1Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama; and.
2Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
J Neurosurg. 2018 May;128(5):1522-1529. doi: 10.3171/2017.1.JNS161243. Epub 2017 Aug 11.
OBJECTIVE Microvascular decompression (MVD) is effective for the treatment of trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia. The transposition technique is the standard procedure to avoid adhesions and granuloma around the decompression site but is more complex and difficult to perform than the interposition technique. The authors describe a simple and safe MVD transposition procedure they call the "birdlime" technique, which uses a tissue glue-coated collagen sponge soaked with fibrin glue, and the results of this technique. METHODS The authors retrospectively reviewed the medical charts and radiographic findings of 27 consecutive patients with TN (8 patients) and HFS (19 patients) who, between January 2012 and December 2015, had undergone an MVD transposition procedure utilizing a tissue glue-coated collagen sponge (TachoSil tissue sealing sheet) soaked with fibrin glue (Tisseel 2-component fibrin sealant, vapor heated). Offending arteries among the patients with TN were the superior cerebellar artery (SCA) in 5 patients, the SCA and anterior inferior cerebellar artery (AICA) in 2, and the AICA in 1. Those among the patients with HFS were the vertebral artery (VA) in 3 patients, the VA and AICA in 4, the VA and posterior inferior cerebellar artery (PICA) in 3, the PICA in 4, the AICA in 1, the AICA-PICA in 3, and the PICA and AICA in 1. Operations were performed according to the Jannetta procedure. The offending artery was transposed and fixed to the dura mater of the petrous bone using TachoSil pieces soaked with fibrin glue. Postoperative constructive interference in steady-state MRI was performed to evaluate the change in the position of the offending artery. RESULTS Transposition of the offending artery was easily and safely performed in all patients. All patients had total remission of symptoms directly after the procedure. No severe complications occurred. The postoperative course was uneventful. No recurrences, adhesions, or dysfunction of the cranial nerves was observed in any of the patients. Postoperative MRI showed that the offending vessels were displaced and fixed in the appropriate position. CONCLUSIONS The described transposition technique provides an easy and adjustable way to perform MVD safely and effectively. In addition, this transposition and fixation technique is simple and avoids the risk of needle injury close to the cranial nerves and vessels. This simple sutureless technique is recommended for MVD to reduce the risk of intraoperative neurovascular injury.
微血管减压术(MVD)是治疗三叉神经痛(TN)、面肌痉挛(HFS)和舌咽神经痛的有效方法。转位技术是避免减压部位周围粘连和肉芽肿的标准方法,但比间隔技术更复杂和困难。作者描述了一种简单安全的 MVD 转位方法,称为“鸟胶”技术,该技术使用涂有组织胶的胶原海绵浸泡纤维蛋白胶,并介绍了该技术的结果。
作者回顾性分析了 2012 年 1 月至 2015 年 12 月期间接受 MVD 转位手术的 27 例连续 TN(8 例)和 HFS(19 例)患者的病历和影像学检查结果。该手术使用涂有组织胶的胶原海绵(TachoSil 组织密封片)浸泡纤维蛋白胶(Tisseel 双组分纤维蛋白密封剂,蒸汽加热)。TN 患者的致病动脉为小脑上动脉(SCA)5 例,小脑前下动脉(AICA)和 SCA 各 2 例,AICA 1 例。HFS 患者的致病动脉为椎动脉(VA)3 例,VA 和 AICA 各 4 例,VA 和后下小脑动脉(PICA)各 3 例,PICA 4 例,AICA 1 例,AICA-PICA 3 例,PICA 和 AICA 各 1 例。手术均按照 Jannetta 手术操作。用涂有纤维蛋白胶的 TachoSil 片将致病动脉转位并固定在岩骨硬脑膜上。术后行稳态对比增强 MRI 以评估致病动脉位置的变化。
所有患者均能安全、顺利地完成动脉转位。所有患者术后即刻症状完全缓解。无严重并发症发生。术后过程顺利。所有患者均未见复发、粘连或颅神经功能障碍。术后 MRI 显示致病血管被移位并固定在适当位置。
该转位技术操作简单,易于掌握,可安全有效地实施 MVD。此外,该转位和固定技术简单,可避免颅神经和血管附近针刺损伤的风险。这种简单的无缝线技术推荐用于 MVD,以降低术中神经血管损伤的风险。