乙状窦后锁孔手术治疗三叉神经痛、半面痉挛和舌咽神经痛

Surgery by a retro-sigmoid keyhole approach in treatment of trigeminal neuralgia,hemi-facial spasm and glossopharyngeal neuralgia

目的评价锁孔术治疗三叉神经痛(TN)、半面痉挛(HFS)和舌咽神经痛(GPN)的疗效。方法 对207例患者实施乙状窦后锁孔入路微血管减压术(MVD)和神经切断术,其中三叉神经痛169例,半面痉挛31例,舌咽神经痛7例。结果三叉神经痛治愈和好转160例(94.7%),无效9(5.3%);半面痉挛患者治愈29例(93.5%),无效2例(6.5%);舌咽神经痛患者治愈7例(100%)。术后未发生严重并发症,如死亡或小脑、脑干梗死等。其他并发症有小脑血肿1例,中度听力损失3例,暂时性面瘫3例,一侧声带不完全性麻痹1例。结论经乙状窦后锁孔入路微血管减压和神经切断术安全有效。

Objective The aim of the study was to describe and evaluate the efficacy of keyhole microsurgery to manage patients with trigeminal neuralgia（TN）,hemi-facial spasm（HFS） and glossopharyngeal neuralgia（GPN）.Methods Two hundred and seven patients underwent micro-vascular decompression（MVD） and neurotomy via the retro-sigmoid keyhole approach in our department clinic： MVD for trigeminal neuralgia 169 cases,hemifacial spasm 31 cases,glossopharyngeal neuralgia 4 cases and neurotomy for glossopharyngeal neuralgia 3 cases.There was no serious complication such as deaths or infarction in the cerebellum or the brainstem.Results Complete and partial symptoms relief was obtained in 160（94.7%） cases and failure in 9（5.3%） cases with MVD for trigeminal neuralgia,postoperatively.Also,complications occurred in one case with only cerebellar hematoma.The postoperative results of MVD for hemi-facial spasm with symptoms relief was noted in 29（93.5%） cases and failure in 2（6.5%） cases.Postoperative complications occurred in one case with moderate hearing loss,and another three cases complained of transient facial paralysis.Symptoms relief was achieved in all 7（100%） cases that had undergone MVD or neurotomy for glosspharyngeal neuralgia.Postoperative complications occurred in one case with moderate vocal paralysis.Conclusion We think that microsurgery via the retro-sigmoid keyhole approach is safe and effective for CPA hyperactive cranial nerve dysfunction syndromes.