三叉神经痛显微血管减压术中岩静脉处理策略的研究

The management of superior petrosal vein in microvascualr decompression for trigeminal neuralgia

目的 在三叉神经痛显微血管减压手术中,观察岩静脉形态特点及其对手术显露的影响,分析岩静脉的处理方式对预后的影响.方法 纳入2009年1月至2010年1月首都医科大学宣武医院功能神经外科经小脑水平裂入路行显微血管减压术的三叉神经痛患者94例,回顾性分析其岩静脉的主干及属支情况、进入岩上窦的位置、术中电凝切断及术后并发症的情况.结果 94例患者中,岩静脉主干有1-3支者分别占22.3％（21例）、62.8％（59例）、14.9％（14例）,静脉属支有1-5支者分别占4.3％（4例）、21.3％（20例）、64.9％（61例）、7.4％（7例）、2.1％（2例）.责任血管明确者83例（88.3％）,可疑11例（11.7％）,其中岩静脉为责任血管者6例（6.4％）.术中岩静脉完全保留者58例（61.7％）,主干切断者4例（4.3％）,属支切断者32例（34％）.术后出现小脑梗死1例（岩静脉属支切断者）,经治疗后未遗留明显神经功能缺损;小脑出血1例（切断岩静脉主干者）,行后颅窝减压术后残留头晕、走路不稳等症状.结论 经小脑水平裂入路是三叉神经痛显微血管减压术较理想的手术入路.多数情况下术中不必切断岩静脉,必要时可以切断主干或部分属支,但切断后极少数患者会发生小脑梗死或出血.

Objective To summarize our experience on management of superior petrosal vein （SPV） in microvascular decompression （MVD） surgery for trigeminal neuralgia,the operative notes and photography were retrospectively reviewed on anatomy characteristics of superior petrosal veins and their influence to operation.Methods The clinical data of the 94 patients with trigeminal neuralgia between January,2009 and January,2010 were collected,including the trunks and the braches of SPV,how much were sectioned,the entry position to superior petrosal sinus,the surgery outcome and complications.Results For all the 94 patients,we found in operation that SPV can have 1-3 trunks accounted for 22.3%,62.8%,14.9%,while the petrosal vein with 1-5 branches respectively accounted for 4.3%,21.3%,64.9%,7.4%,2.1%.The petrosal vein during the operation was fully preserved in 58 cases （61.7%）,the SPV were sectioned completely in 4 patients,while some branches of SPV were sectioned in 32 patients.In total,the offending vessel was identified clearly in 83 patients,while in 11 patients the offending vessel was ambiguous,the SPV was identified as offending vessel in 6 patients.One patient encountered cerebellar infarction （the branch of SPV was sacrificed） and recovered completely at 2 weeks after MVD by using intravenous medication and one patient developed cerebellar hematoma（the trunk of SPV was sectioned）,an posterior fossa decompression was performed and the patient complained minor unsteady gait.Conclusions The reasonable approach of MVD for trigeminal neuralgia is cerebellar transhorizontal fissure approach,mostly SPV is unnecessary to be resected completely,sometimes small braches of SPV can be sacrificed,very few patients may develop cerebellar infarction or hematoma.