全内镜下微血管减压术治疗椎基底动脉所致三叉神经痛：病例系列回顾：二维手术视频
Fully Endoscopic Microvascular Decompression for Trigeminal Neuralgia Caused by Vertebrobasilar Artery: A Case Series Review: 2-Dimensional Operative Video.
作者信息
Sun Jinxing, Wang Jiwei, Jia Junheng, Cao Zexin, Li Zhenke, Zhang Chao, Guo Xing, Wu Qianqian, Li Weiguo, Ma Xiangyu
机构信息
Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan , China.
Jinan Microecological Biomedicine Shandong Laboratory and the Shandong Key Laboratory of Brain Function Remodeling, Jinan , China.
出版信息
Oper Neurosurg (Hagerstown). 2024 Apr 1;26(4):433-441. doi: 10.1227/ons.0000000000000998. Epub 2023 Nov 17.
BACKGROUND AND OBJECTIVE
Microvascular decompression (MVD) is the most definitive and preferred surgical treatment for trigeminal neuralgia (TN). Treatment of TN caused by the vertebrobasilar artery (VBA) has been reported to be challenging and less satisfactory in complications and recurrence. Endoscopy has been implemented to provide a comprehensive view of neurovascular conflicts and minimize brain tissue stretch injury while exploring the trigeminal nerve. However, there are few retrospective studies on the treatment of TN caused by VBA by fully endoscopic microvascular decompression (E-MVD). This article aimed to illustrate the safety and efficacy of E-MVD for TN caused by the VBA.
METHODS
Clinical data for 26 patients with TN caused by the VBA who underwent E-MVD from 2019 to 2022 were retrospectively analyzed. The characteristics of vertebrobasilar-associated TN were summarized. The safety and efficacy of E-MVD for vertebrobasilar-associated TN were estimated based on the analysis of intraoperative manipulation, postoperative symptom relief, and complications.
RESULTS
Intraoperatively, the vertebrobasilar artery was regarded as a direct offending vessel in all 26 patients with TN, the vertebral artery in 18 (69.23%) and the basilar artery in 10 (38.46%). In addition to the vertebrobasilar artery, other vessels involved included the superior cerebellar artery in 12 patients, anterior inferior cerebellar artery in 9, posterior inferior cerebellar artery in 1, and veins in 4. All patients underwent E-MVD, and TN was entirely resolved in 26 (100%) patients immediately postoperatively. During the follow-up period of 12-45 months, no recurrence or serious complications were found. There were no serious postoperative complications, such as cerebellar swelling, intracranial hemorrhage, or death.
CONCLUSION
E-MVD for vertebrobasilar-associated TN is effective and safe.
背景与目的
微血管减压术（MVD）是三叉神经痛（TN）最具决定性且首选的外科治疗方法。据报道，由椎基底动脉（VBA）引起的TN治疗具有挑战性，在并发症和复发方面不太令人满意。在内镜探查三叉神经时，已采用内镜来全面观察神经血管冲突，并将脑组织拉伸损伤降至最低。然而，关于完全内镜下微血管减压术（E-MVD）治疗由VBA引起的TN的回顾性研究较少。本文旨在阐明E-MVD治疗由VBA引起的TN的安全性和有效性。
方法
回顾性分析2019年至2022年接受E-MVD治疗的26例由VBA引起的TN患者的临床资料。总结椎基底动脉相关TN的特征。基于对术中操作、术后症状缓解和并发症的分析，评估E-MVD治疗椎基底动脉相关TN的安全性和有效性。
结果
术中，在所有26例TN患者中，椎基底动脉被视为直接致病血管，其中椎动脉18例（69.23%），基底动脉10例（38.46%）。除椎基底动脉外，其他受累血管包括小脑上动脉12例、小脑前下动脉9例、小脑后下动脉1例和静脉4例。所有患者均接受了E-MVD，术后即刻TN完全缓解26例（100%）。在12至45个月的随访期内，未发现复发或严重并发症。无严重术后并发症，如小脑肿胀、颅内出血或死亡。
结论
E-MVD治疗椎基底动脉相关TN是有效且安全的。
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