原发性舌咽神经痛的显微手术治疗(附33例分析)

Microneurosurgery for glossopharyngeal neuralgia(report of 33 cases)

目的探讨显微手术治疗原发性舌咽神经痛的手术方式、手术疗效及长期随访结果。方法 2003年5月至2014年7月显微手术治疗原发性舌咽神经痛33例,手术均采用单侧枕下乙状窦后入路,微血管减压术23例,舌咽神经根及迷走神经根上部第1、2根丝切断术3例,微血管减压术+神经根切断术7例。所有患者术后随访10个月至11年,平均5.1年。结果责任血管为椎动脉5例,为小脑后下动脉18例,为小脑后下动脉合并椎动脉8例,为小脑后下动脉合并小脑前下动脉1例;1例未发现责任血管。33例患者术后即刻疼痛全部消失。5例术后出现暂时性吞咽困难、饮水呛咳、声嘶,3例有阵发性干咳,l例有耳鸣,1例有复视;随访期间,除复视1例外,余9例患者并发症逐渐减轻至消失。结论显微手术治疗舌咽神经痛是有效、安全的,正确合理选择适宜的术式,在保证疗效的前提下,术后并发症是可控、可接受的。

Objective To investigate the surgical method to treat glossopharyngeal neuralgia （GPN） and the effects of microsurgery on GPN. Methods The clinical data of 33 patients with GPN, who underwent microsurgery through retrosigmoid key hole approach from May, 2003 to July, 2014, were analyzed retrospectively. Of 33 patients followed up from 10 months to 11 years （mean, 5.1 years）, 23 received microvasular decompression （MVD）, 3 rhizotomy of glossopharyngeal nerve root and upper 1 ~2 rootlets of vagal nerve root and 7 MVD and the rhizotomy. Results The vessels responsible for GPN were vertebral artery （~A） in 5 patients, posterior inferior cerebellar artery （PICA） in 18, VA and PICA in 8, PICA and anterior inferior cerebellar artery （AICA） in 1. The responsible vessel was not found in 1 patient. GPN disappeared immediately after the operation in all the patients. The postoperative complications included dysphagia, choking and hoarseness in 5 patients, paroxysmal dry cough in 3, tinnitus in 1, and diplopia in 1. During the following-up period, the complications disappear gradually in 9 patients and there was still diplopia in 1 patient. Conclusions Microneurosurgery for GPN is effective and safe. Based on the correct and suitable operation, the postoperative complications can be controlled and acceptable..