开颅微血管减压术的手术策略和技巧的应用价值

目的评价和总结开颅微血管减压术的手术策略和技巧。方法回顾性分析2011年6月至2014年6月行微血管减压手术853例颅神经疾病病例，其中三叉神经痛532例、面肌痉挛295例、舌咽神经痛26例，从患者的选择、骨窗与硬脑膜切开的改良、脑脊液漏与颅内感染的预防和处理、小脑及岩静脉与听、面神经的保护等方面总结和分析对手术疗效及并发症的影响。结果本组无死亡病列及其它严重并发症发生，三叉神经痛患者手术治愈率为97-31％、面肌痉挛手术治愈率为96．35％，舌咽神经痛100％，手术策略和技巧的改良显著提高手术疗效的同时也明显降低了手术并发症的发生率。结论微血管减压术是根治颅神经疾病的有效外科治疗手段，手术策略和技巧对手术疗效和并发症的预防具有重要意义。

Objective This study aimed to evaluate how surgical strategy and technique affect the results and complications of microvascular decompression （ MVD ） . Methods We accomplished 853 MVD in recent 3 years, including 532 trigeminal neuralgia （ TN ） cases, 295 hemifacial spasm （ HFS ） cases and 26 glossopharyngeal neuralgia （ GPN ） cases. We retrospectively summarized how the following strategies and techniques affect MVD： the selection of patients, the improvement of craniotomy and durotomy, the prevention of cerebrospinal fluid leakage and intracranial infection, the protection of cerebellum, petrosal veins as well as cranial nerve VII ＆ VIII. Results There was no death or severe complication in our group. The postoperative cure rate with TN was 97.31%, 96.35% with HFS and 100% with GPN, which indicated that the improvement of surgical strategy and technique can raise the efficacy and reduce complications. Conclusion MVD is an effective treatment for the patients with TN, HFS or GPN.Improvement surgical strategy and technique can achieve comparable and durable results with lesser complications.