显微血管减压术治疗舌咽神经痛疗效分析

Therapeutic effects of glossopharyngeal nerve microvascular decompression on glossopharyngeal neuralgia

目的探讨显微血管减压术(MVD)治疗原发性舌咽神经痛(GN)的疗效。方法纳入新疆医科大学第一附属医院神经外科中心自2007年10月至2020年12月行MVD治疗的41例GN患者,其中仅行MVD治疗38例,MVD同时行舌咽神经根及迷走神经根上部第1根丝切断术3例,观察术后疗效和并发症,随访平均年限为6.3年。选择本院自2018年2月至2020年12月行MVD治疗的221例面肌痉挛(HFS)患者,术中观察舌咽神经与血管、舌咽神经根与迷走神经根丝的显微解剖关系。结果29例GN患者术后即刻疼痛全部消失;12例术后疼痛明显减轻,2~3 d后疼痛消失。随访末期,2例患者疼痛复发,治愈率为95.1%。结合221例HFS患者显微手术中探查观察,发现舌咽神经根与迷走神经根丝的解剖关系有4种类型,分别是舌咽神经根与迷走神经根上部第1根丝之间间隙较大,彼此之间无交通支;二者之间间隙较小、无交通支;二者之间间隙较小、有交通支;二者之间无间隙。结论MVD可作为GN首选外科治疗方法,结合舌咽神经根及迷走神经根上部根丝切断术可为GN提供有效的治疗方法,手术方式应根据术中有无责任血管压迫及责任血管压迫的方式而定。

Objective To investigate the efficacy of microvascular decompression(MVD)in the treatment of primary glossopharyngeal neuralgia(GN).Methods Forty-one patients with GN who underwent MVD from October 2007 to December 2020 in the Neurosurgery Center of the First Affiliated Hospital of Xinjiang Medical University were included.Among them,only 38 cases were treated with MVD,and 3 cases of them were treated with MVD combined with rhizotomy of glossopharyngeal nerve root and upper 1st root filament of vagus nerve,the therapeutic effects and postoperative complications were observed.The average follow-up period was 6.3 years.From February 2018 to December 2020,221 patients with hemifacial spasm(HFS)were treated by MVD in our hospital.The microanatomic relationship between glossopharyngeal nerve and blood vessel,glossopharyngeal nerve root and vagus nerve root filament were observed.Results All the pain disappeared immediately after operation in 29 GN patients;the pain of 12 patients was obviously reduced,and the pain disappeared after 2-3 d.At the end of follow-up,2 patients had pain recurrence,and the cure rate was 95.1%.Combined with exploration observation of 221 HFS patients with MVD,there were 4 types of anatomical relationship between glossopharyngeal nerve root and vagus nerve root filament.The gap between the glossopharyngeal nerve root and the first upper vagus nerve root was large and there was no traffic branch between them.The gap between the two was small and there was no traffic branch.The gap between the two was small and there was a traffic branch;There was no gap between the two.Conclusion MVD can be used as the preferred surgical treatment for GN,combined with glossopharyngeal nerve root and upper root filamentectomy of the vagus nerve root can provide effective treatment for GN.The surgical method should be determined according to whether or not the responsible vessel is compressed and the condition of compression.