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目的探讨显微血管减压术(MVD)治疗神经源性高血压的临床应用价值。方法回顾性分析2010年1月至2015年7月于神经外科治疗的38例诊断为神经源性高血压的患者,均伴有面肌痉挛、三叉神经痛、舌咽神经痛等颅神经疾病症状。术前对患者进行磁共振检查,提示左侧延髓头端腹外侧区(RVLM)及后组颅神经出(入)脑干区(REZ)存在位置异常的血管压迫。对左侧RVLM及第Ⅸ、Ⅹ颅神经REZ进行MVD,随访12~23个月,观察血压变化情况。结果根据术后血压水平,38例患者中治愈11例(28.9%),显效12例[31.6%,收缩压下降(39±13)mm Hg,舒张压下降(15±7)mm Hg],有效7例[18.4%,收缩压下降(16±8)mm Hg,舒张压下降(6±2)mm Hg],无效8例(21.1%)。显效率60.5%,有效率78.9%。所有患者的颅神经压迫症状均消失并且未出现严重并发症。结论 MVD在治疗神经源性高血压方面具有一定的应用前景。
Objective To investigate the clinical value of microvascular decompression (MVD) in the treatment of neurogenic hypertension. Methods A retrospective analysis of 38 patients with neurogenic hypertension who were treated in neurosurgery from January 2010 to July 2015 were accompanied by symptoms of cranial nerve diseases such as hemifacial spasm, trigeminal neuralgia and glossopharyngeal neuralgia . Preoperative MRI examination of patients, suggesting that the left rostral ventrolateral medulla (RVLM) and the posterior cranial nerve (into) brainstem zone (REZ) there is abnormal vascular compression. MVD was performed on the left RVLM and the Ⅸ, Ⅹ cranial nerves REZ, followed up for 12 to 23 months, the changes of blood pressure were observed. Results According to the postoperative blood pressure level, 11 cases (28.9%) were cured in 38 cases, 12 cases were markedly effective (31.6%), the systolic blood pressure decreased (39 ± 13) mm Hg and the diastolic blood pressure decreased (15 ± 7) mm Hg Seven patients (18.4%, systolic blood pressure decreased (16 ± 8) mm Hg, diastolic blood pressure decreased (6 ± 2) mm Hg], 8 cases (21.1%) were ineffective. Significantly effective rate of 60.5%, effective rate of 78.9%. All patients had symptoms of cranial nerve compression disappeared and no serious complications occurred. Conclusion MVD has certain application prospects in the treatment of neurogenic hypertension.