Taki W, Matsushima S, Hori K, Mouri G, Ishida F
Department of Neurosurgery, Mie University School of Medicine, Tsu City, Mie Prefecture, Japan.
Acta Neurochir (Wien). 2003 Jan;145(1):55-61. doi: 10.1007/s00701-002-1033-3.
Trigeminal neuralgia is usually treated by the padding method using Teflon felt. However this can not be done in certain cases in whom a large tortuous vertebrobasilar artery compresses the fifth nerve. The transposition method using the sling may be an alternative method. But this method is not an easy procedure and requires a relatively large craniotomy. Two cases were treated by a new and simpler effective technique.
Two cases of the trigeminal neruralgia were treated. The first case was a 71 year-old male and the second case was a 63 year-old male. The history of the medical treatments were similar and both cases had had trigeminal nerve blocks and were prescribed carbamazepin. However, the pain control was insufficient in both cases. In both cases, three dimensional computerized tomography showed the large tortuous right vertebral artery ran just behind the clivus and compressed the right trigeminal nerve. In the second case past history showed a recent hypertensive cerebellar hemorrhage.
A right suboccipital craniotomy were performed in both cases. In both cases, the right vertebral artery compressed the trigeminal nerve in a rostral direction. The sling technique with nylon sutures was tried in both cases but failed during surgery. Then, the bone fixation stainless plate was cut to 10 cm in length and pre-shaped with pliers. After being shaped, the distal end of the plate was inserted between the vertebral artery and fifth nerve and the proximal end of the plate was fixed to the skull by screw. The fifth nerve was completely isolated from the artery as they were in direct contact. After surgery, the pain disappeared completely during the follow-up of one and a half year in the first case and 9 months in the second case.
The plate can be bent and curved with plier to suit each individual case. This technique is easily applied even when the slings or other isolation technique is not available and appeared to achieve the mechanically stronger reposition and fixation of a very large and tortuous artery away from the trigeminal nerve.
三叉神经痛通常采用使用特氟龙毡的填塞法进行治疗。然而，在某些病例中，当粗大迂曲的椎基底动脉压迫第五神经时，无法采用这种方法。使用吊带的转位法可能是一种替代方法。但这种方法操作并不容易，需要进行相对较大的开颅手术。有两例患者采用了一种新的、更简单有效的技术进行治疗。
治疗了两例三叉神经痛患者。第一例是一名71岁男性，第二例是一名63岁男性。两例患者的治疗史相似，均接受过三叉神经阻滞，并服用过卡马西平。然而，两例患者的疼痛控制均不充分。两例患者的三维计算机断层扫描均显示粗大迂曲的右侧椎动脉走行于斜坡后方并压迫右侧三叉神经。第二例患者既往史显示近期有高血压性小脑出血。
两例患者均行右侧枕下开颅手术。两例患者中，右侧椎动脉均在头侧方向压迫三叉神经。两例患者均尝试了使用尼龙缝线的吊带技术，但手术过程中失败。然后，将骨固定不锈钢板剪成10厘米长，并用钳子预塑形。塑形后，将钢板远端插入椎动脉和第五神经之间，近端用螺钉固定于颅骨。第五神经与动脉直接接触的部位完全分离。术后，第一例患者在随访的一年半时间内疼痛完全消失，第二例患者在随访9个月时疼痛完全消失。
该钢板可用钳子弯曲和塑形以适应每个个体情况。即使在没有吊带或其他隔离技术的情况下，这种技术也易于应用，并且似乎实现了将非常粗大迂曲的动脉从三叉神经处进行机械上更强有力的重新定位和固定。
