2例,听力下降2例,耳鸣3例,颅内感染2例,无死亡及致残患者。结论微血管减压术是治疗三叉神经痛的可靠方法。对桥小脑角区局部解剖的熟悉,规范娴熟的手术操作,积极应用监测技术,神经内镜的辅助是提高手术疗效、减少并发症发生的关键。     

微血管减压术治疗功能性脑神经疾病(附496例临床分析)

目的探讨微血管减压术治疗功能性脑神经疾病的临床价值、手术中的处理选择及并发症的预防。方法采用耳后小切口微血管减压术治疗功能性脑神经疾496例,共504例次手术,三叉神经痛408例,共进行了416例次手术;面肌痉挛82例;舌咽神经痛6例。术中根据血管与神经的压迫关系分为单纯接触、袢状压迫、黏连包绕和贯穿等4型,并根据不同的压迫类型进行不同的处理。结果本组经1年以上随访,三叉神经痛第一次术后疼痛立即消失312例,明显进步59例,进步24例,无效6例,复发6例。面肌痉挛术后62例抽搐停止,19例术后仍有面部不同程度的抽搐,3例病人无效。舌咽神经痛术后疼痛均消失,无复发。结论微血管减压术治疗功能性脑神经疾病效果肯定,其疗效与血管压迫神经的类型有关。     

面肌痉挛微血管减压手术技巧及并发症分析(附34例报告)

目的探讨微血管减压术治疗面肌痉挛的手术策略及术后并发症。方法采用微血管减压术治疗原发性面肌痉挛患者34例。术前所有患者均行MRI或MRA检查,排除继发性因素并确定责任血管与面神经关系;分析术中经过及术后并发症。结果术后症状立即消失26例(76.5%,26/34),8例好转;术后并发症:9例耳鸣或听力下降,2例脑脊液耳漏,1例脑脊液鼻漏,1例颅内感染,2例面瘫。未见无效病例。随访6个月～3年,31例治愈,1例术后约1年复发;3例听力下降。结论微血管减压术治疗面肌痉挛效果确切,有针对性的手术策略和细致的手术操作能显著减少并发症的产生。     

微骨孔显微血管减压术治疗原发性三叉神经痛32例的临床分析

目的探讨总结微骨孔显微血管减压术治疗原发性三叉神经痛的中的责任血管,并分析手术疗效。方法收集2014年1月至2017年4月在阜阳市第五人民医院采用微骨孔显微血管减压术治疗的原发性三叉神经痛患者32例,根据术中所见分析责任血管,并分析术后临床疗效。结果 32例患者中,术中发现单一动脉血管压迫者22例(68. 75%),2支及以上8例(25. 00%),未探查到责任血管的2例(6. 25%);术后出现周围性面瘫、同侧听力下降饮水呛咳和脑脊液漏各1例,无脑出血、颅内感染和死亡病例;完全缓解24例,显著缓解5例,部分缓解2例,无效1例,总有效率为96. 88%,随访6个月无复发病例。结论原发性三叉神经痛患者的责任血管多变,术中需仔细探查充分减压,微骨孔显微血管减压术治疗的临床疗效好,术后并发症少,安全性高。     

非典型性面肌痉挛(附36例报告)

目的 探讨非典型性面肌痉挛的发病机制和手术治疗方法.方法 回顾性分析2005年7月到2010年7月采用显微血管减压术治疗的36例面肌痉挛病例,临床表现均为非典型性发作.结果 32例患者术后面肌痉挛立即消失,4例患者术后痉挛减轻但未消失,随访5个月时完全消失.随访12-72个月,平均42个月,延迟治愈者4例(11％),无复发病例.术后发生并发症6例(17％),包括中度面瘫、听力下降3例,听力下降伴耳鸣3例;随访期间均好转.结论 非典型性面肌痉挛患者神经受血管压迫位置一般位于面神经出脑干区的远侧端,采用显微血管减压术可获良效,但术后发生面瘫、听力障碍的概率升高.术中责任血管的准确识别、实时脑干听觉诱发电位监测、避免颅神经和细小血管的损伤,有助于提高疗效、减少并发症的发生.     

微血管减压术治疗脑神经血管压迫综合征

目的 总结和分析微血管减压术(MVD)治疗脑神经血管压迫综合征的疗效与术后并发症. 方法 应用MVD治疗脑神经血管压迫综合征39例(三又神经痛19例,面肌痉挛18例,舌咽神经痛2例)并探讨手术技巧及术后并发症的防治.结果 2例舌咽神经痛患者和17例三叉神经痛患者术后疼痛立即消失,面肌痉挛患者中有16例术后痉挛立即消失.术后无血肿、感染、脑脊液漏、偏瘫和死亡病例.34例获随访,平均随访1.58年,其中32例效果良好. 结论 MVD治疗脑神经血管压迫综合征安全、微创、有效,是目前治疗脑神经血管压迫综合征的首选方法.     

