显微血管减压术治疗青少年脑神经疾患

Microvascular decompression for adolescent-onset cranial neuropathies

目的探讨青少年脑神经疾患（ACN）的流行病学、发病机制、临床特征及显微血管减压术（MVD）对其的手术疗效及术后并发症。方法回顾性纳入2001年3月至2016年10月卫生计生委中日友好医院神经外科采用MVD治疗的37例ACN患者（ACN组，获随访34例），并与同时期采用随机抽样方法选取的210例成人脑神经疾患（CN）患者（成人CN组，获随访188例）进行对比研究。结果37例ACN患者均为单侧发病，发病年龄平均为（16．7±1．5）岁。与成人CN组相比，ACN组右侧发病率（56．7％比41．0％）、小脑脑桥角（CPA）区蛛网膜增厚比率（78．4％比25．7％）、后颅窝狭小比率（54．0％比28．6％）、术后面听神经并发症发生率（14．7％比4．3％）更高，而AICA压迫的比率偏低（24．3％比42．8％），且以上差异均有统计学意义（均P〈0．05）。ACN组较成人CN组的MVD总有效率稍低（94．1％比96．3％），但二者的差异并无统计学意义（P〉0．05）。结论ACN患者临床罕见，右侧发病比例高。CPA区蛛网膜增厚、后颅窝狭小可能是ACN的致病相关因素。MVD是治疗ACN安全、有效的外科方法，其手术有效率与成人CN患者相近，但面听神经并发症的发生率较后者更高。

Objective To analyze the epidemiology, pathogenesis, clinical features of adolescentonset cranial neuropathies （ACN） and to discuss the surgical effects and complications of mierovascular decompression （MVD）. Methods We retrospectively analyzed 37 ACN patients （including 34 successfully followed up ） who underwent MVD at Department of Neurosurgery, China-Japan Friendship Hospital from March 2001 to October 2016 （ACN group） and compared them with 210 cases of adult cranial neuropathies （CN） which included 188 successfully followed up and were extracted by random sampling method during the same period （adult CN group）. Results The symptoms of 37 cases in ACN group were unilateral. The average age of onset was 16.7±1.5 years. Compared with the adult CN group, the rate of affecting the right side （56.7% vs. 41.0% ）, the ratio of araehnoid thickening in cerebellopontine angle （CPA） region （78. 4% vs. 25. 7% ）, the rate of narrow posterior fossa （54. 0% vs. 28. 6%） and incidence of acoustic complications （ 14.7% vs. 4.3% ） were all higher in ACN group, which however demonstrated a lower rate of AICA oppression （24.3% vs. 42.8% ）. Those differences were statistically significant （ all P 〈 0.05 ）. The effective rate was slightly lower in ACN group （ 94. 1% vs. 96.3 % ） than that in adult CN group （P 〉 0.05 ）. Conclusions ACN seems to be rare and more commonly affect the right side. Arachnoid thickening in CPA region and the small volume of posterior cranial fossa may be the pathogenic factors. MVD could be a safe and effective surgical method for ACN in which the operational efficiency is almost the same as that of adult CN, while the incidence of complications in ACN group is suggested to be higher than that in the group of adult CN.