“D”字形骨窗微血管减压术治疗三叉神经痛

"D"-shaped bone window microvascular decompression for treating trigeminal neuralgia

目的探讨微血管减压(MVD)术治疗三叉神经痛术中,采用"D"字形骨窗特点及作用。方法76例枕下乙状窦后入路MVD术中,采用"D"字形骨窗,即一端暴露出横窦与乙状窦交界处,另一端到达枕骨大孔缘上(颈静脉孔球边缘)。外侧暴露出乙状窦外缘或到乳突气房暴露,以此形成"D"字形骨窗。"D"形骨窗两端的位置最为重要,是术中有效探查桥小脑角区与后组颅神经的重要解剖标准点。以"D"两端为基准,弧形切开硬脑膜,并术后原位缝合。结果76例行MVD术中根据"D"形骨窗两端的硬脑膜切口端分别探查三叉神经、面神经"敏感区"及血管的关系,同时探查后组颅神经,锐性分离粘连在神经上的蛛网膜,72例发现并移开压迫神经的血管,在神经与血管之间置入减压材料,4例探查后组颅神经过程中发现压迫舌咽神经"敏感区"的血管,实施减压,术后镇痛。关颅后,根据"D"形骨窗外形进行颅骨修补。结论枕下乙状窦后入路MVD术式中,"D"字形骨窗,与圆形骨窗或三角形骨窗相比,更讲求对骨窗下缘的要求,更能有效的释放脑脊液。"D"字形骨窗更适合探查后组颅神经,避免因遗漏压迫舌咽神经的血管,而术后仍然疼痛者。"D"字形骨窗能更好显露术野,是成功实施MVD术的最为重要的一个步骤。

Objective To explore the microvascular decompression （MVD） surgery for the treatment of trigeminal neuralgia using ＂D＂-shaped bone window. Method Suboecipital retrosigmoid approach MVD surgery using ＂D＂-shaped bone window was performed in 76 cases, i.e exposed at one end and the transverse sinus sigmoid sinus junction, the other side of foramen magnum fate got up （the ball edge of the jugular foramen）; Outside the outer edge exposed sigmoid sinus or mastoid air room exposed to the formation of ＂D＂-shaped bone window. ＂D＂-shaped bone window position at both ends were the most important, they are important standard points of effective exploration technique in the eerebellopontine angle and lower cranial nerve anatomy. Both ends of the ＂D＂ were taken as the base, curved dural incision, and postoperative suture in situ. Result MVD in 76 cases in accordance with ＂D＂-shaped bone windows at both ends of the dural incision client separately detecting the relationship of the trigeminal nerve, facial nerve root entry/exit zone and vascular. At the same time, exploration of cranial nerves, sharp separation of adhesions in the nerve on the arachnoid; nerve blood vessels of 72 cases were found and removed decompression materials were implantated between the nerves and blood vessels; cranial nerve exploration of 4 cases found pression of glossopharyngeal nerve root entry/exit zone of the blood vessels, decompression, postoperative analgesia were just taken. According to ＂D＂-shaped bone window cranioplasty was taken after the closure of skull. Conclusion Suboccipital retrosigmoid approach operation in the MVD, compared with a circular bone window or triangular bone window, ＂D＂-shaped bone window can be more emphasis on the lower edge of the bone window requirements and more effective release the eerebrospinal fluid. ＂D＂-shaped bone window is more fit in cranial nerves（X,XI,XII,） exploration, avoid still postoperative pain caused by omission the oppression of the glossopharyngeal nerve of the blood vessels. D ＂-shaped bone window carl reveal a better surgical perspective, it is one of the most important step during the successful implementation of MVD surgery.