摘要
目的 :探讨电视脑室镜下经乙状窦后入路手术治疗三叉神经痛的疗效 ,达到以最小的手术创伤获得最佳的治疗效果。方法 :在患侧耳后乳突内侧行小“S”切口 ,长 3～ 4cm ,骨窗直径 2 .5cm ,在脑室镜下寻找三叉神经后根 ,根据脑室镜下的病理发现进行相应处理 ,原发性三叉神经痛者行微血管减压术 ,继发性者行肿瘤切除术。结果 :术后病人三叉神经痛均消失 ,无严重手术并发症及无菌性脑膜炎 ;经 1年以上的随访 ,无三叉神经痛复发。与传统开颅显微手术相比可全方位观察到手术显微镜不能看到的死角 ,避免了术中遗漏病变 ,提高了手术疗效 ;并且电视脑室镜手术创伤小 ,对病人颅内组织干扰少 ,术后恢复快 ,住院时间短。结论 :对于常规治疗无效的原发性三叉神经痛和继发性三叉神经痛采用电视脑室镜下经乙状窦后入路微侵袭手术治疗是迄今最佳手术方法之一。
Objective: To assess the effectiveness of minimally invasive ventriculoscopic surgery for trigeminal neuralgia by retrosigmoidal approach. Methods: A 'S' shape retroauricular scalp incision about 3～4 cm was applied, with the bone opening (osteotomy) of 2.5 cm in diameter. The posterior root of trigeminal nerve was explored and traced under ventriculoscope. The intraoperative strategy varies with different pathological findings. Microvascular decompression was used in patients with primary trigeminal neuralgia while tumor resection performed accordingly in those individuals with neuralgia secondary to intracranial neoplasms. Results: The symptoms of neuralgia disappeared in all the patients postoperatively, with neither severe complication nor aseptic meningitis. No recurrence was observed after a period of follow up for more than one year. The minimally invasive ventriculoscopic surgery for trigeminal neuroalgia by retrosigmoidal approach can not only observe the intracranial dead zone that cannot be seen by microscope, but also invade minimal intracranial tissue as compared with the traditional microsurgical craniotomy. As a result, the treatment effect is improved because the missing out of pathological change is avoided during operation and the hospital days are significantly less. Conclusion: Video monitored endoscopic minimal invasive retrosigmoidal craniotomy is one of the optimal surgical categories in the patients with primary or secondary trigeminal neuralgia refractory to conventional therapeutic managements.
出处
《中国疼痛医学杂志》
CAS
CSCD
2002年第3期131-133,共3页
Chinese Journal of Pain Medicine
关键词
电视脑室镜
经乙状窦后入路
微侵袭手术
三叉神经痛
桥小脑角
Ventriculoscope
Minimally invasive surgery
Trigeminal neuroalgia
Cerebellopontive angle
Cholesteatoma
