微创功能性手术治疗三叉神经痛相关问题探究.docVIP

微创功能性手术治疗三叉神经痛相关问题探究 　 作者：李光华，梁继锋，刘国伟，李秋丽，乔淑华 ［摘要］ 目的 探讨治疗三叉神经痛的功能性手术方式，讨论有关微创的相关问题。方法 回顾性分析1210例三叉神经痛患者的临床资料，采用经内镜下耳后小切口乙状窦后入路小脑脑桥角显微血管减压梳理术式或小脑脑桥角肿瘤切除术式进行治疗。结果 手术时间平均（1.2±0.3）h。发现责任血管1126例，占93.1%，其中为小脑上动脉1007例，基底动脉29例，用涤纶布或涤纶棉隔离；蛛网膜粘连但未发现责任血管17例，占1.4%；发现小脑脑桥角肿瘤继发三叉神经痛67例，占5.5%，其中原发性胆脂瘤39例，神经鞘瘤11例，脑膜瘤17例。可见三叉神经受压1193例，占98.6%。住院8～22天，平均11天。术中处理岩静脉806例。出现脑脊液耳鼻漏5例，小脑梗死2例，对侧颞叶硬膜下血肿1例，均治愈。无其他并发症及死亡病例。随访1～10年三叉神经痛复发4例，占0.3%，2例再次手术治愈。结论 内镜下耳后小切口乙状窦后入路小脑脑桥角显微血管减压梳理术是治疗三叉神经痛的理想术式。内镜用于手术可获得满意的临床效果，提高了责任血管的发现率，有助于脑组织和神经功能的保护，有临床推广应用价值。避免并发症的重要条件是掌握足够的局部解剖知识、熟练的内镜手术操作技术。 ［关键词］ 三叉神经痛；血管减压梳理术；功能性手术；微创；内镜术 Functional microneurosurgery for the trigeminal neuralgia ［Abstract］ Objective Approaching the operation of functional trigeminal neuralgia and to keep trigeminas physiological function by approach of postauricular suboccipital to the cerebellopontine angle（CPA） with posterior auricular small incision.Methods Since 1995，1210 cases （including 67 cases of tumors） of trigeminal neuralgia had received the operation of nervous decompression and combing by approach of postauricular suboccipital to the cerebellopontine angle.All cases were followed-up for 1 to 5 years，and the material was described in detail.Results The average operation time is （1.2±0.3）h.All patients were found responsible blood vessels，including 327 cases of superior cerebellar artery，11 cases of basilar artery.The root entry zone of the trigeminal were completely decompressed with Teflon.To expand the operated space 106 cases of petrosal veins were electrocoagulated by bipolar coagulation and cut off.All cases were cured through primary operation preserving the nervous and physiological function.The immediate cure rate was 100 percent，and during 6 months to 10 years follow-up，only 4 preliminary suffered relapse，among which 2 cases were cured by the secondary operation.The long term cure rate was 99.7 percent without occurrence of serious complications such as death.Conclusion The microneurosurgery of nervous de