神经内镜辅助微血管减压术治疗三叉神经痛

Microvascular decompression surgery for trigeminal neuralgia assisted by endoscope

目的探讨神经内镜辅助技术,在三叉神经显微镜微血管减压术的临床效果。方法回顾我科三叉神经痛手术患者共72人,其中采用神经内镜辅助MVD治疗的患者38人,其余采用常规显微镜下MVD手术。比较两组的手术时间,术后疗效,术后并发症和随访结果。结果使用神经内镜辅助手术用时(165.26±22.62)min,与常规手术时间比较无统计学差异。1年后随访完全缓解36例(94.7%),疼痛减轻2例,优于常规组(P<0.05)。术后并发症总发生率6例(15.79%),于2周内缓解,无严重并发症,无患者死亡。优于常规组(P<0.05)。结论使用神经内镜可以更广泛清晰地显示桥小脑角区间解剖结构,全程观察三叉神经从REZ区至Meckel囊,有助于精确定位责任血管压迫点,并可了解置入Teflon棉后的减压效果。

Objective To explore the curative effect of endoscope-assisted microvascular decompression （MVD） on idiopathic trigeminal neuralgia （ITN）. Methods The clinical data of 72 patients with ITN in our department, in whom 38 underwent neuroendoscope-assisted MVD, the other used a conventional microscope with MVD surgery were analyzed retrospectively. The operative time, postoperative effects, postoperative complications and follow-up results were compared between the two groups. Results Neuroendoscope-assisted surgery needed 165.26 ＋ 22.62 minutes, it was not longer than conventional MVD surgery （ P 〉 0.05 ）. It showed that 36 patients （ 94.7 % ） were complete remission after the follow-up of one year and 2 with pain relief. It＇ s better than MVD surgery term （ P 〈 0.05 ）. The total incidence of postoperative complications were 7 patients （ 18. 4% ）. All of them were relieved in 2 weeks, no serious complications occurred and no patients died. It＇ s also better than MVD surgery term （ P 〈 0.05 ）. Conclusions The neuroendoscope-assisted MVD can widely and clearly show the anatomic structures of the eerebellopontine angle and the entire paragraph from trigeminal nerve REZ to Meckel cave. The vessels responsible for the neuralgia are easily and accurately indentified and the effect of Teflon can be checked through the endoscope.