Microvascular decompression as a treatment for cranial nerve hyperactive dysfunction – a critical view

Neurovascular compression has been postulated as a probable mechanism for a large number of cranial nerve syndromes, with trigeminal neuralgia (TGN) as the prime example. Microvascular decompression (MVD) is often cited as the procedure of choice for treatment of medically refractory TGN. Arguments against these assumptions are: MRA studies indicate that vascular contact with the trigeminal nerve is present in most healthy individuals. Treatment results of MVD in multiple sclerosis patients with TGN are almost as good (at least in the short term) as in idiopathic cases. MVD is reported to provide pain relief even in TGN patients without visible neurovascular contact . In other syndromes of cranial nerve'hyperactive dysfunction'– vertigo, tinnitus and neurogenic hypertension – the documentation is even weaker.     

运用磁共振弥散张量成像观察显微血管减压术后三叉神经的结构变化

目的：利用磁共振弥散张量成像（DTI）序列,观察显微血管减压术（MVD）后,三叉神经痛（TN）患者三叉神经的微观结构改变。方法9例原发性 TN 患者术前及术后行 DTI 扫描,测算两侧三叉神经向异性分数（FA）、平均弥散率（MD）、轴向弥散率（AD）、垂直弥散率（RD）和两侧各弥散参数差值比。按手术疗效分为治愈和未治愈两组,分析两组患者在手术前后,两侧三叉神经各 DTI 参数及两侧间各弥散参数差值比的变化。结果男性6例,女性3例;平均年龄52．1岁,平均病程5．1年。于术后第一次复查（平均12．3个月）时行 DTI ,术后疗效随访平均66个月。治愈组6例,均有明显的血管压迫,三叉神经有受压变形;未治愈组3例,2例有血管压迫,1例患者仅有严重的蛛网膜粘连而无血管压迫。治愈组术前患侧明显下降的 FA 值及明显上升的 MD 、RD 值,术后复查时均恢复。而未治愈组的各弥散参数及差值比则在手术前后无明显变化。结论 MVD 术后疼痛消失的患者,患侧三叉神经的脱髓鞘变恢复正常。然而术后疼痛仍然存在的患者,神经的脱髓鞘变依然存在。三叉神经的脱髓鞘变与 TN 关系密切。     

Hemifacial spasm: a prospective long-term follow up of 83 cases treated by microvascular decompression at two neurosurgical centres in the United Kingdom.

OBJECTIVE--To evaluate the use of microvascular decompression (MVD) for the treatment of hemifacial spasm (HFS). METHODS--Eighty three patients with HFS who underwent MVD via a suboccipital craniectomy are presented. RESULTS--Seventy two out of seventy eight patients available for follow up remained free of any spasms at a mean follow up period of eight years. Two patients continued to have minor intermittent muscle twitches and three had recurrence of HFS. One patient's operation was not completed. Twenty had a transient complication and eight were left with permanent postoperative deficits, the commonest being unilateral sensorineural deafness. Seventy one patients declared themselves satisfied with the procedure. A causative vessel was found on the root exit zone of the seventh cranial nerve in 81 patients. CONCLUSION--The procedure seems to provide lasting relief for most patients. The correct operative technique is essential if complications are to be avoided.     

Spontaneous internal carotid artery dissection with lower cranial nerve palsy

BACKGROUND: Typical presentation of spontaneous internal carotid artery (ICA) dissection is an ipsilateral pain in neck and face with Horner's syndrome and contralateral deficits. Although rare, lower cranial nerve palsy have been reported in association with an ipsilateral spontaneous ICA dissection. CASE STUDIES: We report three new cases of ICA dissection with lower cranial nerve palsies. RESULTS: The first symtom to appear was headache in all three patients. Examination disclosed a Horner's syndrome in two cases (1 and 2), an isolated XIIth nerve palsy in two patients (case 1 and 3) and IX, X, and XIIth nerve palsies (case 2) revealing an ipsilateral carotid dissection, confirmed by MRI and angiography. In all cases, prognosis was good after a few weeks. CONCLUSIONS: These cases, analysed with those in the literature, led us to discuss two possible mechanisms: direct compression of cranial nerves by a subadventitial haematoma in the parapharyngeal space or ischemic palsy by compression of the ascending pharyngeal artery.     

