原发性三叉神经痛的显微外科治疗

目的:探讨显微血管减压术治疗三叉神经痛的方法和经验。方法:报告236例原发性三叉神经痛患者行微血管减压术,所有病例均发现三叉神经入脑干区血管压迫神经,将血管与神经根分离,在其间植入Teflon棉片。结果:所有患者术后疼痛减轻或缓解,所有病例无严重并发症。结论:微血管减压术是治疗三叉神经痛的安全、有效方法;内镜辅助手术可提高手术治疗效果。     

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。     

乙状窦后锁孔入路微血管减压治疗原发性三叉神经痛

目的：探讨原发性三叉神经痛微血管减压治疗的疗效和手术技巧。方法：选择Teflon棉为减压垫,采用乙状窦后锁孔入路对30例原发性三叉神经痛行显微血管减压术治疗,随访观察其疗效。结果：三叉神经入脑干区有血管压迫者28例。术后疼痛立即消失27例,显著减轻者2例,1周内明显减轻者1例。随访3～15个月（平均8个月）,疼痛消失29例（96．3％）,服用卡马西平片控制满意者1例,无复发病例。结论：微血管减压术是原发性三叉神经痛有效的治疗方法,准确判定责任血管并采取适当材料及方法使三叉神经痛入脑干区减压是提高有效率,减少复发的主要措施。     

原发性三叉神经痛的显微外科治疗

三叉神经痛(trigeminal neuralgia ,TN)是一种在三叉神经分布区域出现的反复发作的阵发性剧痛,又称痛性抽搐,为神经性疼痛疾患中最常见者,其治疗仍然是神经外科的难点.尽管1976年Jannetta[1]提出神经血管压迫是原发性三叉神经痛的原因,并发展了显微血管减压术,但由于血管压迫并非系唯一原因,手术方案应以术中具体情况确定.1998-2006年对收治的原发性三叉神经痛53例,采用显微外科技术,根据术中探查有无血管压迫分别采用显微血管减压和感觉根部分切断术,取得了较好的手术效果.     

影响微血管减压术治疗三叉神经痛手术疗效的因素分析

目的探讨影响微血管减压术治疗三叉神经痛疗效的因素。方法选择68例原发性三叉神经痛患者进行微血管减压术治疗,详细描述病程、发病年龄、症状典型性、责任血管类型、压迫程度等因素,分析这些因素与手术疗效的关系。结果病程小于2年、症状典型、责任血管仅与神经相粘连者术后完全缓解、延迟缓解比例较高,相反,病程长、症状不典型、责任血管与神经关系复杂者疗效较差,差异有统计学意义。结论病程、症状是否典型、血管对三叉神经根的压迫程度是影响微血管减压术治疗三叉神经痛疗效的独立因素。     

神经微血管减压术治疗原发性三叉神经痛48例的临床分析

目的:观察神经微血管减压术治疗原发性三叉神经痛的临床疗效。方法:对48例三叉神经痛患者采用乙状窦后入路,用Teflon棉行三叉神经根显微血管减压术治疗。结果:本组治愈42例,显效3例,有效2例,总有效率为97.92%。结论:微血管减压术,使三叉神经功能可以得到保护,疗效确切,是首选治疗方法。通过内镜辅助治疗可提高微血管减压术的疗效。     

局麻下显微血管减压及神经松解术治疗颅神经疾病1956例的手术配合

目的 总结局麻下显微血管减压及神经松解术治疗颅神经疾病1956例的手术配合经验。方法 通过对局麻下显微血管减压及神经松解术治疗颅神经疾病1956例的手术配合，回顾性分析和总结该手术的配合要点。结果 手术确定了1462例三叉神经痛、428例面肌痉挛和51例舌咽神经痛患者的压迫责任血管；对1876例局部蛛网膜和颅神经间的粘连行神经松解手术；对45例行神经根部分切断。手术效果满意，总有效率100％。随访6个月至两年，疗效稳定。全组无术后死亡。结论 局麻下显微血管减压及神经松解术是治疗颅神经疾病的有效方法。良好的心理护理、周密的术前准备、个性化的术中配合是发现和防止遗漏责任血管的重要保证。     

