目的 探讨显微血管减压术(MVD)治疗神经源性高血压的手术适应症、疗效等进行分析.方法 选择1 例单纯性神经源性高血压患者,符合手术入选标准,术前MRI影像支持,在全麻下行左侧延髓腹外侧(VLM)和后组颅神经MVD.结果 患者MVD术后血压与术前血压对比有统计学显著性差异(P＜0.01).结论 选择合适的患者,左侧VLM和后组颅神经MVD治疗神经源性高血压疗效确切.

The surgical diagnosis and treatment of peripheral neuropathic pain involves multiple interdisciplinary disciplines such as neurology, orthopedics, neurosurgery, and pain management. Peripheral nerve compression is an important pathological basis for most peripheral neuropathic pain, including multiple peripheral neuropathies related to systemic diseases, peripheral nerve injury to limbs, migraines, and painful cranial nerve disorders, etc. Peripheral nerve decompression is the most important surgical treatment for peripheral neuropathic pain. This article mainly reviews the composition of peripheral neuropathic pain and the treatment strategies and key points of peripheral nerve decompression surgery.

Objective:To study the effectiveness and safety of great occipital nerve decompression in great occipital neurogenic intractable migraine.Methods:Fifty-one patients with great occipital neurogenic intractable migraine admitted to our hospital from December 2018 to December 2019 were chosen in our study. All patients were confirmed to be of great occipital neurogenic intractable migraine by blocked test and all patients underwent minimally invasive decompression of great occipital nerve. Preoperative and postoperative questionnaires were used to compare the severity of pain and frequency of pain episodes, and the prognoses of these patients were evaluated at the last follow-up.Results:Fifty-one patients were followed up for (12.02±3.36) months after surgery; at last follow-up, 10 patients were cured, 31 patients had obvious effect, 6 patients got improvement, 2 patients had poor effect, and 2 patients had no effect, with total effective rate of 80.40% (41/51). There were significant differences between before surgery and after surgery in the pain visual analog scale scores (7.47±0.76 vs.1.75±1.91) and frequency of pain episodes ([9.00±1.74] times/month vs. [2.82±2.47] times/month, P<0.05). Seven patients had temporary numbness at the surgical site after surgery, but 6 patients improved about 3 months after surgery and only one patient had persistent numbness. Conclusion:Great occipital nerve decompression is an effective and safe treatment method for great occipital neurogenic intractable migraine.

Objective:To investigate the correlation between changes in brainstem auditory evoked potentials (BAEPs) Ⅴ wave latency and (or) amplitude and hearing loss (HL) after hemifacial spasm (HFS) microvascular decompression (MVD).Methods:The clinical data of HFS patients treated with MVD in Neurosurgery Department of China-Japan Friendship Hospital from September 2015 to August 2019 were selected to analyze the changes of V-wave latency and amplitude of BAEPs before and after MVD as well as the changes of hearing status before and after MVD. Audiology was evaluated by mean pure tone hearing threshold and speech recognition rate changes. According to the AAO-HNS grading method, the postoperative patients' hearing was divided into non significant HL group and significant HL group. BAEPs changes in the whole intraoperative process were collected, and V-wave intraoperative changes of BAEPs were divided into: no significant abnormality, simple V wave latency (LwV) prolonged >1.5 ms, simple V wave amplitude (AwV) decreased >50%, prolonged >1.5 ms and AwV decreased >50%, LwV prolonged >1.5 ms or AwV decreased >50%. The correlation between the degree of postoperative hearing injury and grouping under the five group classification mode was statistically analyzed, and the predictive value of BAEPs changes on postoperative HL in the four groups was statistically analyzed.Results:Among 1009 HFS patients who underwent MVD, 943 patients had no significant HL, 66 patients had abnormal hearing after surgery, the waveforms of BAEPs monitoring had no significant change during surgery, and 5 patients (0.6%) had HL after surgery. Intraoperative LwV was prolonged >1.5 ms, and 4 cases (18.2%) had postoperative HL. Intraoperative AwV decreased by more than 50%, and postoperative HL occurred in 19 cases (25.0%). Intraoperative LwV prolonged >1.5 ms and AwV decreased >50%, and postoperative HL occurred in 38 cases (64.4%). Intraoperative LwV prolonged >1.5 ms or AwV decreased >50%, and postoperative HL occurred in 61 cases (38.8%). In addition, positive predictive value of each group was compared. The results showed that "1.5 ms extension of LwV and over 50% reduction of AwV" was the highest. The group "intraoperativLewV prolonged >1.5 ms and AwV decreased >50%" had the highest sensitivity. The group "1.5 ms extension of LwV and over 50% reduction of AwV" had the most strong specificityConclusion:Intraoperative BAEPs monitoring can provide reference for MVD patients. The positive prediction of V-wave latency prolonged by 1.5 ms and wave amplitude decreased by more than 50% at the end of operation was the highest among the four groups. In addition, timely adjustment of surgical strategies according to BAEPs monitoring results during surgery can effectively improve the incidence of postoperative hearing impairment.

