微血管减压术治疗原发性三叉神经痛和面肌痉挛

Microvascular decompression for idiopathic trigeminal neuralgia and hemifacial spasm

目的探讨微血管减压术在三叉神经痛和面肌痉挛治疗中的疗效。方法回顾性分析2001年3月～2008年6月126例三叉神经痛和58例面肌痉挛患者的临床资料。所有病例均经枕下乙状窦后入路行相应神经的微血管减压术。三叉神经隔离技术为全程小脑脑桥角池段三叉神经予脑膜补片包裹并银夹固定;面神经隔离技术为在面神经出脑干处用2～3层修剪的脑膜补片隔离面神经和责任血管。结果随访3个月至8年,平均5.6年,三叉神经痛有效率96.1%,复发2例,神经并发症8例;面肌痉挛有效率100%,延期治愈4例,神经合并症7例。无手术死亡。结论微血管减压术是三叉神经痛和面肌痉挛的有效治疗方法,娴熟的显微神经外科技术、三维的小脑脑桥角池神经血管解剖知识和一定数量病例的积累是获得满意疗效的重要保证。

Objective To investigate the efficacy and complications of microvascular decompression technique for idiopathic cranial rhizopathies, including trigeminal neuralgia and hemifacial spasm. Methods 186 patients with idiopathic cranial rhizopathies, including 126 cases of trigeminal neuralgia and 58 cases of hemifacial spasm, were treated with microvascular decompression from March 2001 to August 2008. In cases of trigeminal neuralgia patients, the roots of trigeminal nerve in the cerebellopontine angle were wrapped with duropatch which was then fixed with a silver clip. In cases of hemifacial spasm, the root entry zone of the facial nerve was padded with two or three pieces of duropatch. The mean follow-up time is 5. 6 years. Results The efficacy rate in patients with trigeminal neuralgia and hemifacial spasm were 96 % and 100 % , respectively. The overall incidence of complications was 8.2 % withno surgical mortality. Conclusion Microvascular decompression is an effective treatment of idiopathic trigeminal neuralgia and hemifacial spasm. Adaptive surgical technique, threedimensional anatomy of cerebellopontine angle and surgeons＇ experience are indispensable combination for excellent outcome.