三叉神经显微血管减压术中对岩上静脉的处理方式及并发症的影响
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摘要
目的探讨三叉神经显微血管减压术中岩上静脉的处理方式及并发症的影响。方法回顾性分析济宁市第一人民医院神经外科2012年6月1日—2013年5月30日,行显微血管减压术治疗的200例三叉神经痛患者的临床资料,对其治疗和结果进行总结。结果 200例患者中,术中切断岩上静脉主干2例,其中小脑水肿1例,脑干梗死1例;术中切断岩上静脉分支17例,其中小脑出血1例;术中完全保护岩上静脉181例。根据责任血管情况,单纯动脉压迫138例,单纯静脉压迫4例,动脉合并岩上静脉压迫58例。结论根据岩上静脉和三叉神经的解剖关系,对岩上静脉术中予以不同的处理,尽可能保留岩上静脉,尤其对岩上静脉蛛网膜双层结构的充分锐性分离,可明显降低术后并发症的发生率。
Objective To discuss the management of superior petrosal vein and the influence of complications during trigeminal nerve microvascular decompression (MVD). Methods The clinical data of 200 patients with trigeminal neuralgia treated by MVD from June 1,2012 to May 30,2013 in Jining First People's Hospital of Shandong Province were analyzed retrospectively. Results Of 200 patients,the complications were counted according to the management of superior petrosal vein during operation. 2 cases were cut off the main trunk of superior petrosal vein during operation,including 1 of cerebellar edema and 1 of brainstem infarction. The branches of superior petrosal vein were cut off in 17 cases during operation,including 1 of cerebellar hemorrhage and 181 of complete protection of superior petrosal vein during operation. According to the compression of the responsible vessels of trigeminal nerve during operation,4 were simple venous compression,while 58 were arterial compression coexist with superior petrosal vein,and 138 were simple arterial compression.Conclusions Different types of superior petrosal veins should be treated in different ways according to the actual situation during the operation. Retaining the superior petrosal veins,especially to sharp separation of the double-layer structure of the arachnoid of the superior petrosal veins adequately can greatly reduce the incidence of postoperative complications.
Objective To discuss the management of superior petrosal vein and the influence of complications during trigeminal nerve microvascular decompression (MVD). Methods The clinical data of 200 patients with trigeminal neuralgia treated by MVD from June 1,2012 to May 30,2013 in Jining First People's Hospital of Shandong Province were analyzed retrospectively. Results Of 200 patients,the complications were counted according to the management of superior petrosal vein during operation. 2 cases were cut off the main trunk of superior petrosal vein during operation,including 1 of cerebellar edema and 1 of brainstem infarction. The branches of superior petrosal vein were cut off in 17 cases during operation,including 1 of cerebellar hemorrhage and 181 of complete protection of superior petrosal vein during operation. According to the compression of the responsible vessels of trigeminal nerve during operation,4 were simple venous compression,while 58 were arterial compression coexist with superior petrosal vein,and 138 were simple arterial compression.Conclusions Different types of superior petrosal veins should be treated in different ways according to the actual situation during the operation. Retaining the superior petrosal veins,especially to sharp separation of the double-layer structure of the arachnoid of the superior petrosal veins adequately can greatly reduce the incidence of postoperative complications.
引文
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[18]Robert T,Blanc R,Ciccio G,et al.Trigeminal neuralgia due to arterialization of the superior petrosal vein in the context of dural or cerebral arteriovenous shunt[J].Stroke,2015,138:83.
[19]钱涛,王坤鹏.三叉神经痛显微血管减压术中岩静脉保护的可行性探讨[J].临床合理用药杂志,2014,7:115.
[20]Liebelt BD,Barber SM,Desai VR,et al.Superior petrosal vein sacrifice during microvascular decompression:perioperative complication rates and comparison with venous preservation[J].World Neurosurg,2017,104:788.
[21]Mclaughlin MR,Jannetta PJ,Subach BR,et al.Coagulation of the petrosal vein for MVD-response[J].J Neurosurg,1999,90:1148.
[22]Pathmanaban ON,O’brien F,Al-Tamimi YZ,et al.Safety of superior petrosal vein sacrifice during microvascular decompression of the trigeminal nerve[J].World Neurosurg,2017,103:84.
[23]Morisako H,Goto T,Chokyu I,et al.Preoperative evaluation of the petrosal vein with contrast-enhanced PRESTO imaging in petroclival meningiomas to establish surgical strategy[J].Neurol Med Chir(Tokyo),2013,53:490.