目的 回顾性分析中日友好医院颅底外科中心近5年的内镜经鼻颅底手术出现的严重并发症.方法 回顾性分析中日友好医院颅底外科中心2016年8月1日～2021年8月1日间接受内镜经鼻颅底手术患者共225例,调阅纳入研究患者的病历和相关影像学资料,随访至2021年12月31日.结果 在225例内镜经鼻颅底手术患者中有6例(2.7％)出现严重并发症.其中大血管损伤3例(颈内动脉损伤2例,大脑前动脉损伤1例),爆发性颅内感染1例,颅内多发性肿瘤种植转移1例,颅底重建移植物大面积坏死1例.结论 内镜经鼻颅底手术对于有经验的颅底外科团队而言是安全的,出现严重手术并发症的几率低,严重并发症的处理仍具有挑战性.

Objective:To investigate the efficacy of microsurgical decompression in carpal tunnel syndrome (CTS) caused by different etiologies.Methods:A retrospective analysis was performed. The clinical data of 54 patients with CTS, admitted to our hospital from January 2018 to December 2018, were chosen; 20 patients were with idiopathic CTS (20 laterals), 16 patients were with diabetic-related CTS (26 laterals), and 18 patients were with dialysis-related CTS (22 laterals). All patients were treated with median nerve microsurgical decompression. Before surgery and 2 weeks after surgery, Boston carpal tunnel questionnaire (BCTQ) was used to evaluate the symptom and function scores, and median nerve conduction velocity was detected.Results:Intraoperatively, there was definite nerve entrapment in all three groups, but the neuropathy scopes in the diabetic-related CTS group were more extensive than those in the idiopathic group and dialysis-related CTS group. The postoperative BCTQ symptom and functional scores in the three groups were significantly decreased as compared with the preoperative ones ( P<0.05); however, there were no significant differences among the three groups in the postoperative BCTQ symptom and functional scores ( P>0.05). The postoperative sensory nerve conduction velocity and motor nerve conduction velocity in the three groups were significantly improved as compared with the preoperative ones ( P<0.05). There were significant differences among the three groups in postoperative sensory nerve conduction velocity and motor nerve conduction velocity ( P<0.05); the sensory nerve conduction velocity and motor nerve conduction velocity in the diabetic-related CTS group were significantly decreased as compared with those in idiopathic CTS group, and the sensory nerve conduction velocity and motor nerve conduction velocity in dialysis-related CTS group were significantly increased as compared with those in the diabetic-related CTS group ( P<0.05). The main surgical complications in three groups included poor incision healing: the incidence was 5% (1/20) in the idiopathic group, 15.3% (4/26) in the diabetic-related CTS group, and 18.1% (4/22) in dialysis-related CTS group, without significant differences ( χ2=1.755, P=0.416). Conclusion:Microsurgical decompression can achieve satisfactory results in the treatment of dialysis-related CTS, diabetes-related CTS and idiopathic CTS.

