Komatsu Fuminari, Imai Masaaki, Hirayama Akihiro, Hotta Kazuko, Hayashi Naokazu, Oda Shinri, Shimoda Masami, Matsumae Mitsunori
Department of Neurosurgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
J Neurol Surg A Cent Eur Neurosurg. 2017 May;78(3):291-295. doi: 10.1055/s-0036-1592077. Epub 2016 Sep 5.
Endoscopic microvascular decompression (MVD) offers reliable identification of neurovascular conflicts under superb illumination, and it provides minimally invasive surgery for trigeminal neuralgia and hemifacial spasm. Transposition techniques have been reported as a decompression method to prevent adhesion and granuloma formation around decompression sites, providing better surgical outcomes. The feasibility and effects of transposition under endoscopic MVD were evaluated. Fully endoscopic MVD was performed using 4-mm 0- and 30-degree endoscopes. The endoscope was fixed with a pneumatic holding system, and a bimanual technique using single-shaft instruments was performed. Transposition was performed with Teflon felt string and fibrin glue. Surgical results were evaluated using the scoring system proposed by Kondo et al. The endoscope was introduced via a retrosigmoid keyhole. The 0-degree endoscope was advanced through the lateral aspect of the cerebellar tentorial surface to the trigeminal nerve in cases of trigeminal neuralgia and through the petrosal surface of the cerebellum to the facial nerve in cases of hemifacial spasm. Neurovascular conflicts and perforators from the offending artery were clearly demonstrated under the 30-degree endoscopic view, and transposition of the offending artery was safely performed with preservation of perforators. Clinical symptoms improved without permanent complications. Endoscopic MVD with the transposition technique is feasible. Superb endoscopic views demonstrate perforators arising from the offending artery behind the corner, allowing damage to perforators to be avoided during the transposition technique. Endoscopic MVD using the transposition technique is expected to offer excellent surgical results.
内镜下微血管减压术（MVD）在极佳的照明条件下能可靠地识别神经血管冲突，为三叉神经痛和半面痉挛提供微创手术。已有报道称转位技术作为一种减压方法可防止减压部位周围粘连和肉芽肿形成，从而获得更好的手术效果。本研究评估了内镜下MVD中转位技术的可行性和效果。
使用4毫米0度和30度内镜进行全内镜MVD。内镜通过气动固定系统固定，并采用单轴器械的双手操作技术。使用聚四氟乙烯毡条和纤维蛋白胶进行转位。采用近藤等人提出的评分系统评估手术结果。
通过乙状窦后锁孔入路插入内镜。在三叉神经痛病例中，0度内镜经小脑幕表面外侧推进至三叉神经；在半面痉挛病例中，经小脑岩骨表面推进至面神经。在30度内镜视野下可清晰显示神经血管冲突和肇事动脉的穿支，在保留穿支的情况下安全地进行肇事动脉转位。临床症状改善且无永久性并发症。
内镜下MVD联合转位技术是可行的。出色的内镜视野可显示拐角后方肇事动脉发出的穿支，从而在转位技术过程中避免损伤穿支。采用转位技术的内镜下MVD有望获得优异的手术效果。