[24]Anichini G,Iqbal M,Rafig NM,et al.Sacrificing the superior petrosal vein during microvascular decompression.Is it safe?Learning the hard way.Case report and review of literature[J].Surg Neurol Int,2016,7:S415.
[25]Strauss C,Neu M,Bischoff B,et al.Clinical and neurophysiological observations after superior petrosal vein obstruction during surgery of the cerebellopontine angle:Case report[J].Neurosurgery,2001,48:1157.
[26]Samii M,Matthies C.Recurrent trigeminal neuralgia attributable to veins after microvascular decompression-Comment[J].Neurosurgery,2000,46:362.
[27]Fujimaki T,Kirino T.Combined transhorizontal-supracerebellar approach for microvascular decompression of trigeminal neuralgia[J].Br J Neurosurg,2000,14:531.
[28]Sekula J,Frederickson AM,Jannetta PJ,et al.Microvascular decompression in patients with isolated maxillary division trigeminal neuralgia,with particular attention to venous pathology[J].Neurosurg Focus,2009,27:E10.
[29]Sekula J,Frederickson AM,Jannetta PJ,et al.Microvascular decompression in patients with isolated maxillary division trigeminal neuralgia,with particular attention to venous pathology[J].Neurosurg Focus,2009,27:E10.
[30]Helbig GM,Callahan JD,Cohen-Gadol AA.Variant intraneural vein-trigeminal nerve relationships:An observation during microvascular decompression surgery for trigeminal neuralgia[J].Neurosurgery,2009,65:958.
[31]Zhong J,Li ST,Xu SQ,et al.Management of petrosal veins during microvascular decompression for trigeminal neuralgia[J].Neurol Res,2008,30:697.
[32]Wang H,Ying X,Yu WH,et al.Suprafloccular approach via the petrosal fissure and venous corridors for microvascular decompression of the trigeminal nerve:technique notes and clinical outcomes[J].J Neurosurg,2018,129:324.
[33]Zhong J,Sun H.Surgical technique of microvascular decompression surgery for trigeminal neuralgia[M].Springer,2016.
[2]Nanda A,Javalkar V,Zhang SH,et al.Long term efficacy and patient satisfaction of microvascular decompression and gamma knife radiosurgery for trigeminal neuralgia[J].J Clin Neurosci,2015,22:818.
[3]Samii M,Gerganov V.Microsurgical anatomy of the cerebellopontine angle by the retrosigmoid approach.In:Surgery of cerebellopontine lesions[M].Springer,2013.
[4]Feng BH,Zheng XE,Wang XQ,et al.Management of different kinds of veins during microvascular decompression for trigeminal neuralgia:technique notes[J].Neurol Res,2015,37:1090.
[5]Lacerda Leal PR,Roch JA,Hermier MA,et al.Structural abnormalities of the trigeminal root revealed by diffusion tensor imaging in patients with trigeminal neuralgia caused by neurovascular compression:A prospective,double-blind,controlled study[J].Pain,2011,152:2357.
[6]Koerbel A,Wolf SA,Kiss A.Peduncular hallucinosis after sacrifice of veins of the petrosal venous complex for trigeminal neuralgia[J].Acta Neurochir(Wien),2007,149:831.
[7]Hong W,Zheng X,Wu Z,et al.Clinical features and surgical treatment of trigeminal neuralgia caused solely by venous compression[J].Acta Neurochir(Wien),2011,153:1037.
[8]Ward C,Corns R,Offa-Jones B,et al.Cerebellar infarction following division of Dandy's vein in microvascular decompression for trigeminal neuralgia[J].J Neurol Surg B Skull Base,2012,73:A380.
[9]Matsushima K,Matsushima T,Kuga Y,et al.Classification of the superior petrosal veins and sinus based on drainage pattern[J].Neurosurgery,2014,10:357.
[10]Masuoka J,Matsushima T,Hikita T,et al.Cerebellar swelling after sacrifice of the superior petrosal vein during microvascular decompression for trigeminal neuralgia[J].J Clin Neurosci,2009,16:1342.
[11]Broggi G,Broggi M,Ferroli P,et al.Surgical technique for trigeminal microvascular decompression[J].Acta Neurochir(Wien),2012,154:1089.
