总结面听神经根压迫综合征48例的手术治疗经验.DOCVIP

临床医学论文-总结面听神经根压迫综合征48例的手术治疗经验 【摘要】??　　目的?总结面听神经根压迫综合征48例的手术治疗经验，并对病因进行探讨。方法?经乙状窦后入路进入桥小脑角区，在手术显微镜下对面听神经根及周围进行仔细检查，寻找病因，对相关病灶给予相应微血管减压、粘连分解及面神经梳理等处理。结果?术中发现48例面听神经根均有责任血管压迫，其中16例伴有明显的蛛网膜增厚、粘连。术后全部病例均痊愈出院。随访1~15年，有2例耳鸣症状复发，4例面肌痉挛症状复发，但均较术前轻，无耳聋者。结论?面听神经压迫综合征48例，其致病因素以责任血管压迫为主，部分伴有蛛网膜粘连。? 【关键词】??面听神经；血管压迫；综合征?　　　Abstract： Objective? To summarize the 48 reports of the patients with auditory and cranial nerve root compression and research the causes of the disease.Methods? Cerebellopontine angle was reached via retrosigmoid approach. The auditory and cranial nerve root was carefully checked so that the causes could be found. Microvascular decompression (MVD), adherence splitting and cranial nerve combing were performed to different niduses under microscope.Results?The auditory and cranial nerve roots were found to be oppressed by primary blood vessels in all the patients, 16 of whom were accompanied with arachnoid thickening and adhesion. All the patients were operated successfully and discharged. Tinnitus recurred in two patients and mimetic convulsion recurred in four ones according to 1-15 years, followup, but they were ameliorated after operation. Conclusion? The main etiological factor of auditory and cranial nerve compression syndrome is oppression of primary blood vessel as to the 48 patients. Some ones suffer from additional arachnoid thickening and adhesion. 　　Key? words： auditory and cranial nerve; primary blood vessel oppression; syndrome?????1990年6月—2006年3月，经乙状窦后入路，桥小脑角显微手术828例，其中面听神经根探查、微血管减压及梳理术治疗面听神经根压迫综合征48例，效果满意，现报告如下。2007年12月?第35卷?第6期临??床?军?医?杂?志?(Clin?J?Med?Offic) 　　1??资料与方法 　　1.1??一般资料? 　　面听神经压迫综合征48例，男18例，女30例；年龄22~78岁，平均52.2岁；病史2~40年，平均6.5年；左侧25例，右侧21例，双侧2例。临床表现为在同一侧既有面肌痉挛(简称HFS)的症状体征，又有与颈动脉和心脏搏动相一致的节律性耳鸣，部分病人伴有不同程度的眩晕及听力减退等症状，压迫同侧颈动脉时耳鸣症状可明显减轻或消失，长期非手术治疗效果不佳。 　　1.2??手术方法? 　　患者平卧位头抬高15°，略偏向健侧，在局麻下于患侧乳突后中下部作一长宽约4?cm×3?cm?之“U”形切口，一次性切开皮肤、皮下组织、肌肉及骨膜。用骨膜剥离子沿颅骨壁依次向前剥离，并将该“U”形骨膜肌皮瓣向前翻转固定，用开颅钻在乙状窦后缘与横窦下缘夹角处钻开一直径约2?cm?之骨窗，“U”形切开硬脑膜并向前翻起，在20%甘露醇