腰大池置管外引流在显微血管减压术的应用

Lumbar cerebrospinal fluid drainage in microvascular decompression

目的探讨微血管减压术(MVD)应用腰大池置管引流脑脊液对预防小脑挫裂伤及出血的作用。方法回顾性分析249例行MVD治疗的病例资料。术中应用腰大池置管外引流者(实验组)120例,术中未用腰大池置管外引流者(对照组)129例,比较两组术中、术后小脑挫裂伤及岩静脉属支及远隔部位出血发生率。结果术中发生小脑挫裂伤对照组10例(7.75%),实验组1例(0.83%);术后复查头颅CT示小脑挫裂伤对照组4例(3.10%),实验组无术后小脑挫裂伤。对照组术中可见由于释放CSF牵拉造成岩静脉属支出血4例(3.10%),术后对侧幕上远隔部位硬膜下出血1例(0.78%)。实验组术中、术后均未见出血。实验组未见明显腰大池置管相关并发症出现。结论术中应用腰大池置管持续引流可缓慢释放脑脊液,避免由于过快释放脑脊液导致的远隔部位出血。同时预防术中释放脑脊液时由于操作不当引发小脑挫裂伤,减少MVD手术相关并发症。

Objective To explore the role of lumbar cerebrospinal fluid drainage in microvascular decompression （MVD） for preventing cerebellar contusion and hemorrhage. Methods The clinical data of 249 patients undergoing MVD were analyzed retrospectively to compare the incidence rates of intraoperative and postoperative cerebellar contusion and the hemorrhage of petrosal vein branches and their distal parts between the experimental group （n=120） in which a lumbar subarachnoid catheter was placed before surgery to drain cerebrospinal fluid （CSF） drainage at the time of dural exposure and control group （n=129） without intraoperative CSF drainage. Results Intraoperative cerebellar hemorrhage occurred in 10 patients （7.75%） of the control group and one patient （0.83%） of the experimental group. Postoperative head CT revealed that cerebellar contusion was seen in 4 patients （3.10%） in the control group and no one in the experimental group. Intraoperative petrosal vein hemorrhage due to CSF release was seen in 4 patients （3.10%） and postoperative subdural hemorrhage in one patient （0.78%） at the contralateral distal supratentorial part in the control group. No intraoperative or postoperative hemorrhage and other evident lumbar catheter placement-associated complications were seen in the experimental group. Conclusions CSF drainage during MVD surgery can slowly release CSF, which can avoid distal hemorrhage due to too fast release of CSF, meanwhile, prevent cerebellar contusion resulting from inadequate operation during releasing CSF and reduce MVD-associated complications.