原发性舌咽神经痛的显微神经外科手术治疗

目的探讨显微神经外科手术治疗舌咽神经痛的疗效.方法对50例舌咽神经痛病人采用枕下乙状窦后锁孔入路,行显微血管减压术(MVD)17例,舌咽神经根及迷走神经根上部1～2根丝切断术(R)16例,两种术式合用17例.结果术后病人疼痛均即刻消失.44例病人获平均6.1年的随访,疼痛均无复发.并发症包括吞咽困难、饮水呛咳、声音嘶哑6例,阵发性干咳4例,无菌性脑膜炎2例,耳鸣1例,化脓性脑膜炎1例.结论枕下乙状窦后锁孔入路显微神经外科手术治疗舌咽神经痛安全、有效.     

面肌痉挛显微血管减压术后远期疗效及影响因素分析

目的评价显微血管减压术（MVD）治疗面肌痉挛的远期疗效,并分析影响其疗效的相关因素。方法回顾性分析473例经MVD治疗的面肌痉挛病人的临床资料,观察术后疗效、复发率及相关并发症：并通过有序多分类Logistic回归分析影响MVD疗效的相关因素。结果经MVD治疗后痊愈359例（75．9％）,缓解86例（18．2％）,无效28例（5．9％）,总有效率达94．1％。有序多分类Logistic回归分析显示：术中面神经受压程度和术中异常肌反应（AMR）检测消失情况对病人的远期疗效有显著影响（P〈0．01）。随访期间复发11例,行再次手术5例。面瘫、耳鸣和脑脊液漏等术后并发症均在随访期间恢复,部分听力下降病人无改善。结论MVD治疗面肌痉挛安全、有效。在明确解除责任血管压迫的前提下,术中面神经可见有压迹和术中AMR消失的病人,MVD的远期疗效更好。     

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.     

左侧延髓血管减压术治疗原发性高血压病的疗效研究

目的 探索左侧延髓微血管减压术(MVD)对颅神经疾病、脑出血病人的原发性高血压病的手术疗效.方法 26例左侧幕上脑内血肿、2例小脑血肿病人在血肿清除后,再行同侧枕下乙状窦后开颅,并对延髓进行MVD,其中15例病人是急诊手术;4例三叉神经痛、2例听神经瘤、1例三叉神经鞘瘤、1例舌咽神经痛的高血压病人,在完成肿瘤切除、颅神经MVD手术后再行MVD.观察病人的血压以及降血压药物用量和种类的变化.结果 术中发现压迫延髓和迷走神经根入脑区(REZ)的责任血管为小脑后下动脉20例,椎动脉主干11例,小脑前下动脉5例;其中接触型14例、压迫型10例、粘连型9例、贯穿型3例.24例高血压病得到治愈、好转10例、2例无效.结论 左侧延髓MVD可以有效治疗原发性高血压病.术中仔细探查远离REZ区的血管袢,并解除它们对迷走神经及延髓腹外侧的"琴弦式"牵拉刺激可以提高延髓MVD治疗原发性高血压病的疗效.     

选择性舌咽、迷走神经根丝切断术治疗舌咽神经痛

目的探讨选择性舌咽神经根、迷走神经根丝切断术治疗原发性舌咽神经痛的解剖基础、临床术式选择及疗效。方法1986年5月至2005年7月对50例舌咽神经痛患者进行了显微神经外科手术治疗,均采用枕下乙状窦后锁孔入路,其中显微血管减压术17例,舌咽神经根、迷走神经根上部1~2根丝切断术16例,显微血管减压术同时加行舌咽神经根、迷走神经根上部1~2根丝切断术17例;2004年3月至2005年3月在113例面肌痉挛和5例舌咽神经痛病例显微手术中探查观察舌咽神经根与迷走神经根丝的解剖关系类型。结果33例行选择性舌咽神经根、迷走神经根丝切断术的患者100%术后即刻疼痛全部消失,其中31例获平均6.3年的随访,随访期间治愈率为100%。疼痛无1例复发。并发症包括:5例出现吞咽困难、饮水呛咳、声嘶,3例有阵发性干咳,耳鸣1例,化脓性脑膜炎1例,无菌性脑膜炎1例。118例显微手术中探查观察发现舌咽神经根与迷走神经根丝的解剖关系有5种类型。结论选择性舌咽神经根、迷走神经根丝切断术治疗舌咽神经痛是有效、安全的;可以根据术中探查舌咽神经根与迷走神经根丝的解剖关系类型来进行术式选择。