改良微血管减压术预防术后脑脊液切口漏和皮下积液的效果
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摘要
目的观察改良微血管减压术预防术后脑脊液切口漏和皮下积液的效果。方法回顾性分析行改良微血管减压术的305例患者的临床资料。结果所有患者术后均无脑脊液切口漏的发生。出现皮下积液1例,经对症治疗后痊愈出院。6～36个月随访结果:180例三叉神经痛患者中,157例患者术后症状消失,22例症状明显减轻,1例无好转;122例面肌痉挛患者中,120例症状完全消失,2例好转;3例舌咽神经痛患者,术后疼痛均消失。结论改良微血管减压术可有效预防术后脑脊液切口漏和皮下积液的发生。
Objective To observe the efficiency of modified microvascular decompression in prevention of cerebrospinal fluid incision leakage and subcutaneous effusion.Methods The clinical data of 305 patients underwent modified microvascular decompression were retrospectively analyzed.Results No case with cerebrospinal fluid incision leakage after modified microvascular decompression occurred in 305 cases.One case appeared subcutaneous effusion,who was discharged one week after treatment.The patients were followed up for 6 to 36 months.Of 180 patients with trigeminal neuralgia,the symptoms disappeared in 157 cases and were obviously attenuated in 22 cases and one case had no improvement.Of 122 patients with facial spasm,the symptoms were completely disappeared in 120 cases and improved in 2 cases.The glossopharyngeal neuralgia in three cases disappeared after surgery.Conclusion The modified microvascular decompression may effectively prevent the occurrence of cerebrospinal fluid incision leakage and subcutaneous effusion.
Objective To observe the efficiency of modified microvascular decompression in prevention of cerebrospinal fluid incision leakage and subcutaneous effusion.Methods The clinical data of 305 patients underwent modified microvascular decompression were retrospectively analyzed.Results No case with cerebrospinal fluid incision leakage after modified microvascular decompression occurred in 305 cases.One case appeared subcutaneous effusion,who was discharged one week after treatment.The patients were followed up for 6 to 36 months.Of 180 patients with trigeminal neuralgia,the symptoms disappeared in 157 cases and were obviously attenuated in 22 cases and one case had no improvement.Of 122 patients with facial spasm,the symptoms were completely disappeared in 120 cases and improved in 2 cases.The glossopharyngeal neuralgia in three cases disappeared after surgery.Conclusion The modified microvascular decompression may effectively prevent the occurrence of cerebrospinal fluid incision leakage and subcutaneous effusion.
引文
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[4] Kalkanis SN,Eskandar EN,Carter BS,et al.Microvascular decompression surgery in the United States,1996 to 2000:mortality rates,morbidity rates,and the effects of hospital and surgeon volumes[J].Neurosurgery,2003,52(6):1251-1262.
[5] Dubey A,Sung WS,Shaya M,et al.Complications of posterior cranial fossa surgery-an institutional experience of 500 patients[J].Surg Neurol,2009,72(4):369-375.
[6] Stieglitz LH,Wrede KH,Gharabaghi A,et al.Factors affecting postoperative cerebrospinal fluid leaks after retrosigmoidal craniotomy for vestibular schwannomas[J].J Neurosurg,2009,111(4):874-883.
[7] Malliti M,Page P,Gury C,et al.Comparison of deep wound infection rates using a synthetic dural substitute (neuro-patch) or pericranium graft for dural closure:a clinical review of 1 year[J].Neurosurgery,2004,54(3):599-603.
[8] 李宁,赵卫国,沈建康,等.应用人工硬膜预防神经微血管减压术后脑脊液漏[J].中华神经外科杂志,2006,22(4):237-239.
[9] Lüdemann WO,Stieglitz LH,Gerganov V,et al.Fat implant is superior to muscle implant in vestibular schwannoma surgery for the prevention of cerebrospinal fluid fistulae[J].Neurosurgery,2008,63(1):538-543.
[10] Kim YH,Han,JH,Kim CY,et al.Closed-suction drainage and cerebrospinal fluid leakage following microvascular decompression:a retrospective comparison study[J].JKorean Neurosurg Soc,2013,54(2):112-117.
[2] 徐裕,徐向东,那汉荣,等.小骨窗微血管减压术治疗原发性三叉神经痛[J].江苏医药,2018,44(10):1213-1215.
[3] Park JS,Kong DS,Lee JA,et al.Intraoperative management to prevent cerebrospinal fluid leakage after microvascular decompression:dural closure with a “plugging muscle”method[J].Neurosurg Rev,2007,30(2):139-142.
[4] Kalkanis SN,Eskandar EN,Carter BS,et al.Microvascular decompression surgery in the United States,1996 to 2000:mortality rates,morbidity rates,and the effects of hospital and surgeon volumes[J].Neurosurgery,2003,52(6):1251-1262.
[5] Dubey A,Sung WS,Shaya M,et al.Complications of posterior cranial fossa surgery-an institutional experience of 500 patients[J].Surg Neurol,2009,72(4):369-375.
[6] Stieglitz LH,Wrede KH,Gharabaghi A,et al.Factors affecting postoperative cerebrospinal fluid leaks after retrosigmoidal craniotomy for vestibular schwannomas[J].J Neurosurg,2009,111(4):874-883.
[7] Malliti M,Page P,Gury C,et al.Comparison of deep wound infection rates using a synthetic dural substitute (neuro-patch) or pericranium graft for dural closure:a clinical review of 1 year[J].Neurosurgery,2004,54(3):599-603.
[8] 李宁,赵卫国,沈建康,等.应用人工硬膜预防神经微血管减压术后脑脊液漏[J].中华神经外科杂志,2006,22(4):237-239.
[9] Lüdemann WO,Stieglitz LH,Gerganov V,et al.Fat implant is superior to muscle implant in vestibular schwannoma surgery for the prevention of cerebrospinal fluid fistulae[J].Neurosurgery,2008,63(1):538-543.
[10] Kim YH,Han,JH,Kim CY,et al.Closed-suction drainage and cerebrospinal fluid leakage following microvascular decompression:a retrospective comparison study[J].JKorean Neurosurg Soc,2013,54(2):112-117.