桥小脑角内镜下神经减压术

Microneurosurgery for the trigeminal neuralgia and hemifacial spasm and glosspharyngeal neuralgia with endoscopic

目的：探讨内镜在治疗三叉神经痛、面肌痉挛、舌咽神经痛及部分桥小脑角肿瘤手术中应用的相关问题。方法：回顾性分析采用经内镜下耳后小切口乙状窦后入路桥小脑角神经减压术或肿瘤切除术进行治疗的973例患者的临床资料,其中420例三叉神经痛（含28例桥小脑角肿瘤）、487例面肌痉挛和66例舌咽神经痛。结果：420例三叉神经痛中,发现责任血管390例（92.9%）,用Teflon隔离;蛛网膜粘连但未发现责任血管2例（0.5%）;桥小脑角肿瘤继发三叉神经痛28例。487例面肌痉挛中486例有责任血管,用Teflon隔离。66例舌咽神经痛均采用舌咽神经切断加迷走神经减压术治疗。出现脑脊液耳鼻漏3例,小脑梗塞1例,小脑出血2例,颅内积气3例;均治愈。无其他并发症及死亡病例。随访1~5年,三叉神经痛复发4例,面肌痉挛复发4例,舌咽神经痛无复发。结论：内镜用于耳后小切口乙状窦后入路桥小脑角神经减压术治疗三叉神经痛、面肌痉挛、舌咽神经痛手术中可获得满意疗效,提高了责任血管的发现率,有助于脑组织和神经功能的保护,有临床推广应用价值。

Objective：Discussing the use of endoscopy in the operation of microvascular decompression of cra- nial nerves to treat trigeminal neuralgia（TN） , hemifacial spasm（HFS）,glosspharyngeal neuralgia（GN） and some tumors of the cerebellopontine angle（CPA）. Method：Since 2006,973 cases （including 420 cases of TN, 487 cases of HFS, 66 cases of GN）had received the operation of nervous decompression by approach of postauricular suboc- cipital to the CPA. All cases who used the endoscopy and the material was described in detail. Result： In 420 TN patients, 390（92.9 %） were found responsible blood vessels. Two（0.5 %） were found no responsible blood vessels but arachnoid adhesion, 28 were found CPA tumor secondary trigeminal neuralgia. In 487 HFS patients, 486 were found responsible blood vessels. Between the vascular and trigeminal nerve, teflon was used to decompress and iso- late the facial nerve. In 66 GN, the glossopharyngeal nerve were cut and vagus nerve were decompressed. The short term cure rate was 100%. Cerebrospinal fluid rhinorrhea occurred in 3 cases, 1 case of cerebellar infarction, 2 patients of cerebellar hemorrhage, 2 cases of pneumatosis. All complications were cured at last. There were no deaths. All cases were followed-up for 1 to 5 years. Four cases of TN and 4 cases of HFS recurrent, and none of GN recurrence. Conclusion：The microneurosurgery of nervous decompression endoscopy technology for the treat- ment of TN, HFS,GN and some tumors of the CPA is an ideally functional and etiotropic operation. It is helpful to detect the responsible blood vessel and to protect the brain tissue and nerve function with endoscope, which can im- prove the success rate of the operation and avoid the complications. This technology has clinical application value.