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目的探讨神经内镜在三叉神经痛显微血管减压术(MVD)治疗中的作用。方法在三叉神经痛MVD中打开硬脑膜后,应用硬性30°角观察内镜,在桥小脑区观察三叉神经与周围血管的关系,找到责任血管。结果术中发现压迫血管小脑上动脉5例,小脑前下动脉3例,小脑后下动脉1例,小脑上、下动脉3例,合并静脉压迫2例。其中2例显微镜下遗漏,在神经内镜下发现。随访3～15个月,疼痛完全缓解10例,2例明显好转,1例行感觉根切断后,面部麻木,无其他并发症。结论 MVD中在显微镜下神经内镜辅助操作,可全方位观察神经、脑干及血管的关系,不易遗漏责任血管,减少术后复法,便于术中操作,减少对脑干、神经的牵拉及周围血管的骚扰,减少术后并发症。
Objective To explore the role of endoscopic neurosurgery in the treatment of trigeminal neuralgia with microvascular decompression (MVD). Methods After opening the dura in the trigeminal neuralgia MVD, the endoscope was observed with rigid angle of 30 °. The relationship between the trigeminal nerve and the surrounding blood vessels was observed in the cerebellopontine area to find the responsible vessels. Results In operation, 5 cases of superior vascular superior artery, 3 cases of anterior inferior cerebellar artery, 1 inferior cerebellar inferior artery, 3 superior cerebellar superior and inferior arteries, and 2 cases complicated with venous compression. Two of them were missed under the microscope and were found under endoscopy. All the patients were followed up for 3 to 15 months. Ten cases were completely relieved of pain and two cases were markedly improved. One case had sensory root severing and facial numbness without other complications. Conclusion MVD in the endoscopic assisted operation under the microscope, all-round observation of the relationship between nerve, brain stem and blood vessels, difficult to miss the responsibility of vascular, reduce postoperative rehabilitation, ease of intraoperative manipulation, reduce the brainstem, nerve stretch And surrounding blood vessels harassment, reduce postoperative complications.