全程神经内镜下锁孔入路微血管减压术治疗原发性三叉神经痛效果分析

Efficacy analysis of fully endoscopic microvascular decompression in primary trigeminal neuralgia via keyhole approach

目的探讨全程神经内镜下锁孔入路微血管减压术(MVD)治疗原发性三叉神经痛(PTN)的疗效及技术特点。方法收集首都医科大学附属北京世纪坛医院神经外科2014年12月至2019年2月期间运用全程神经内镜下锁孔入路MVD的97例PTN患者的临床资料,术者利用自然间隙,无需磨除发达的岩骨嵴或者过度牵拉脑组织,可视化、全景化地观察和评估脑桥小脑三角(CPA)区情况,准确识别责任血管,避免责任血管遗漏或者减压不充分,同时采用预垫技术、架桥技术及潜水技术,保证手术疗效的同时减少手术副损伤。采用巴罗神经学研究所(BNI)疼痛评分进行疗效评估及复发鉴定,分析其手术疗效。结果本组97例PTN患者中,96例在神经内镜下发现责任血管,其中单纯动脉性压迫77例,单纯静脉性压迫6例,动静脉同时压迫者13例。本组中87例患者术后疼痛立即消失;5例疼痛显著缓解,术后无需口服药物;4例疼痛部分缓解但仍需口服药控制,剂量较术前减少;1例无效。术后出现患侧面部麻木4例,患侧听力下降1例,经对症治疗后痊愈。无脑梗死和脑出血,无颅内和切口感染。随访3.0~38.0(22.4±2.2)个月,术后复发3例,口服药物可控制疼痛,未再行手术治疗。其余患者无复发或加重。结论全程神经内镜下锁孔入路MVD治疗PTN可提供全景化视野,避免责任血管遗漏,并发症少,是一种安全、可靠、有效的手术方式。

Objective To explore the efficacy and technical features of fully endoscopic microvascular decompression(MVD)in primary trigeminal neuralgia(PTN)via keyhole approach.Methods The clinical data of 97 patients with PTN underwent fully endoscopic MVD via keyhole approach in the Department of Neurosurgery,Beijing Shijitan Hospital,Capital Medical University from December 2014 to February 2019 was collected.During fully endoscopic MVD in PTN via keyhole approach,performer use natural clearance without grinding except developed rock bone crest or excessive retraction of the brain tissue,visually and panoramically observe and evaluate the CPA area,accurately identify the responsible vessels,to avoid the omission of responsible vessels or insufficient decompression.And the use of preplaced technology,bridging technology and submersible technology,ensure the efficacy of surgery and reduce the surgical side injuries.Barrow Neurological Institute(BNI)pain score was used to evaluate the efficacy and identify the recurrence.The surgical efficacy was analyzed.Results The offending vessels were identified under endoscope in 96 cases.Among them,arterial compression was found in 77 cases,venous compression in 6 cases,and both arterial and venous compression in 13 cases.About the pain outcomes,87 cases had immediate and complete relief of pain,5 cases had almost relief of pain,4 cases had partial relief of pain,and still needed medication control,but the dose was lower than that before operation,and 1 case had no obvious relief of pain.About complications,there were 4 cases of temporary facial numbness,1 case of temporary hearing loss,both of them recovered after symptomatic treatment.There was no cerebral infarction or hemorrhage,intracranial or incision infection.All cases were followed up for 3.0-38.0 months with a median period of(22.4±2.2)months.During the follow-up periods,postoperative recurrence occurred in 3 cases.Conclusion Fully endoscopic MVD for PTN through keyhole approach,provides panoramic view to avoid omission of offending vessels and reduce complications,seemed to be a safe and effective surgical method.