小切口开颅显微技术治疗继发性三叉神经痛

Treatment of Secondary Trigeminal Neuralgia with Small Incision Craniotomy

目的探讨小切口开颅显微技术切除桥小脑角区肿瘤治疗继发性三叉神经痛的效果。方法 2010年1月~2012年12月采用小切口开颅显微技术治疗30例继发性三叉神经痛。采用枕下乙状窦后小切口开颅技术,在显微镜下沿小脑半球外侧面逐步进入,显露桥小脑角池,探查颅神经与肿瘤的关系,继而全/近全切除肿瘤,彻底解除三叉神经根区压迫。结果术后三叉神经痛症状均消失,其中29例术后症状立即消失,1例术后1个月内逐渐消失。24例(80.0%)肿瘤全切除,6例胆脂瘤次全切除囊壁。面神经功能保留27例(90.0%),有效听力保留28例(93.3%)。30例随访3~24个月,中位数10个月,无复发。结论小切口开颅技术切除桥小脑角区肿瘤治疗继发性三叉神经痛安全有效。

Objective To investigate the clinical efficacy of small incision craniotomy to resect the tumors in the cerebellopontine angle for secondary trigeminal neuralgia. Methods A total of 30 patients with secondary trigeminal neuralgia were treated by using small incision craniotomy from January 2010 to December 2012. All the patients were treated with suboccipital retrosigmoid small incision craniotomy. The lateral surface of the cerebellar hemisphere was gradually entered by the microscope. The cistern of the cerebellopontine angle was exposed and the relationship between the cranial nerve and the tumor was revealed. Then the tumor was totally or near totally resected for complete removal of the compression of the root zone of the trigeminal nerve. Results In postoperation all the patients had no pain symptoms of trigeminal neuralgia. The symptoms disappeared immediately in 29 cases and gradually disappeared during one month in 1 case. Gross total tumor removal was accomplished in 24 patients（80. 0%）,and subtotal resection was performed in 6 cases of cholesteatoma. The facial nerve function was preserved in 27 patients（90. 0%）. The effective audition was preserved in 28 patients（93. 3%）. Follow-ups for 3-24 months（median,10 months） in the 30 cases found no recurrence. Conclusion The suboccipital retrosigmoid small incision craniotomy is a valid choice for treating the secondary trigeminal neuralgia.