Jarrahy Reza, Cha Sung Tae, Eby Joseph B, Berci George, Shahinian Hrayr K
Division of Skull Base Surgery, Cedars-Sinai Medical Center, 8635 West Third Street, Los Angeles, CA 90048, USA.
J Craniofac Surg. 2002 Jan;13(1):90-5. doi: 10.1097/00001665-200201000-00021.
Microvascular decompression of the glossopharyngeal nerve is an effective treatment of patients with glossopharyngeal neuralgia in whom compression of the nerve by a blood vessel is implicated in the pathogenesis of the disease. The standard surgical technique uses a binocular operating microscope for intra-operative visualization. Growing experience with posterior fossa endoscopy, however, has suggested that endoscopes may provide more comprehensive anatomical views of cerebellopontine angle. This report describes the case of a patient suffering from glossopharyngeal neuralgia who underwent fully endoscopic vascular decompression of the glossopharyngeal nerve. During this procedure the endoscope was used to survey the posterior fossa, guide the placement of insulating sponges, and conduct a final assessment of the intervention. We found the endoscope ideally suited to the constricted operating space of the posterior fossa, allowing for accurate localization and careful separation of the pathological vascular conflict with minimal brain retraction and no damage to surrounding structures. The versatility of endoscopy allows for superior visual appreciation of neurovascular conflicts in the posterior fossa. To date, endoscopy has primarily been used to supplement microscopy in cranial nerve decompression surgery. This report demonstrates how the endoscope can be used as the sole imaging modality in glossopharyngeal nerve decompression, with excellent results.
微血管减压术治疗舌咽神经痛患者效果显著，这类患者的疾病发病机制与血管对神经的压迫有关。标准手术技术是使用双目手术显微镜进行术中可视化操作。然而，随着后颅窝内镜经验的不断积累，有研究表明内镜可能能提供更全面的桥小脑角解剖视野。本报告描述了一例舌咽神经痛患者接受全内镜下舌咽神经血管减压术的病例。在此手术过程中，内镜用于探查后颅窝、引导绝缘海绵的放置，并对手术效果进行最终评估。我们发现内镜非常适合后颅窝狭窄的手术空间，能够在对脑牵拉最小且不损伤周围结构的情况下，准确地定位并仔细分离病理性血管冲突。内镜的多功能性使其能够更好地观察后颅窝的神经血管冲突。迄今为止，内镜主要用于在颅神经减压手术中辅助显微镜。本报告展示了内镜如何可作为舌咽神经减压术中唯一的成像方式，并取得了优异的效果。