目的 探讨国产睿米手术机器人(神经外科定位导航系统)在颅骨或脑内微小病灶及功能区病灶精准切除手术中的效果及安全性.方法 中日友好医院神经外科自2021年10月至2022年3月在国产睿米手术机器人辅助下导航、定位并切除颅骨和脑内微小病灶及功能区病灶12例,术中均采用头皮Markers进行光学注册,记录注册误差,根据病灶的颅骨映射,由机械臂激光导航描记、设计头皮切口及骨瓣边界;术后行头颅CT和MRI扫描观察颅内出血、病灶切除情况;将术后影像与术前手术计划相融合,计算计划骨瓣中心与实际骨瓣中心的偏移误差.结果 12例患者的注册误差为(0.90±0.12)mm(范围为0.6～1.5 mm),机械臂注册误差为0.09～0.12 mm.计划骨瓣中心与实际骨瓣中心的偏移误差为(1.9±1.1)mm(范围为1.4～4.5 mm).所有患者均在手术机器人机械臂导航下一次性精准找到病灶边界,对皮层及病灶周围组织破坏性小;术后复查头颅CT或MRI提示所有病灶均完整切除,均无严重并发症发生.结论 国产睿米手术机器人可为颅骨或脑内微小病灶及功能区病灶切除术提供精准的定位和导航功能,提高了手术效率,保障了手术安全.

糖尿病周围神经病(DPN)是糖尿病最为常见的并发症之一,防治困难.DPN患者多有感觉、运动、自主神经功能的减退或丧失,严重者可能导致神经性溃疡甚至截肢,严重影响患者的生活质量.本文复习国内外相关领域的文献资料,就高血糖、代谢综合征、微血管病变、神经营养因素、免疫因素、遗传等方面的DPN病因学进行综述,以期为其防治提供新的思路.

Objective:To investigate the clinical application value of frameless stereotactic electroencephalography (SEEG) electrode implantation assisted by domestic Remebot robot in patients with drug-refractory epilepsy.Methods:Ten patients with medically-refractory epilepsy, admitted to and accepted SEEG electrode implantation assisted by domestic Remebot robot in our hospital from October 2021 to March 2022, were chosen in our study. Epileptogenic focuses of these patients were determined. Bone Fiducial Markers were used for registration during surgery, and the registration error and implantation time of each electrode were recorded in detail. Thin-layer CT scan was performed immediately after surgery to observe the occurrence of complications. Three-dimensional reconstruction of all implanted electrodes was performed postoperatively, which was fused with the preoperative surgical planning paths and targets, and the electrode entry point error and target error were calculated.Results:SEEG electrodes were implanted in all 10 patients with the assistance of frameless surgical robot, and the resection areas were accurately determined according to the results of SEEG records. The registered error of these 10 patients was (0.24±0.03) mm. A total of 97 SEEG electrodes were implanted, and the average effective implantation time of each electrode was (6.3±1.2) min. After the fusion of three-dimensional electrode reconstruction with preoperative surgical plan, the mean entry point error of 97 electrodes was (1.9±1.2) mm, and the mean target error was (2.1±1.2) mm. Immediate postoperative head CT showed that none of the 10 patients had surgical complications such as intracranial hemorrhage or severe pneumoencephalos.Conclusion:The SEEG electrode implantation assisted by Remebot frameless robot is safe, accurate, and effective, which can meet the clinical needs.

Objective:To explore the reasons for the recurrence or ineffectiveness of primary trigeminal neuralgia (PTN) after microvascular decompression (MVD), as well as the method and efficacy of re-craniotomy.Methods:The clinical data of 36 patients with recurrent or ineffective PTN after MVD surgery who were treated by the same surgeon in the Department of Neurosurgery of China-Japan Friendship Hospital from August 2020 to February 2022 were retrospectively analyzed. According to intraoperative findings, the causes of recurrence or ineffectiveness were divided into adhesion and compression of trigeminal nerve (type Ⅰ), omission of offending vessels (type Ⅱ), incomplete decompression (type Ⅲ) or misjudgment of offending vessels (type Ⅳ), and " granulomatous" changes caused by implanted materials (type Ⅴ). For different reasons, strategies such as separation of adhesions, MVD surgery, and removal of " granulomatous" mass were adopted. The Barrow Neurological Institute (BNI) pain scale was used to evaluate the efficacy, and postoperative BNI pain score ≤ 2 was defined as an excellent surgical outcome.Results:All patients successfully underwent the operation. The recurrence or ineffectiveness cause was type Ⅰ in 22 cases (61.1%), type Ⅱ in 7 cases (19.4%), type Ⅲ in 3 cases (8.3%), type Ⅳ in 2 cases (5.6%), and type Ⅴ in 2 cases (5.6%). In this series, 47% (17/36) of patients had varying degrees of facial or ipsilateral anterior tongue numbness after surgery, which gradually eased after 3 to 6 months. The follow-up time of 36 patients was (10.2±3.7) months (3-16 months). To the last follow-up, the postoperative BNI pain score of 36 patients was 1 point in 34 cases, 2 points in 1 case, and 4 points in 1 case (improved to 2 points after balloon compression therapy). There was no case of recurrence. The rate of excellent and good outcomes was 97% (35/36).Conclusions:For patients with recurrent or ineffective PTN after MVD surgery, the recurrence or ineffectiveness causes can be divided into 5 types according to the intraoperative findings of reoperation. It is safe and effective to use specific surgical methods according to different etiologies.

