完全神经内镜与显微镜下显微血管减压术治疗脑神经疾病的临床疗效的分析

Analysis of curative effect of microvascular decompression in treating cranial nerve diseases under endoscope and microscope

目的分析完全神经内镜与显微镜下血管减压术治疗脑神经疾病的安全性和有效性。方法回顾性分析2014年1月至2016年9月266例行血管减压术的脑神经疾病患者的临床资料．所有患者按手术方式分组．内镜组141例经乙状窦后人路在神经内镜下进入桥小脑角区．检查相关区域有无异常血管或其他病灶压迫情况．对责任血管进行推移减压、垫片、分解粘连等治疗，显微镜组125例按照传统乙状窦后人路显微血管减压术。所有手术均由同一术者完成。术后随访1年。结果失访6例．有效随访患者中，内镜组、显微镜组患者术后症状立即消失，分别为137例（97．2％）、120例（96．0％）；术后1年治愈，分别为124例（87．9％）、108例（86．4％）：听力下降，分别为2例（1．42％）、5例（4．00％）；面部浅感觉减退，分别为5例（3．54％）、8例（6．40％）；短暂性共济失调，分别为3例（2．13％）、5例（4．00％）；脑脊液漏，分别为3例（2．13％）、3例（2．40％）；口周疱疹，分别为23例（22．5％）、27例（24.3％）。两组均未出现颅内感染、死亡、面瘫、脑内出血。两组疗效及并发症比较，差异无统计学意义（P〉O．05）。结论完全神经内镜下血管减压术与相对于显微镜下血管减压术并非占据优势。

Objective To analyse the safety and effectiveness of microvascular decompression completely un- der endoscopy-assisted or microscope-assisted （EVD or MVD） for trigeminal neuralgia. Methods A retrospective analysis was conducted for patients who underwent completely EVD or MVD from January, 2014 to September, 2016. The clinical data, operative data and results were analyzed. The patients were divided into two groups according to the techniques. The all procedure of distinguishing the responsible vessels and decompressing which was done completely under endoscope were EVD group （n=141）. Those being done completely under microscope were MVD group （n=125）. All operations were done by same operator and same approach. Results The intracranial nerve symptoms disap- peared in 137 cases（97.2%） in EVD group and 120 cases（96.0%） in MVD group. There were no severe operative com- plications such as intracranial infection, facial paralysis, intracranial hematoma and death. Mild hearing loss was hap- pened in 2 cases （1.42%） in EVD group and 5 cases （4.00%） in MVD group; facial hypoesthesia, 5 cases （3.54%） in EVD group, 8 cases（6.40%） in MVD group; Transient ataxia, 3 cases （2.13%） in EVD group, 5 cases（4.00%） in MVD group; cerebrospinal fluid leakage, 3 cases（2.13%） in EVD group, 3 cases（2.40%） in MVD group; Oral herpes, 23 cas- es （22.5%） in EVD group, 27 cases（24.3%） in MVD group. There was no statistically significant differences in curative effect and complications between two groups （P〉 0.05）. Conclusion There is no difference in curative effect and complications between the two methods of completely EVD and MVD.