锁孔入路颅神经血管减压术诊治前庭阵发症的临床观察

Clinical observation of keyhole neurovascular decompression on diagnosis and treatment of vestibular paroxysmia

目的探讨局部麻醉下锁孔入路颅神经血管减压术对前庭阵发症的诊断价值及疗效评估。方法 40例三叉神经痛、面肌痉挛及舌咽神经痛患者中,8例合并前庭阵发症患者采用局麻下经乙状窦后锁孔入路探查听神经根血管压迫情况,并进行神经血管减压治疗。运用症状卡,评价术后眩晕情况,随访期为36~61个月。结果术中8例前庭阵发症患者前庭神经根部均可见责任血管压迫,7例患者可诱发血管压迫性眩晕,术后眩晕均消失;1例患者未诱发出血管压迫性眩晕,术后眩晕无明显改善。平均随访57个月,8例前庭阵发症患者中,7例前庭阵发症患者无血管压迫性眩晕复发,眩晕有效控制率为87.5%。结论局麻下听神经根血管减压术是治疗前庭阵发症、控制血管压迫性眩晕的有效治疗方法,同时该方法对明确诊断前庭阵发症也具有一定的临床意义。

OBJECTIVE To evaluate the diagnostic value and curative effect of keyhole neurovascular decompression with local anesthesia for vestibular paroxysmia.METHODS Of 40 patients with trigeminal neuralgia,hemifacial spasm and glossopharyngeal neuralgia,8 of them combined with vestibular paroxysmia underwent keyhole neurovascular decompression under local anesthesia to explore the vascular compression of acoustic nerve root and have the neurovascular decompression.The evaluation of the vertigo after operation was performed with symptom report card.The patients were followed-up for 36 to 61 months.RESULTS The vessels compressing the root zone of the vestibular nerve were found in 8 patients with vestibular paroxysmia,of whom 7 patients had the vascular compression vertigo induced during operation and the vertigo was disappeared after operation,moreover,one patient had no vascular compression vertigo induced during operation and the vertigo was not changed after operation.With the average follow-up of 57 months,of 8 patients with vestibular paroxysmia,7 patients had no recurrence of the vertigo,and the effective control rate was 87.5%.CONCLUSION Local anesthesia keyhole neurovascular decompression was not only an effective way for treating vestibular paroxysmia and controlling the vertigo,but also had certain clinical significance in the diagnosis of vestibular paroxysmia.