Diabetic peripheral neuropathy (DPN) is a common chronic complication of diabetes. At present, the treatment methods include drug therapy used to nourishing nerve and improving microcirculation, surgical method to decompressing peripheral nerve. But the treatment effect of some patients is not well. Spinal cord stimulation (SCS), as a new neuromodulation technique, can effectively relieve the pain of patients with DPN, dilate the peripheral blood vessels of lower limbs, improve blood supply, and improve the quality of life of patients. It is becoming a research hotspot. In this paper, the mechanism and progress of SCS in the treatment of DPN are described, in order to provide an effective alternative treatment for DPN patients.

Objective:To investigate the value of brainstem auditory evoked potential (BAEPs) combined with cochlear electrogram (ECochG) monitoring in the protection of auditory function during microvascular decompression (MVD) for patients with facial spasm (HFS).Methods:Clinical data of 908 patients with HFS who received MVD treatment in our hospital from January 2018 to December 2020 were retrospectively analyzed. The patients were divided into BAEPs group ( n=309), ECochG group ( n=301) and BAEPs+ECochG group ( n=298) according to the different methods of auditory nerve function monitoring. Waveform extraction rate, mean extraction time, amplitude, latency, intraoperative warning effect of 3 monitoring methods, as well as hearing status immediately after surgery and during follow-up were compared in patents from the 3 groups. Results:(1) The overall waveform extraction rate in ECochG group and BAEPs+ECochG group was significantly higher than that in BAEPs group, and the average waveform extraction time in ECochG group and BAEPs+ECochG group was significantly shorter than that in BAEPs group ( P<0.05). The amplitude of compound action potential (CAP) wave in ECochG group was significantly higher than that of V wave in BAEPs group, and the latency of CAP wave was also significantly earlier than that of V wave ( P< 0.05). (2) A total of 48 patients of the 288 patients in the BAEPs group showed warning signs; a total of 73 of the 292 patients in the ECochG group showed warning signs; and a total of 65 of the 292 patients in the BAEPs+ECochG group showed warning signs. (3) There was significant difference in hearing grading (American Association of Otolaryngology Head and Neck Surgery [AAO-HNS] grading) among the 3 groups immediately after surgery ( H=18.041, P=0.000), and the average rank suggested that the hearing of patients in the BAEPs+ECochG group was superior to the other two groups. All patients were followed up for an average of 15 months (ranged 3-24 months); there was still a significant difference in AAO-HNS grading among the 3 groups ( H=29.625, P=0.000), and the hearing of patients in the BAEPs+ECochG group was still superior to the other two groups. Conclusion:The combined application of ECochG and BAEPs monitoring can reflect the changes of intraoperative hearing impairment comprehensively, accurately and timely, which is of great significance for the protection of auditory function in HFS patients during MVD.

