围套式微血管减压术治疗舌咽神经痛32例临床分析

Microvascular decompression with an encircling method for glossopharyngeal neuralgia of 32 cases

目的 总结1982年至2005年采用围套式微血管减压术治疗32例舌咽神经痛的经验教训。方法耳后横切口，小骨窗，切开硬脑膜。牵开小脑半球后暴露舌咽神经和迷走神经。根据“责任血管”与舌咽神经的关系，分为贯穿型与非贯穿型。非贯穿型的患者，动脉或较粗的静脉要使之与舌咽神经分开，细小静脉则分开后电凝并切除与舌咽神经并行的部分。最后进行神经血管减压。将减压材料自血管与神经之间插入并包绕舌咽神经一周后前后两断端对合，以两银夹固定，这称为“围套式减压”；贯穿型患者，尽可能将血管推向舌咽神经远端，再行“围套式减压”。结果 术后当日疼痛消失31例（96．88％）。27例得到随访（84．38％），远期复发1例（3．13％），随访时间0．5～12年，平均4．5年。结论“围套式减压”可避免减压材料的滑脱、吸收，或新生血管重新压迫，还易于发现被神经根挡住的“责任血管”，疗效好，远期复发率低。

Objective To summarize the experience and lessons learned from 32 cases of glossopharyngeal neuralgia treated by microvascular decompression with an encircling method between 1982 and 2005. Methods A small transverse incision was made behind the ear, then to open a bony window and make an incision in the dura mater. First the cerehellar hemisphere was retracted and then the glossopharyngeal nerve and the vagus were exposed. According to the relationship of the ＂responsible vessel（s）＂ and the glossopharyngeal nerve, the ＂responsible vessel （s）＂ were divided into two types., the transfixing type and the non-transfixing type. Arteries and large veins should he separated from the glossopharyngeal nerve,and small veins he separated and electrocoagulated,and then he excised the concurrent part with the glossopharyngeal nerve. Finally,the neurovascular decompression was carried out with an encircling method. As for the nontransfixing type patient, the decompression material was inserted between the vessel（s） and the initial segment of the nerve root and fixed with silver clips after wrapping the nerve root. It was called ＂Microvascular decompression with an encircling method＂. For the patient with a transfi- xing type, the vessel（s） should he pushed to the distal part of the nerve and then to carry through the ＂microvascular decompression with an encircling method＂. Results Pain.relieved immediately after operation in 31 cases （96. 88%）. 27 cases （84.38%） were followed up with an average of 4. 5 years （0. 5 to 12 years） ,and the recurrent rate was 3. 13% （1 cases）. Conclusion Microvascular decompression with an encircling method could avoid the surge and/or absorbing of the decompression material, or the recompression of a renascence vessel, and the ＂responsible vessel（s）＂ which is shut out by the root of the cranial nerves could he found easier. Therefore, the curative effect is good and the recurrent rate is low.