背景:微血管减压术(MVD)是舌咽神经痛(GPN)患者的正确选择。然而,舌咽/迷走神经根切断术是否应联合MVD仍存在争议。
目的:评估MVD期间舌咽/迷走神经根切断术是否需要治疗GPN。
方法:我们对我院46例仅接受MVD手术的GPN患者进行了回顾性研究,和他们病人的人口统计,临床表现,显示了术中发现。研究了近期和长期随访结果,以显示治疗的效率和安全性;也将结果与我们之前的研究进行了比较。回顾了相关文献,以显示GPN患者行舌咽/迷走神经根切断术伴MVD的并发症。
结果:最常见的侵犯血管是小脑后下动脉(60.9%)。100%的患者在MVD手术后立即无痛(BarrowNeurologicalInstitute疼痛强度[BNI-P]量表上的I评分),而1例患者术后12个月偶尔出现疼痛复发(BNI-P评分III)。伤口愈合不良和听力损失各1例。未报告与舌咽神经/迷走神经相关的并发症。一些手术技术,例如对CNIX-X小根的彻底探索,完全摆脱蛛网膜粘连,和使用潮湿的明胶海绵,可以提高手术的成功率。
结论:对于GPN患者,单用MVD而不进行脊神经切断术是一种有效且安全的方法。
BACKGROUND: Microvascular decompression (MVD) has been the right choice for glossopharyngeal neuralgia (GPN) patients. However, whether glossopharyngeal/vagal nerve root rhizotomy should be combined with MVD is still controversial.
OBJECTIVE: To evaluate whether glossopharyngeal/vagal nerve root rhizotomy during MVD is necessary for the treatment of GPN.
METHODS: We performed a retrospective study of 46 GPN patients who underwent MVD surgery alone in our hospital, and their patient demographics, clinical presentations, and intraoperative findings are shown. The immediate and long-term follow-up outcomes were investigated to show the treatment\'s efficiency and safety; the outcome was also compared with our previous study. The relevant literature was reviewed to show complications for GPN patients undergoing glossopharyngeal/vagal nerve root rhizotomy with MVD.
RESULTS: The most common offending vessel was the posterior inferior cerebellar artery (60.9%). 100% of the patients were pain-free (score of I on the Barrow Neurological Institute pain intensity [BNI-P] scale) immediately after MVD surgery, while 1 patient relapsed with occasional pain 12 months after the operation (score of III on the BNI-P scale). Poor wound healing and hearing loss were found in 1 case each. No complications related to the glossopharyngeal nerve/vagal nerve were reported. Some surgical techniques, such as thorough exploration of the CN IX-X rootlets, full freeing from arachnoid adhesions, and usage of a moist gelatin sponge, can improve the success rate of the operation.
CONCLUSIONS: MVD alone without rhizotomy is an effective and safe method for patients with GPN.