Objective:To investigate the clinical characteristics of hyperactive dysfunction syndrome (HDS) to cerebellar pontine angle (CPA) tumors and to evaluate the clinical value of microvascular decompression (MVD) after tumor resection to investigate the presence of offending vessels.Methods:A total of 13 186 HDS patients with trigeminal neuralgia (TN), hemifacial spasm and glossopharyngeal neuralgia admitted to the Neurosurgery Department of China-Japan Friendship Hospital from January 2013 to January 2020 were retrospectively analyzed. Among them, 218 cases (1.7%) were secondary to CPA tumors. They were included in the secondary group. According to the preoperative symptoms and intraoperative exploration of the relationship between blood vessels and cranial nerves, 60 cases (27.5%) underwent MVD of trigeminal nerve, facial nerve or glossopharyngeal nerve after tumor resection. Of the 12 968 primary patients, 226 were randomly selected and included in the primary group, and all received MVD. There was no significant difference in gender and age between secondary group and primary group (P>0.05); There were significant differences in the course of disease and the proportion of cranial nerve symptoms (P<0.05). The incidence of two or more cranial nerve symptoms in the secondary group (8.3%) was significantly higher than that in the primary group (0.4%). The complication rate and recurrence rate between the two groups were compared and analyzed.Results:In the secondary group, TN was the most common, and the proportion of cholesteatoma was the highest (44.5%). After 2-82 months of follow-up, there was no significant difference in the remission rate and recurrence rate of cranial nerve symptoms between the two groups (P>0.05).Conclusion:Patients with HDS secondary to tumors in CPA area have the characteristics of short clinical history and frequent TN symptoms. Some patients have the compression of the corresponding cranial nerves by the responsible blood vessels, MVD should be performed after tumor resection, and the postoperative symptom relief showed significant efficacy and good safety.

Objective:To evaluate the value of Guyon’s canal decompression in the treatment of diabetic peripheral neuropathy with (DPN) microsurgery.Methods:Eleven patients (14 sides) with upper extremity DPN, admitted to Neurosurgery Department of China-Japan Friendship Hospital from March 2019 to March 2020, underwent microsurgical decompression of the Guyon’s canal, 7 of whom underwent unilateral ulnar nerve decompression of the cubital canal. The ulnar nerve decompression of the cubital canal and Guyon’s canal were performed in 4 patients, 3 patients were bilateral and 1 patient was unilateral. Postoperative follow-up was conducted to observe the improvement of sensory dysfunction (hand numbness, pain), motor dysfunction and two-point discrimination perception.Results:All patients were followed up for an average of 12 months. In 11 patients with upper extremity DPN, numbness was relieved by 85.71% (12/14), pain was relieved by 100% (14/14), dyskinesia was improved by 71.43% (10/14), and little finger discrimination was improved by 85.71% (12/14).Conclusion:The ulnar nerve entrapment in the Guyon’s canal is easy to be neglected in DPN and should be paid enough attention in clinical practice. The ulnar nerve decompression in the Guyon’s canal plays an important value in upper extremity DPN.

Objective:To study the risk factors for ipsilateral severe hearing impairment in patients with hemifacial spasm (HFS) after microvascular decompression (MVD).Methods:MVD was performed in 3700 patients with HFS, admitted to our hospital from October 2007 to August 2020; according to the existence of ipsilateral severe hearing impairment, these patients were divided into severe hearing impairment group and non-severe hearing impairment group. The clinical data of these patients were compared. Multivariate linear regression analysis was used to determine the independent influencing factors for ipsilateral severe hearing impairment.Results:Forty-five patients (1.2%) had ipsilateral severe hearing impairment after MVD; no one got recovery of hearing impairment during the follow-up period (0.6-11.8 years, 6.3 years in average). As compared with those in the non-severe hearing impairment group, patients in the severe hearing impairment group had significantly older age, significantly higher percentages of male patients, and patients with left HFS, hypertension, and diabetes mellitus, statistically higher percentage of patients having small posterior fossa volume, arachnoid thickening and adhesion, and vertebral artery compression, significantly lower percentage of patients with anterior inferior cerebellar artery compression, significantly higher percentage of patients with arteriosclerosis of offending arteries and difficult decompression ( P<0.05). Multivariate linear regression analysis revealed that hypertension, vertebral artery compression, arteriosclerosis of offending artery and difficult decompression were independent risk factors for severe hearing impairment in patients with HFS after MVD. Conclusion:It's difficult to get recovery for severe hearing impairment in patients with HFS after MVD; this complication is much common in patients with hypertension, vertebral artery compression, arteriosclerosis of offending artery or difficult decompression.

