原发性舌咽神经痛的脑内窥镜微创治疗

Endoscopic Minimally Invasive Surgery for Primary Glosspharyngeal Neuralgia

目的探讨在脑内窥镜下乙状窦后入路舌咽神经微创手术治疗原发性舌咽神经痛的临床效果。方法2000年1月～2008年5月,对16例原发性舌咽神经痛,在脑内窥镜下经乙状窦后入路行舌咽神经微血管减压/切断术。患侧耳后纵行发际内缘切口,桥小脑角池释放脑脊液,形成操作通道,在脑内窥镜下广泛分离松解蛛网膜粘连,探查舌咽神经结构以及局部动脉走形。其中行舌咽神经切断术9例,单纯血管减压加舌咽迷走神经梳理7例。结果16例咽部疼痛术后均消失。16例随访3个月～8年,其中1～3年4例,3～8年2例。声音嘶哑2例,无吞咽困难,无复发。结论该手术具有创伤轻微、视野清晰、操作精确、疗效确切、术后反应轻、恢复快等特点。

Objective To explore the outcomes of endoscopic minimally invasive surgery as a new technique for the treatment of glossopharyngeal neuralgia. Methods From January 2000 to May 2008, 16 cases of primary glossopharyngeal neuralgia were treated by endoscopic minimally invasive surgery through suboccipital retrosigmoid approach in our hospital. We made a 6- to 8-cm vertical incision within the inner hairline to drain the cerebrospinal fluid from the cerebellopotine angle cistern （CPA） so that to form an operational path. And tlien, the adherent arachnoid membrane was freed and the structure of the glossopharyngeal nerve and local arteries were detected. Results After the endoscopic surgery, pharyngeal pain disappeared in all of the 16 cases. Follow-up was available for 3 months to 8 years in the patients （ 1 - 3 years in 4 cases, and 3 - 8 years in 2 cases）. Two patients had hoarse voice after the operation. No one had dysphagia or recurrence during the follow-up. Conclusion Endoscopic surgery through suboccipital retrosigmoid approach is a minimally invasive method for primary glossopharyngeal neuralgia with good outcomes, mild surgery-related complications, and quick post-operative recovery.