小脑水平裂—小脑脑桥裂入路在三叉神经痛微血管减压术中的应用

Application of transcerebellar horizontal fissure cerebellopontine fissure approach in trigeminal microvascular decompression

目的探讨小脑水平裂-小脑脑桥裂入路在三叉神经痛微血管减压术中的应用。方法选取2018-03至2020-10在安徽医科大学附属第一医院神经外科就诊的72例三叉神经痛患者,术中岩静脉均存在阻挡,分为两组,一组采用小脑水平裂-小脑脑桥裂入路(脑裂组),一组常规小脑外侧入路(常规组),比较两组病例的岩静脉术中破裂或被切断的发生率及手术效果。结果脑裂组无一例术中岩静脉破裂或被切断,常规组岩静脉破裂6例(16.7%),术中被切断6例(16.7%),脑裂组术中岩静脉破裂或被切断的发生率小于常规组,差异有统计学意义(P<0.05)。两组疗效比较,差异无统计学意义(χ^(2)=6.063,P=0.109);但脑裂组治愈率高于常规组,差异有统计学意义(χ^(2)=5.171,P=0.023)。随访6个月,脑裂组复发率小于常规组(18.75%),差异有统计学意义(P<0.05)。结论在三叉神经痛微血管减压术中,经小脑水平裂-小脑脑桥裂入路可以降低术中岩静脉破裂或被切断的风险,且治愈率及术后6个月复发率均优于常规入路。

Objective To investigate the application of transcerebellar horizontal fissure cerebellopontine fissure approach in microvascular decompression for trigeminal neuralgia.Methods Seventy-two patients with trigeminal neuralgia treated in the department of neurosurgery of the First Affiliated Hospital of Anhui Medical University from March 2018 to October 2020 were divided into the cerebral fissure group which were treated with transcerebellar horizontal fissure cerebellopontine fissure approach and the normal group which were treated with normal lateral cerebellar approach.The incidence and effect of intraoperative rupture or disconnection of petrosal vein were compared between the two groups.Results There was no intraoperative petrosal vein rupture or cut-off in the cerebral fissure group.There were 6 cases of petrosal vein rupture(16.7%)and 6 cases of intraoperative cut-off(16.7%)in the normal group.The incidence of intraoperative petrosal vein rupture or cut-off in the cerebral fissure group was lower than that in the conventional group,and the difference was statistically significant(P<0.05);There was no significant difference between the two groups in curative effect(χ^(2)=6.063,P=0.109);But the cure rate of cerebral fissure group was higher than that of normal group,and the difference was statistically significant(χ^(2)=5.171,P=0.023).After 6 months of follow-up,the recurrence rate(0)of cerebral fissure group was lower than that of routine group(18.75%).The difference was statistically significant(P<0.05).Conclusion In microvascular decompression for trigeminal neuralgia,the transcerebral horizontal fissure cerebellopontine fissure approach can reduce the risk of intraoperative petrosal vein rupture or disconnection,and the cure rate and recurrence rate 6 months after operation are better than the conventional approach.