小脑水平裂－小脑脑桥裂入路在三叉神经痛微血管减压术中的应用

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摘要目的探讨小脑水平裂－小脑脑桥裂入路在三叉神经痛微血管减压术中的应用。方法选取2018-03至2020-10在安徽医科大学附属第一医院神经外科就诊的72例三叉神经痛患者,术中岩静脉均存在阻挡,分为两组,一组采用小脑水平裂－小脑脑桥裂入路(脑裂组),一组常规小脑外侧入路(常规组),比较两组病例的岩静脉术中破裂或被切断的发生率及手术效果。结果脑裂组无一例术中岩静脉破裂或被切断,常规组岩静脉破裂6例(16.7%),术中被切断6例(16.7%),脑裂组术中岩静脉破裂或被切断的发生率小于常规组,差异有统计学意义(P<0.05)。两组疗效比较,差异无统计学意义(χ²=6.063,P=0.109);但脑裂组治愈率高于常规组,差异有统计学意义(χ²=5.171,P=0.023)。随访6个月,脑裂组复发率小于常规组(18.75%),差异有统计学意义(P<0.05)。结论在三叉神经痛微血管减压术中,经小脑水平裂－小脑脑桥裂入路可以降低术中岩静脉破裂或被切断的风险,且治愈率及术后6个月复发率均优于常规入路。

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	吕波
	韩轶鹏

关键词 ：三叉神经痛, 小脑水平裂, 小脑脑桥裂, 岩静脉

Abstract：Objective To investigate the application of transcerebellar horizontal fissure cerebellopontine fissure approach in microvascular decompression for trigeminal neuralgia.Methods Seventy-two patients with trigeminal neuralgia treated in the department of neurosurgery of the First Affiliated Hospital of Anhui Medical University from March 2018 to October 2020 were divided into the cerebral fissure group which were treated with transcerebellar horizontal fissure cerebellopontine fissure approach and the normal group which were treated with normal lateral cerebellar approach. The incidence and effect of intraoperative rupture or disconnection of petrosal vein were compared between the two groups.Results There was no intraoperative petrosal vein rupture or cut-off in the cerebral fissure group. There were 6 cases of petrosal vein rupture (16.7%) and 6 cases of intraoperative cut-off (16.7%) in the normal group. The incidence of intraoperative petrosal vein rupture or cut-off in the cerebral fissure group was lower than that in the conventional group, and the difference was statistically significant (P<0.05); There was no significant difference between the two groups in curative effect (χ²=6.063,P=0.109); But the cure rate of cerebral fissure group was higher than that of normal group, and the difference was statistically significant (χ²=5.171,P=0.023). After 6 months of follow-up, the recurrence rate (0) of cerebral fissure group was lower than that of routine group (18.75%). The difference was statistically significant (P<0.05).Conclusion In microvascular decompression for trigeminal neuralgia, the transcerebral horizontal fissure cerebellopontine fissure approach can reduce the risk of intraoperative petrosal vein rupture or disconnection, and the cure rate and recurrence rate 6 months after operation are better than the conventional approach.

Key words： trigeminal neuralgia horizontal fissure cerebellopontine fissure petrosal vein

收稿日期: 2022-02-15

ZTFLH:

R651.1

通讯作者: 韩轶鹏,E-mail:hanyipeng79@163.com

作者简介: 吕波,硕士,主治医师。

引用本文:

吕波, 韩轶鹏. 小脑水平裂－小脑脑桥裂入路在三叉神经痛微血管减压术中的应用[J]. 武警医学, 2022, 33(7): 569-572. LV Bo, HAN Yipeng. Application of transcerebellar horizontal fissure cerebellopontine fissure approach in trigeminal microvascular decompression. Med. J. Chin. Peop. Armed Poli. Forc., 2022, 33(7): 569-572.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2022/V33/I7/569

