脑神经疾病微血管减压术不同开颅术式的可行性及疗效分析

Comparison of two microvascular decompression methods in treatment of cranial neuropathy

目的探讨微血管减压术两种开颅术式治疗脑神经疾病的可行性及疗效。方法回顾性分析75例微血管减压术治疗的脑神经疾病患者的临床资料,其中三叉神经痛65例,面肌痉挛7例,舌咽神经痛2例,中间神经痛1例。常规开颅组38例采用经乙状窦后入路小骨瓣开颅暴露所需结构后行神经微血管减压术,术后还纳骨瓣;改良锁孔组37例采用经乙状窦后入路钻孔后咬骨钳扩大骨窗2.5 cm×3.0 cm暴露所需结构后行神经微血管减压术,术毕不用恢复骨瓣。分析两种术式开颅的操作时间、手术风险、手术医师掌握程度、暴露所需血管减压的术野、经济效益、术后并发症等,随访2组患者的远期疗效。结果2组患者随访6~12个月,常规开颅组面肌痉挛复发1例,有效率97.4%(37/38),改良锁孔组有效率100%(37/37),2组有效率、术式暴露的术野、术后疼痛缓解率、并发症差异无统计学意义(P>0.05)。2组术式的操作时间、手术风险、手术医师掌握程度、经济效益等差异有统计学意义(P<0.05)。结论改良锁孔术式微血管减压术手术的效果满意,手术操作简单、手术医师易掌握,降低了费用,且能有效避免导静脉、乙状窦被牵拉或铣刀损伤所致大出血,是一种安全、有效、经济的开颅方法。

Objective To investigate the feasibility of two types of craniotomy for microvascular decompression in the treat⁃ment of cranial neuropathy and their differences on the efficacy and complications.Methods The clinical data of 75 patients of mi⁃crovascular decompression for surgical treatment of cranial neuropathy were retrospectively analyzed.Among them,65 cases of trigemi⁃nal neuralgia,7 cases of hemifacial spasm,2 cases of glossopharyngeal neuralgia,and 1 case of Intermediate Nerve Neuralgia were an⁃alyzed.In the conventional craniotomy group of 38 cases,a small bone flap through the retrosigmoid approach was used to expose the required structures and then neuromicrovascular decompression was performed,and the bone flap was restored after the operation.In the modified keyhole group of 37 cases,a hole was drilled through the retrosigmoid sinus approach and the rongeur was used to ex⁃pand the bone window by 2.5 cm×3.0 cm to expose the required structure.Neurovascular decompression was performed without restor⁃ing the bone flap after the operation.The differences in operating time,surgical risk,surgeon’s mastery,exposure required vascular de⁃compression field,patient economic benefits,postoperative complications of the two surgical methods of craniotomy were analyzed,and the long-term efficacy of the two groups was followed-up.Results Two groups of patients were followed up for 6-12 months.There was 1 case of hemifacial spasm recurrence in the conventional craniotomy group,the effective rate was 97.4%(37/38),and the effective rate in the modified keyhole group was 100%(37/37).There were no statistically significant differences on the effective rate,the surgical field,postoperative pain relief rate,and complications(P>0.05).There were statistically significant differences on operat⁃ing time,surgical risk,surgeon’s mastery,and patient economic benefit between the two groups(P<0.05).Conclusion The modified keyhole technique of microvascular decompression is satisfactory in the treatment of cranial nerve diseases.The operation is simple,easy for the surgeon to master,reduces the cost of the patient,and can effectively avoid hemorrhage caused by the traction of the guid⁃ing vein and the sigmoid sinus or the injury of the milling cutter.It is a safe,effective and economical method of craniotomy.