Objective:To investigate the therapeutic effects of different hearing protection strategies in microvascular decompression for hemifacial spasm (HFS-MVD).Methods:A randomized controlled trial was designed to include 360 patients with HFS-MVD under the monitoring of brainstem auditory evoked potentials (BAEPs) in Neurosurgery Department of China-Japan Friendship Hospital from December 2015 to October 2018. Before surgery, random digital table method was performed and patients were divided into "simple waiting group" , "warm saline perfusion group" and "Nimodipine perfusion group" , 120 cases in each group. When the hearing loss alarm occurs in BAEPs during the operation (the latency of Ⅰ-Ⅴ wave delayed more than 1ms or the amplitude of wave V decreases more than 50%), the intervention was performed according to the preoperative grouping. The changes of BAEPs during the operation were divided into four types: stable maintenance type Ⅰ (no alarm, no intervention), stable recovery type Ⅱ, partial damage type Ⅲ, and complete damage type Ⅳ. All patients underwent postoperative hearing examinations (pure tone audiometry and speech discrimination score) to confirm the hearing loss.Results:The intervention measures were implemented in 146 patients in this group, including 47 patients in simple waiting group, 50 patients in warm saline perfusion group and 49 patients in Nimodipine perfusion group. The difference of composition of Ⅱ, Ⅲ, Ⅳ for total interventions among three groups was considered statistically significant (P<0.05). The difference of type and composition ratio between the simple waiting group and the warm saline perfusion group was considered statistically significant (χ2=8.754, P=0.013). The difference of Nimodipine perfusion group and simple waiting group or warm saline perfusion group was no significant difference (χ2=6.119, 0.247; P=0.047, 0.884). There was no significant difference of postoperative hearing function to the total number of interventions among three groups (P>0.05).Conclusion:When hearing damage occurs by combined electrophysiological monitoring during MVD operation, immediately suspending the operation and using warm normal saline to backfill the operation area, which re-establishes the cerebrospinal fluid environment, is a simple and relatively effective rescue method.

高龄三叉神经痛患者通常病程较长、基础疾病多且复杂。选择此类患者的外科治疗方式时需考虑上述特点。目前尚无足够证据可证明哪一种外科治疗方式最为理想。经皮球囊压迫术、经皮半月神经节甘油破坏术、经皮射频热凝术均具有微创的优点，可反复进行，但其导致的感觉障碍难以避免。立体定向放射外科治疗为一种非侵入性、有效的治疗方法，且不良反应相对较少。显微血管减压术虽为开放性手术，但随着手术技术和条件的成熟，高龄已不再被视为禁忌，对三叉神经不造成破坏为其显著优势。三叉神经感觉根部分切断术作为可提高显微血管减压术效果的方式之一，在高龄患者中放宽其适应证具有重要意义。各种治疗方式的安全性和有效性仍有待进一步证实。

Hemifacial spasm (HFS), characterized by unilateral involuntary clonic muscle contractions, is a common cerebral nerve disease. Currently, microvascular decompression based on the classical etiological theory of neurovascular compression is considered to be the most effective treatment for HFS. In recent years, studies on the etiology of HFS have been further deepened. This paper will review the progress in related aspects and provide theoretical basis for determining the etiology of HFS in the future.

脑性瘫痪(CP)是一组运动发育障碍及姿势异常综合征,常由发育中的胎儿或婴儿脑部受损伤所致,是儿童期致残的主要原因.脑性瘫痪患者的活动能力明显受限,生活质量受到明显影响,且具有独特的临床表现及发育异常.目前传统治疗方案包括康复训练、药物治疗、外科手术等,但疗效参差不齐,预后差异较大.本文章结合近年来国内外文献,针对脑性瘫痪的流行病学、病因学、诊断分型、治疗现状等方面的研究进展进行综述.

显微血管减压术(MVD)是治疗脑神经疾患的首选外科方法。近年来，随着神经内镜技术的不断成熟，越来越多的学者将神经内镜应用于MVD。本文将着重从神经内镜应用于MVD的概况、技术要点、优势、局限性等方面进行综述，并对其未来进行展望。