Peng W C, Guan F, Hu Z Q, Huang H, Dai B, Zhu G T, Mao B B, Xiao Z Y, Zhang B L, Liang X
Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
Zhonghua Yi Xue Za Zhi. 2021 Mar 30;101(12):856-860. doi: 10.3760/cma.j.cn112137-20200630-02002.
To explore the efficacy and technical features of fully endoscopic microvascular decompression(MVD) in primary trigeminal neuralgia(PTN) via keyhole approach. The clinical data of 97 patients with PTN underwent fully endoscopic MVD via keyhole approach in the Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University from December 2014 to February 2019 was collected. During fully endoscopic MVD in PTN via keyhole approach, performer use natural clearance without grinding except developed rock bone crest or excessive retraction of the brain tissue, visually and panoramically observe and evaluate the CPA area, accurately identify the responsible vessels, to avoid the omission of responsible vessels or insufficient decompression. And the use of preplaced technology, bridging technology and submersible technology, ensure the efficacy of surgery and reduce the surgical side injuries.Barrow Neurological Institute (BNI) pain score was used to evaluate the efficacy and identify the recurrence. The surgical efficacy was analyzed. The offending vessels were identified under endoscope in 96 cases. Among them, arterial compression was found in 77 cases, venous compression in 6 cases, and both arterial and venous compression in 13 cases. About the pain outcomes, 87 cases had immediate and complete relief of pain, 5 cases had almost relief of pain, 4 cases had partial relief of pain, and still needed medication control, but the dose was lower than that before operation, and 1 case had no obvious relief of pain. About complications, there were 4 cases of temporary facial numbness, 1 case of temporary hearing loss, both of them recovered after symptomatic treatment. There was no cerebral infarction or hemorrhage, intracranial or incision infection. All cases were followed up for 3.0-38.0 months with a median period of(22.4±2.2) months. During the follow-up periods, postoperative recurrence occurred in 3 cases. Fully endoscopic MVD for PTN through keyhole approach, provides panoramic view to avoid omission of offending vessels and reduce complications, seemed to be a safe and effective surgical method.
探讨锁孔入路全内镜下微血管减压术（MVD）治疗原发性三叉神经痛（PTN）的疗效及技术特点。收集2014年12月至2019年2月在首都医科大学附属北京世纪坛医院神经外科行经锁孔入路全内镜下MVD治疗的97例PTN患者的临床资料。在锁孔入路全内镜下MVD治疗PTN过程中，术者利用自然间隙，除发育性岩骨嵴或过度牵拉脑组织外无需磨除骨质，直观全景式观察和评估桥小脑角（CPA）区，准确识别责任血管，避免责任血管遗漏或减压不充分。并采用预置技术、架桥技术和潜行技术，确保手术疗效并减少手术副损伤。采用巴罗神经学研究所（BNI）疼痛评分评估疗效并判断复发情况。分析手术疗效。96例在内镜下明确责任血管。其中，动脉压迫77例，静脉压迫6例，动静脉联合压迫13例。疼痛结局方面，87例疼痛立即完全缓解，5例疼痛基本缓解，4例疼痛部分缓解，仍需药物控制但剂量低于术前，1例疼痛无明显缓解。并发症方面，4例出现暂时性面部麻木，1例出现暂时性听力减退，经对症治疗后均恢复。无脑梗死或出血、颅内或切口感染。所有病例随访3.0 - 38.0个月，中位随访时间为（22.4±2.2）个月。随访期间，3例出现术后复发。锁孔入路全内镜下MVD治疗PTN，能提供全景视野以避免责任血管遗漏并减少并发症，似乎是一种安全有效的手术方法。