[1]	刘彪,郭盼,王鹏,等. 微血管减压术与微球囊压迫术治疗三叉神经痛疗效的Meta分析[J]. 中国微侵袭神经外科杂志, 2021, 26(5): 205-209.
[2]	雷楠,黄杰,徐龙,等. 原发性三叉神经痛的多模态结构神经影像研究进展[J]. 中国疼痛医学杂志,2021,27(4):287-291.
[3]	张施远,廖进,蒋永明. 原发性三叉神经痛微血管减压术中困难减压的处理[J]. 中国临床神经外科杂志,2021,26(10):772-775,779.
[4]	Mizobuchi Y,Ohtanim M,Satomi J,et al. The current status of microvascular decompression for the treatment of trigeminal neuralgia in Japan:an analysis of 1619 patients using the Japanese diagnosis procedure combination database[J]. Neurol Med Chir(Tokyo),2018,58(1):10-16.
[5]	Bendtsen L,Zakrzewska J M,Abbott J,et al. EAN guideline on trigeminal neuralgia[J]. Eur J Neurol,2019,26(6):831-849.
[6]	中华医学会神经外科学分会功能神经外科学组,中国医师协会神经外科医师分会功能神经外科专家委员会.三叉神经痛诊疗中国专家共识[J].中华外科杂志,2015,53(9):657-664.
[7]	杨玉明,王作伟,崔壮, 等. 三叉神经微血管减压术岩静脉特点及处理方法探讨[J]. 中华医学杂志,2017, 97(7):522-524.
[8]	王鼎,沈永锋,杜垣峰,等. 经小脑水平裂-小脑桥脑裂入路在三叉神经痛微血管减压术中的应用[J]. 浙江医学,2019, 41(2):177-179.
[9]	李加昆,刘岩,雒仁玺,等. 微血管减压术中岩下静脉处理方法分析[J]. 浙江临床医学,2018,20(1):34-36.
[10]	杨超,冯慧宇,刘金龙,等. 单责任血管和多责任血管三叉神经痛微血管减压术的疗效比较[J]. 中华神经医学杂志,2016,15(9):918-922.
[11]	药天乐,赵学明,万大海,等. 显微血管减压术治疗原发性三叉神经痛及合并舌咽神经痛的疗效观察[J]. 中西医结合心脑血管病杂志,2020,18(9):1485-1488.
[12]	Matsushima K, Yagmurlu K, Kohno M, et al. Anatomy and approaches along the cerebellar-brainstem fissures[J]. J Neurosurg,2016,124(1):248-263.
[13]	郑鲁,楚燕飞,姚智强,等. 小脑水平裂小脑桥脑裂入路治疗三叉神经痛 [J]. 中华神经外科杂志,2010,26(7): 640-642.
[14]	Russell R,Ronald I.Neurovascular decompression in craniat nerves V,VII,IX,and X//Sehmidek & Sweet.Operative Neurosurgical Technique:Indications,Methods,and results [M].6th ed.Philadclphia:Saunders,2012:1419-1432.
[15]	王杨灵犀,王翀. 三叉神经显微血管减压术中对岩上静脉的处理方式及并发症的影响[J]. 临床神经外科杂志, 2019,16(2): 147-152.
[16]	杨德宝, 王之敏, 蒋栋毅, 等. 三叉神经痛微血管减压术中岩静脉的处理[J]. 临床神经外科杂志, 2012,9(3): 174-175.
[17]	赵有让,于炎冰,张黎. 显微血管减压术后颅内出血性并发症的研究进展[J]. 中华神经外科杂志,2016,32( 3) : 317-321
[18]	马凯,李勇杰,胡永生,等.三叉神经痛显微血管减压术中岩静脉处理策略的研究[J]. 中华神经外科杂志, 2015,1(31): 44-47.
[19]	artínez-Anda J J,Barges-Coll J,Ponce-Gomez J A,et al. Surgical management of trigeminal neuralgia in elderly patients using a small retrosigmoidal approach:analysis of efficacy and safety[J]. J Neurol Surg A Cent Eur Neurosurg,2014,76 (1):540-545.
[20]	赵有让, 于炎冰, 张黎,等. 显微血管减压术后的死亡原因及危险因素分析[J].中华神经外科杂志, 2017, 33(2): 154-159.