显微血管减压术治疗原发性三叉神经痛28例体会

目的探讨原发性三叉神经痛的治疗方法。方法选择Teflon棉为减压垫,采用乙状窦后入路对28例原发性三叉神经痛患者行显微血管减压术治疗。结果28例中三叉神经入脑干区有血管压迫27例。术后疼痛立即消失22例,显著减轻2例,1周内减轻1例。随访10-35个月（平均16个月）,疼痛消失26例（92.86%）,复发1例,因并发症死亡1例。结论微血管减压是原发性三叉神经痛有效的治疗方法,准确判定责任血管并采取适当材料及方法使异常血管袢和三叉神经入脑干区分离是提高有效率、减少复发的有效措施。     

面神经显微血管减压术治疗原发性面肌痉挛(附60例分析)

目的:探讨显微血管减压术治疗面肌痉挛的手术疗效、并发症.方法:回顾性分析显微血管减压术治疗的60例面肌痉挛患者的临床资料.术前行颅脑CT排除继发性面肌痉挛.术中确认责任血管后,以Teflon棉分离血管与面神经.结果:本组术中均能见到动脉压迫面神经出脑干处(REZ),其中小脑前下动脉30例(50%),小脑后下动脉24例(40%),椎动脉1例(1.7%),多根血管压迫5例(8.3%).术后42例症状立即消失,17例明显好转,术后3个月仍未缓解者1例,术后1年复发者1例.常见并发症包括发热、头晕、头痛、呕吐52例,听力下降1例,脑脊液漏l例,切口感染6例.结论:面神经显微血管减压术是治疗原发性面肌痉挛的首选方法,良好疗效的关键是判断责任血管并以Teflon棉与面神经分离,同时防止术后颅内出血.     

三叉神经微血管减压术与部分切断术治疗三叉神经痛的疗效比较

目的:探讨三叉神经微血管减压术与部分切断术用于治疗三叉神经痛的临床疗效。方法:选择三叉神经痛患者75例,其中60例患者采取微血管减压术进行治疗(减压组),另15例因术中未找到责任血管而行部分切断术(切断组),比较两组患者手术结果及并发症情况。结果:减压组患者优良率为90%,切断组患者优良率为86.7%,两组患者疗效差异无统计学意义(P>0.05)。减压组并发症发生率明显低于对照组,但复发率则明显较高(P<0.05)。结论:临床上应根据三叉神经根血管压迫以及术后复发情况进行术式选择。     

锁孔入路微血管减压治疗面肌痉挛的临床研究

目的：探讨面肌痉挛微血管减压治疗的术前评估和手术技巧。方法：选择67例经MRTA检查确认面神经REZ存在责任血管的面肌痉挛患者,采用乙状窦后锁孔入路微血管减压治疗,对比观察术中发现责任血管情况。并随访分析手术疗效。结果：67例术中在面神经REZ均发现了责任血管并进行了充分减压,术后面肌抽搐立即停止37例．2周内停止9例,2个月内停止12例。2例术后轻度面瘫及3例术后耳鸣经对症治疗1周内恢复,1例存留听力下降,无颅内感染等其它并发症。随访3～48个月（平均10个月）,1例复发并较术前加重,3例症状改善不佳（抽搐频率减少〈50％）。4例明显改善（抽搐频率减少〉50％）,抽搐症状完全消失59例。总体有效率94．O％。结论：微血管减压术是血管源性面肌痉挛有效的治疗方法,术前MRTA评估、术中准确判定责任血管并充分减压有助于提高手术疗效．而责任血管穿行于面听神经之间是影响手术疗效的重要原因之一。     

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。     

神经内镜在三叉神经痛显微血管减压术中的应用价值

目的 探讨神经内镜辅助显微手术治疗原发性三叉神经痛的实用性及其优势.方法 回顾性分析62例应用神经内镜辅助显微血管减压手术治疗三叉神经痛的患者的临床资料和疗效.手术方式为经枕下乙状窦后入路,并在垫入Teflon垫片前后均置入30.神经内镜进行多角度观察,主要目的是观察神经全程及其周围血管,判别责任血管,并观察确认垫片位置,协助垫片调整.结果 62例三叉神经痛患者术后59例疼痛消失,3例疼痛减轻,无一例发生颅内感染、出血等并发症.结论 应用神经内镜辅助显微手术治疗三叉神经痛可以消除桥小脑角区显微手术的外科解剖死角,有助于正确地判断责任血管以及置入Teflon垫片,避免遗漏责任血管,协助调整垫片位置,能提高手术的疗效。     

