影像后处理技术辅助乙状窦后入路手术治疗原发性三叉神经痛

Application of imaging post-processing techniques to microvascular decompression through retrosigmoid approach for primary trigeminal neuralgia

目的探讨影像后处理技术辅助乙状窦后入路微血管减压术(MVD)治疗原发性三叉神经痛(PTN)的安全性和有效性。方法回顾性分析2020年12月至2021年4月影像后处理技术辅助乙状窦后入路MVD治疗的10例PTN的临床资料。9例应用3D-Slicer软件三维重建技术、1例利用DSA影像后处理技术定位关键孔,经乙状窦后入路手术。结果无手术死亡病例,无术后出血、感染、皮下积液;术后出现暂时性眩晕伴听力下降1例。9例术后疼痛即刻缓解;1例未缓解,二次术后疼痛消失,出现感觉麻木。术后随访6~24个月,无复发;1例仍有感觉麻木,无面瘫、听力下降、行走不稳。结论利用影像后处理技术可精确定位关键孔,并完整游离骨瓣,为MVD提供足够的显露空间,有助于减少感染、脑脊液漏发生率,手术效果良好。

Objective To explore the accuracy of imaging post-processing techniques in locating the key holes during craniotmy and to evaluate the safety and efficacy of microvascular decompression(MVD)via retrosigmoid approach for the patients with primary trigeminal neuralgia(PTN).Methods A retrospective analysis was performed on the clinical data of 10 patients with PTN treated in our department from December 2021 to April 2022.Before MVD,the imaging post-processing techniques were used to locate the key holes.Results There was no intraoperative death or postoperative bleeding.Immediate relief of pain was achieved in 9 patients after the surgery and was not in 1 patient who underwent a second operation with sensory root electrocautery.There was no postoperative infection and subcutaneous bleeding.One patient had temporary vertigo and hearing loss after operation.The postoperative follow-up ranged from 6months to 24 months.There was no recurrence.One patient had numbness without facial paralysis,hearing loss,or walking instability.Conclusions Imaging post-processing techniques can be used to accurately locate the key holes and make a complete bone flap during opening a fully exposed operating window for MVD,which is helpful to reducing the incidence of postoperative infection and cerebrospinal fluid leakage and obtaining good surgical outcomes.