显微血管减压手术治疗舌咽神经痛远期疗效分析

Microvascular decompression for the treatment of glossopharyngeal neuralgia:a long-term a- nalysis of the clinical effect

目的评价显微血管减压手术治疗舌咽神经痛（glossopharyngeal neuralgia，GN）的远期疗效，提高治疗效果。方法观察并分析我科自2001年1月到2011年10月收治的19例接受显微血管减压手术的舌咽神经痛患者的相关资料。所有患者均行地卡因实验明确诊断，影像学提示血管对舌咽神经存在不同程度的压迫。手术采取经乙状窦后-幕下入路行微血管减压术，术后对其进行疗效随访。结果所有患者术后早期疗效明显，随访时间1．5～12．5年，平均5．6年。随访过程中1例出现复发，1例疼痛程度及次数较术前明显缓解。本组1例患者术后出现轻度声音嘶哑和吞咽困难，1例出现脑脊液漏，经处理后均痊愈。结论显微血管减压手术是治疗舌咽神经痛的一种安全、有效的方法，影像学诊断对判断神经-血管压迫有重要意义。显微血管减压手术远期效果良好。

Objective To evaluate the clinical therapeutic effect of microvascular decompression （MVD） for glossopharyngeal neuralgia （GN）. To explore the effective operation methods for GN. Methods We followed up 19 patients with GN who received microvascular decompression in our department from 2001 to 2011. The pain disappeared after sprinkling amethacaine on pharynx and larynx of all patients. We used this method to establish the diagnosis of GN. We found different vascular compression ways of the glossopharyngeal nerve by MRI. We chosed the retrosigmoid approach in MVD. Clinical effects were followed up inthe study. Results 17 of the all cases got rid of their pain immediately and 1 of them relived after the surgery. 1 recurred 2 years after the operation. No other recurrence showed in the following--up period （1. 5 12.5years,5.6years on average）. 1 case showed slightly hoarse voice and dysphagia and 1 showed leak of cerebrospinal fluid after the operation. However, both of them healed after proper treatments. Conclusion Microvasclar decompression is a kind of safe and effective way to cure GN in long--term follow--ups. Imageology is rather important in diagnosing GN.