前庭神经切断术中内镜技术的应用

The Vestibular Neurotomy Assited with Endoscope in Meniere's Disease

目的 探讨经乙状窦后径路行前庭神经切断术 (vestibularneurotomy ,VNT)控制梅尼埃病眩晕症状中 ,辅助应用内镜微创技术的方法及其减轻术中脑组织压迫和减少术后并发症发生率的价值和意义。方法 临床观察乙状窦后径路常规VNT( 12例 )与辅助应用内镜技术VNT( 9例 )的 2组手术患者手术前后症状控制效果、面神经功能及其听觉和前庭生理功能变化结果。结果 常规VNT组患者术后有 2例发生脑水肿 ,需行脱水、降压等处理 ;平均听阈上升>15dB者 2例 ;平衡功能代偿所需时间平均为 ( 2 9.0 0± 9.60 )天。辅助应用内镜的VNT组术后平均听阈上升 >15dB者 2例 ;平衡功能代偿所需时间平均为 ( 2 8.5 6± 7.91)天。 2组术后均未出现面瘫等并发症 ;术后 2年内再发作眩晕 ,常规手术组有 2例 (分别发作 1次和 4次 ) ,内镜手术组有 1例 (发作 2次 )。结论 经乙状窦后径路行VNT是目前普遍采用的一种较为方便、安全的控制或消除梅尼埃病患者眩晕症状手术方法 ,同时能保存听觉功能和面神经完整性 ;手术中辅助应用内镜技术 ,使该手术操作成为微创和安全 ,可有效地减轻对脑组织的压迫和减少术后脑水肿发生 。

Objective To study the vestibular neurotomy(VNT) via retrosigmoid approach assisted with the endoscope technique for relieving vertigo in Meniere's disease(MD), and the significance of reducing brain tissue oppression and postoperative complication. Methods Twelve MD patients with severe vertigo were operated with the VNT via retrosigmoid approach alone(conventional operation group,group 1) and 9 MD patients operated the above VNT were assisted with endoscopic neurotomy (endoscopic operation group, group 2). The pre and postoperative healt level of the patients eg. relieving effect of symptoms, facial nerve function, auditory level and vestibular function,were compared between the two groups. Results After operation in group 1,cerebral edema occurred in 2 patients needed to treat with dehydration for lowering the intracranial pressure. The average compensation time of equilibrium function was (29.00±9.60) days and (28.56±7.91) days in group 1 and 2 respectively. In each of the both groups, there were 2 patients with average auditory thresthold >15 dB.The complications of facial nerve palsy etc. were not found in both groups. The recurrent vertigo were found in two cases in group 1 and one case in group 2 postoperatively. Conclusion The VNT via retrosigmoid approach is the wide adopted operation which is a convenient and safe technique for controlling and eliminating the vertigo in Meniere's disease. It can preserve the auditory function and integrity of facial nerve, effective in reducing the cerebral tissue compression and postoperative cerebral edema. Any postoperative complications were not found in this study.