三叉神经显微血管减压术中对岩上静脉的处理方式及并发症的影响

Management of superior petrosal vein and its complications during microvascular decompression of trigeminal nerve

目的探讨三叉神经显微血管减压术中岩上静脉的处理方式及并发症的影响。方法回顾性分析济宁市第一人民医院神经外科2012年6月1日—2013年5月30日,行显微血管减压术治疗的200例三叉神经痛患者的临床资料,对其治疗和结果进行总结。结果 200例患者中,术中切断岩上静脉主干2例,其中小脑水肿1例,脑干梗死1例;术中切断岩上静脉分支17例,其中小脑出血1例;术中完全保护岩上静脉181例。根据责任血管情况,单纯动脉压迫138例,单纯静脉压迫4例,动脉合并岩上静脉压迫58例。结论根据岩上静脉和三叉神经的解剖关系,对岩上静脉术中予以不同的处理,尽可能保留岩上静脉,尤其对岩上静脉蛛网膜双层结构的充分锐性分离,可明显降低术后并发症的发生率。

Objective To discuss the management of superior petrosal vein and the influence of complications during trigeminal nerve microvascular decompression(MVD).Methods The clinical data of 200 patients with trigeminal neuralgia treated by MVD from June 1,2012 to May 30,2013 in Jining First People's Hospital of Shandong Province were analyzed retrospectively.Results Of 200 patients,the complications were counted according to the management of superior petrosal vein during operation.2 cases were cut off the main trunk of superior petrosal vein during operation,including 1 of cerebellar edema and 1 of brainstem infarction.The branches of superior petrosal vein were cut off in 17 cases during operation,including 1 of cerebellar hemorrhage and 181 of complete protection of superior petrosal vein during operation.According to the compression of the responsible vessels of trigeminal nerve during operation,4 were simple venous compression,while 58 were arterial compression coexist with superior petrosal vein,and 138 were simple arterial compression.Conclusions Different types of superior petrosal veins should be treated in different ways according to the actual situation during the operation.Retaining the superior petrosal veins,especially to sharp separation of the double-layer structure of the arachnoid of the superior petrosal veins adequately can greatly reduce the incidence of postoperative complications.