[12]Leonhard T,Lehmann R.The petrosal vein and its demonstration in the normal vertebral angiogram[J].Neuroradiology,1976,10:271.
[13]Choudhari KA.Superior petrosal vein in trigeminal neuralgia[J].Br J Neurosurg,2007,21:288.
[14]陈广鑫,徐伦山,许民辉,等.三叉神经痛显微血管减压术中对静脉压迫的处理[J].重庆医学,2013,42:1280.
[15]Tanriover N,Abe H,Rhoton J,et al.Microsurgical anatomy of the superior petrosal venous complex:new classifications and implications for subtemporal transtentorial and retrosigmoid suprameatal approaches[J].J Neurosurg,2007,106:1041.
[16]Tubbs RS,Hansasuta A,Loukas M,et al.The basilar venous plexus[J].Clin Anat,2007,20:755.
[17]Dumot C,Sindou M.Trigeminal neuralgia due to neurovascular conflicts from venous origin:an anatomical-surgical study(consecutive series of 124 operated cases)[J].Acta Neurochir(Wien),2015,157:455.
[18]Robert T,Blanc R,Ciccio G,et al.Trigeminal neuralgia due to arterialization of the superior petrosal vein in the context of dural or cerebral arteriovenous shunt[J].Stroke,2015,138:83.
[19]钱涛,王坤鹏.三叉神经痛显微血管减压术中岩静脉保护的可行性探讨[J].临床合理用药杂志,2014,7:115.
[20]Liebelt BD,Barber SM,Desai VR,et al.Superior petrosal vein sacrifice during microvascular decompression:perioperative complication rates and comparison with venous preservation[J].World Neurosurg,2017,104:788.
[21]Mclaughlin MR,Jannetta PJ,Subach BR,et al.Coagulation of the petrosal vein for MVD-response[J].J Neurosurg,1999,90:1148.
[22]Pathmanaban ON,O’brien F,Al-Tamimi YZ,et al.Safety of superior petrosal vein sacrifice during microvascular decompression of the trigeminal nerve[J].World Neurosurg,2017,103:84.
[23]Morisako H,Goto T,Chokyu I,et al.Preoperative evaluation of the petrosal vein with contrast-enhanced PRESTO imaging in petroclival meningiomas to establish surgical strategy[J].Neurol Med Chir(Tokyo),2013,53:490.
[24]Anichini G,Iqbal M,Rafig NM,et al.Sacrificing the superior petrosal vein during microvascular decompression.Is it safe?Learning the hard way.Case report and review of literature[J].Surg Neurol Int,2016,7:S415.
[25]Strauss C,Neu M,Bischoff B,et al.Clinical and neurophysiological observations after superior petrosal vein obstruction during surgery of the cerebellopontine angle:Case report[J].Neurosurgery,2001,48:1157.
[26]Samii M,Matthies C.Recurrent trigeminal neuralgia attributable to veins after microvascular decompression-Comment[J].Neurosurgery,2000,46:362.
[27]Fujimaki T,Kirino T.Combined transhorizontal-supracerebellar approach for microvascular decompression of trigeminal neuralgia[J].Br J Neurosurg,2000,14:531.
[28]Sekula J,Frederickson AM,Jannetta PJ,et al.Microvascular decompression in patients with isolated maxillary division trigeminal neuralgia,with particular attention to venous pathology[J].Neurosurg Focus,2009,27:E10.
[29]Sekula J,Frederickson AM,Jannetta PJ,et al.Microvascular decompression in patients with isolated maxillary division trigeminal neuralgia,with particular attention to venous pathology[J].Neurosurg Focus,2009,27:E10.
[30]Helbig GM,Callahan JD,Cohen-Gadol AA.Variant intraneural vein-trigeminal nerve relationships:An observation during microvascular decompression surgery for trigeminal neuralgia[J].Neurosurgery,2009,65:958.
[31]Zhong J,Li ST,Xu SQ,et al.Management of petrosal veins during microvascular decompression for trigeminal neuralgia[J].Neurol Res,2008,30:697.
[32]Wang H,Ying X,Yu WH,et al.Suprafloccular approach via the petrosal fissure and venous corridors for microvascular decompression of the trigeminal nerve:technique notes and clinical outcomes[J].J Neurosurg,2018,129:324.
[33]Zhong J,Sun H.Surgical technique of microvascular decompression surgery for trigeminal neuralgia[M].Springer,2016.
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