Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China.
Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.
World Neurosurg. 2019 Aug;128:e74-e80. doi: 10.1016/j.wneu.2019.03.289. Epub 2019 Apr 5.
Microvascular decompression (MVD) is the most definitive surgical treatment for trigeminal neuralgia (TN). In the case in which an atherosclerotic vertebrobasilar artery (aVBA) offends the trigeminal nerve, the postoperative outcomes have been reported to be less satisfactory in terms of symptom recurrence and complications. In this study, the authors present their experience using a biomedical sling for MVD in patients with aVBA-associated TN.
A retrospective study of 22 consecutive patients who underwent the biomedical glue sling technique in MVD for TN with aVBA was conducted between September 2016 and June 2017.
Intraoperatively, aVBA was regarded as the direct or indirect offending vessel in 22 patients. In addition to aVBA, other vessels involved in neurovascular conflict included superior cerebellar artery in 12 patients, veins in 1, and anterior inferior cerebellar artery in 6. All 22 patients underwent the biomedical glue sling technique. Postoperatively, TN was completely resolved in 20 (91%) patients and partially relieved in 2 (9%) patients. During the follow-up period of 18-27 months, pain developed severely in those 2 patients but could be relieved with carbamazepine. As for complications, postoperative hypoacusia occurred immediately in 1 case, with complete resolution in 2 months.
The biggest advantage of the biomedical glue sling technique is its simplicity in achieving complete decompression, requiring relatively less space and time. Because the outcome of traditional MVD regarding aVBA-associated TN remains controversial, the biomedical glue sling technique in MVD provides an alternative decompressive method for patients with TN associated with aVBA. However, further studies with a larger series and control group are required to prove the high effectiveness of this method.
微血管减压术（MVD）是治疗三叉神经痛（TN）最有效的手术方法。在椎动脉基底动脉（aVBA）压迫三叉神经根的情况下，术后症状复发和并发症的报道结果并不令人满意。在这项研究中，作者介绍了他们在伴有 aVBA 的 TN 患者中使用生物医学吊带进行 MVD 的经验。
对 2016 年 9 月至 2017 年 6 月间 22 例接受伴有 aVBA 的 TN 患者行生物医学胶吊带技术 MVD 的连续患者进行回顾性研究。
术中，22 例患者将 aVBA 视为直接或间接的致病血管。除了 aVBA，其他参与神经血管冲突的血管还包括 12 例患者的小脑上动脉、1 例患者的静脉和 6 例患者的小脑前下动脉。所有 22 例患者均行生物医学胶吊带技术。术后，20 例（91%）患者 TN 完全缓解，2 例（9%）患者部分缓解。在 18-27 个月的随访期间，2 例患者疼痛严重，但卡马西平可缓解。至于并发症，术后立即出现听力减退 1 例，2 个月完全缓解。
生物医学胶吊带技术的最大优势在于其可实现完全减压，所需空间和时间相对较少。由于传统 MVD 治疗 aVBA 相关 TN 的结果仍存在争议，因此 MVD 中的生物医学胶吊带技术为伴有 aVBA 的 TN 患者提供了一种替代减压方法。然而，需要进一步进行更大系列和对照组的研究来证明该方法的高效性。
