原发性舌咽神经痛显微外科手术治疗的并发症

Complications of Microneurosurgical Treatment for Glossopharyngeal Neuralgia

目的探讨显微神经外科手术治疗原发性舌咽神经痛的并发症的防治。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,包括显微血管减压术17例,舌咽神经根及迷走神经根上部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及迷走神经根上部1～2根丝切断术17例。结果100%患者术后即刻疼痛全部消失。44例患者获平均6.1年的随访,随访期间治愈率为100%。无1例疼痛复发。并发症包括吞咽困难、饮水呛咳、声嘶6例,阵发性干咳4例,耳鸣1例,化脓性脑膜炎1例,无菌性脑膜炎2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是有效、安全的,合理选择术式、熟悉局部显微解剖、掌握娴熟显微手术技巧和积累丰富手术经验是降低并发症发生率的前提。

Objective To explore the prevention and treatment of the complications of microneurosurgery for glossopharyngeal neuralgia. Methods Fifty patients with glossopharyngeal neuralgia were treated by microneurosurgery through retrosigmoid key hole approach from May 1986 to July 2005. Of 50 patients, 17 received microvascular decompression（MVD）, 16 rhizotomy of glossopharyngeal nerve root and upper 1-2 rootlets of vagal nerve root（R）, 17 MVD＋R. Results The pain disappeared in all the patients immediately after the operation. Forty-four patients, who were averagely followed up for 6.1 years. The cured rate was 100%, and the neuralgia did not recur in all the 44 patients during the follow-up period. The postoperative complications included dysphagia, choking and coughing over self water, and hoarseness （6 eases）, tits of coughing （4 cases）, tinnitus （1 case）, suppurative meningitis （1 case）, and chemical meningitis（2 case）. Conclusions MVD, R and MVD＋R are effective and safe microneurosurgical methods for the treatment of glossopharyngeal neuralgia. The measures to prevent eomplieations include proper choice of surgical fashion, and good understanding of the regional mieroanatomy, skilful microsurgical techniques and surgical experienee.