Banczerowski Péter, Czigléczki Gábor, Nyáry István
National Institute of Neurosurgery, and.
J Neurosurg. 2014 Dec;121(6):1492-6. doi: 10.3171/2014.8.JNS132445. Epub 2014 Sep 26.
An enlarged, elongated, ectatic, and sclerotic aberration of the vertebrobasilar system is known as a megadolichoectatic basilar artery (BA) anomaly. The anomaly is often involved in the pathological process of trigeminal neuralgia by compressing and distorting the trigeminal nerve. First-line medical treatment includes drug therapy, but a second-line surgical procedure could be effective in medication-resistant cases. The authors report the case of a 65-year-old man with a 12-year history of progressing trigeminal neuralgia who underwent microvascular decompression after the first-line drug treatment had failed. This case is unique because an in situ tailored titanium microplate was used as a spacer to alleviate compression by the BA on the trigeminal nerve. The titanium implant provided durable and sufficient retraction for the sclerotic arterial complex when the trigeminal nerve was placed in the tunnel of the implant. The 9-year follow-up examination proves the safety and long-term efficacy of titanium implants in the treatment of trigeminal neuralgia caused by a megadolichoectatic BA anomaly. The method applied in this case was not intended to be and certainly is not an alternative to routine microvascular decompression-this surgical solution may be reserved for some extreme cases.
椎基底动脉系统的一种扩大、延长、扩张和硬化性畸变被称为巨大冗长扩张型基底动脉（BA）异常。这种异常常通过压迫和扭曲三叉神经而参与三叉神经痛的病理过程。一线药物治疗包括药物疗法，但二线手术程序在药物抵抗性病例中可能有效。作者报告了一例65岁男性患者，其患有长达12年的进行性三叉神经痛病史，在一线药物治疗失败后接受了微血管减压术。该病例独特之处在于使用了定制的原位钛微板作为间隔物，以减轻BA对三叉神经的压迫。当三叉神经置于植入物的通道中时，钛植入物为硬化的动脉复合体提供了持久且充分的牵拉。9年的随访检查证明了钛植入物在治疗由巨大冗长扩张型BA异常引起的三叉神经痛中的安全性和长期有效性。本病例所应用的方法并非旨在成为且肯定不是常规微血管减压术的替代方法——这种手术解决方案可能仅适用于某些极端病例。