显微微血管减压术在三叉神经痛的临床应用

目的探讨三叉神经痛微血管减压术的手术方法和手术效果。方法分析四川省人民医院神经外科124例行显微微血管减压术患者的临床结果、手术发现及随访资料。结果术后有103例得到随访,平均随访时间2.3年(2个月～9.1年),发作性疼痛彻底缓解92例(89.3%),部分缓解9例(8.7%),无效2例(1.9%))。术中发现88例(71.0%)系动脉压迫,静脉压迫23例(18.5%),在三叉神经出颅处发现一静脉球2例。静脉、动脉同时压迫者8例(6.5%)。另外5例(4.0%)未发现任何血管压迫,术中行三叉神经感觉根后下1/2切断。术后5例发生小脑血肿,其中2例需行开颅血肿清除术。术后脑脊液鼻漏1例。该组病例无一例死亡。结论三叉神经痛微血管减压术是一种安全、有效的手术,但其良好的效果取决于术前患者的选择与术中仔细的操作。     

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。     

Microvascular decompression in patients with hemifacial spasm: report of 1200 cases

Background Microvascular Decompression (MVD) operation is the most reliable treatment for hemifacial spasm (HFS), but it causes many complications. The aim of this retrospective study was to investigate the factors relavent to the effects and postoperative complications of microvascular decompression on hemifacial spasm. Methods A total of 1200 HFS patients treated with MVD were studied retrospectively. The root exit zone(REZ) of the facial nerve was exposed through the infraflocculus approach,the offending vessels were identified and separated from the REZ, and a Teflon graft was interposed between the offending vessels and the brain stem. Brain stem auditory evoked potential (AEP) was monitored intraoperatively. Results The offending vessels can be identified in all patients. The anteroinferior cerebellar artery was the main offending vessel (42.6%). Patients with vertebral artery compression had a multiple vascular compression fashion. Follow-up for 2-10 years (mean 4.2 years) showed that 88.7% patients were cured and 5.6% relieved, with an effective rate of 94.3%. Recurrence rate was 3.2%, and the ineffective rate was 2.6%. The most frequent complication washearing dysfunction (2.8%).Conclusions MVD is the most definitive treatment method of HFS. The key procedures of this operation include adequate exposure of the REZ, identification of the offending vessels, and proper positioning of Teflon grafts. Complications can be reduced effectively by utilizing a real-time AEP monitoring during the operation.     

小区域备头皮在微血管减压术治疗三叉神经痛和面肌痉挛中的应用

目的探讨小区域备头皮在微血管减压术治疗三叉神经痛和面肌痉挛术中应用的可行性。方法三叉神经痛和面肌痉挛女性病人62例(观察组),术前备皮仅理去手术区域的头发,术中先用外科贴膜贴于手术区及头发上,然后距切口线周围头发2 mm处剪去贴膜,用20 g/L碘酊擦试和体积分数0.75乙醇脱碘,消毒后再贴一层无菌手术贴膜,然后常规铺手术巾,铺完手术巾后再贴一层有引流袋的手术贴膜;以同期全部剃发备皮的病人106例作为对照。观察两组的切口愈合情况及抗生素应用时间。结果两组切口均无感染。观察组抗生素平均使用7.2 d,对照组抗生素平均使用6.8 d。结论小区域备头皮在微血管减压术治疗三叉神经痛和面肌痉挛术中应用是安全的。     

显微血管减压术治疗原发性三叉神经痛的临床研究

【目的】探讨显微血管减压手术治疗原发性三叉神经痛的手术效果。【方法】回顾性分析2009年1月-2013年5月在我科手术的90例原发性三叉神经痛病例,均采用枕下乙状窦后入路小骨窗开颅三叉神经显微血管减压术治疗,术中采用垫片隔开责任血管和三叉神经。【结果】75例患者术后疼痛完全消失（84％）,明显改善10例（11％）,总有效率95％,无改善4例（5％）。【结论】显微血管减压术创伤小,对血管和神经均无损伤,效果确切,是治疗原发性三叉神经痛的首选方法。     

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.