椎基底动脉扩张延长症所致三叉神经痛及面肌痉挛的微血管减压手术策略及临床分析

Surgical strategy and clinical analysis of microvascular decompression for the treatment of trigeminal neuralgia and hemifacial spasm caused by vertebrobasilar dolichoectasia

目的探讨椎基底动脉扩张延长症所致三叉神经痛及面肌痉挛的微血管减压术中采用悬吊法的手术技巧及疗效。方法回顾分析中国科学技术大学附属第一医院(安徽省立医院)2015年6月至2018年2月160例椎基底动脉扩张延长症所致的三叉神经痛及面肌痉挛患者的临床资料,总结悬吊法在不同责任血管类型减压中的操作技巧,分析临床疗效。结果椎基底动脉扩张延长症所致三叉神经痛及面肌痉挛的病例中,椎基底动脉很少作为单支责任血管压迫神经,常伴有一支或多支血管压迫,术中结合悬吊法进行了责任血管的充分减压,三叉神经痛的手术有效率为93%,面肌痉挛的手术有效率98.2%,术后疗效及并发症较其他非椎基底动脉相关的微血管减压术无明显差异。结论对于复杂血管压迫类型,术中采用悬吊法可以充分减压,为微血管减压提供一种新的安全、有效的手术方法。

Objective To explore the surgical skills and effectiveness of the suspension method in the microvascular decompression for the treatment of trigeminal neuralgia and hemifacial spasm caused by vertebrobasilar dolichoectasia.Methods The clinical data of 160 patients with trigeminal neuralgia and hemifacial spasm caused by vertebrobasilar dolichoectasia admitted to the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)from June 2015 to February 2018 were retrospectively analyzed.Results In cases of trigeminal neuralgia and hemifacial spasm caused by vertebrobasilar dolichoectasia,vertebrobasilar artery rarely acted as a single responsible vessel to compress the nerve.It often accompanied by one or more vessels to form compression.Intraoperative combination of suspension method can effectively decompress the responsible vessels.The surgical effective rate of trigeminal neuralgia was 93%,and the effective rate of hemifacial spasm was 98.2%.The postoperative effectiveness and complications were not significantly different from those of other microvascular decompressions that were not related to vertebrobasilar artery.Conclusion For the types of complex vascular compression,the intraoperative application of suspension method can fully decompress,providing a new safety and effective surgical method for microvascular decompression.