目的 探讨显微血管减压术治疗三叉神经痛的效果,并分析导致面神经损伤的原因.方法 回顾性分析2013年10月至2017年12月贵州医科大学第三附属医院及哈尔滨医科大学第四附属医院神经外科收治的192例显微血管减压术治疗三叉神经痛患者的临床资料,手术实况录像回放,全部患者均采用枕下乙状窦后入路,显微血管减压术,术中游离责任血管,并以Teflon棉球隔离.结果 192例患者中,术后疼痛完全缓解173例,大部分缓解11例,延迟治愈5例,不缓解0例,面神经损伤3 例.对所有患者随访3 ~6 个月,三叉神经痛复发2 例,永久性面神经损伤1 例.结论 显微血管减压术治疗三叉神经痛效果可靠,术中避免导致面神经损伤的不当操作,可以完全或极大程度降低面神经损伤的可能.

脑出血是指非外伤性脑实质内的自发性出血,大多是由高血压导致小动脉硬化、血管破裂引起的,故也称为高血压性脑出血. 脑出血是中老年人常见的急性脑血管病,病死率和致残率较高,是我国脑血管疾病中病死率最高的临床类型之一. 高血压脑出血外科治疗的最终目的是清除血肿,减轻脑组织受压,保护神经功能,减少或防止脑出血后一系列继发性病理变化. 随着医学进入精准时代,脑出血的微创治疗理念也应随之变化.

目的 探讨夹闭基底动脉分叉部动脉瘤的可行性与手术入路的选择.方法 回顾性分析2007年1月至2010年6月哈尔滨医科大学第四附属医院神经外科收治的9例基底动脉分叉部动脉瘤患者的临床资料.三维数字减影全脑血管造影(3D-DSA)显示动脉瘤位于基底动脉分叉部,囊状,根据3D-DSA显示动脉瘤与后床突的位置关系及动脉瘤顶的指向,7例选择翼点入路,2例选择右侧颞下入路.结果 9例患者均成功夹闭,随访6个月.3例术前合并脑积水的患者中,2例缓解,1例行脑室腹腔分流术.3例动眼神经麻痹的患者中,1例痊愈,2例好转.9例患者中,3例行3D-DSA,6例行CTA复查,未见动脉瘤残留.格拉斯哥预后(GOS)评分5分7例,4分2例.结论 根据基底动脉分叉部动脉瘤瘤颈与后床突的位置关系及瘤顶的指向,选择合理的手术入路,手术夹闭是治疗基底动脉分叉部动脉瘤的一种良好方法.

Surgeons often rely on intraoperative electrophysiological monitoring to determine whether decompression is sufficient during microvascular decompression surgery for hemifacial spasms. A new monitoring method is needed when an abnormal muscle response is occasionally not available or is unreliable. This study was an observational clinical trial exploring a new waveform recorded from the facial muscles while the offending artery wall was electrically stimulated.

The pathophysiologic basis of hemifacial spasm is abnormal cross-transmission between facial nerve fibers. The author hypothesized that the demyelinated facial nerve fibers were connected with the sympathetic nerve fibers on the offending artery wall, and thus the latter function as a bridge in the cross-transmission circuit. This hypothesis was tested using a rat model of hemifacial spasm. A facial muscle response was recorded while the offending artery wall was electrically stimulated. The nerve fibers on the offending artery wall were blocked with lidocaine, or the superior cervical ganglion, which innervates the offending artery, was resected, and meanwhile the abnormal muscle response was monitored and analyzed. A waveform was recorded from the facial muscle when the offending artery wall was stimulated, named as "Z-L response". The latency of Z-L response was different from that of abnormal muscle response. When the nerve fibers on the offending artery wall were blocked by lidocaine, the abnormal muscle response disappeared gradually and recovered in 2h. The abnormal muscle response disappeared permanently after the sympathetic ganglion was resected. Our findings indicate that cross-transmission between the facial nerve fibers is bridged by the nerve fibers on the offending artery wall, probably sympathetic nerve fibers.

Objective To study the effect of steroid hormones in the prevention and treatment of delayed facial paralysis following microvascular decompression.Methods From April to June 2009 and from April to May 2010,145 cases of hemifacial spasm undergoing microvascular decompression were followed up for 6 to 18 months.All the operations were performed by the same medical team.Pre-operative herpes simplex virus(HSV) IgG and IgM were detected.All the cases were divided into two groups,group A(n=93) without administration of steroid hormones and group B(n=52) with administration of steroids from the day of operation for 4 w.The incidence of delayed facial paralysis was compared between groups.Results In group A,5 cases of delayed facial paralysis(5/93,5.38%) occurred,lasting for(56.6±37.7) d.According to House-Brackmann classification,there were 1 case of grade Ⅳ,2 cases of grade Ⅲ,and 2 cases of grade Ⅱ~Ⅲ.In group B,3 cases of delayed facial paralysis(3/52,5.77%) were found,lasting for(29.3±1.2) d and all three cases were grade Ⅱ.There was no significant difference in the incidence of delayed facial paralysis(P=0.2895) and duration of facial palsy(P=0.2711).ConclusionSteroid can not prevent the occurrence of delayed facial paralysis following microvascular decompression for hemifacial spasm,but can effectively reduce the extent of delayed facial paralysis and shorten the course of disease.

Objective To explore the possible correlations between compressive degree of facial nerve and the effect of microvascular decompression(MVD) treatment in patients with hemifacial spasm(HFS).Methods A total of 1 047 patients with HFS underwent MVD in department of neurosurgery in Xinhua Hospital during 2009-2010 were studied retrospectively,in which 48 cases(group A) were found with facial nerve seriously compressed or degeneration.Retrospectively comparative analysis was conducted on group A and 680(group B)typical HFS patients whose facial nerve compression was not obvious and had no nerve degeneration.Contents compared included clinical characteristics,three-dimensional time of flight magnetic resonance angiography(3D-TOF MRA),surgery videos and postoperative curative effect.Results Among patients in group A,77.1% cases were cured(excellent),18.8% obviously relieved(good),and the failure and recurrence rates were 0.0%(n = 0) and 2.1%(n = 1).The total effective rate was 95.8%.Among patients in group B,82.8% cases were cured(excellent),12.6% obviously relieved(good),and the failure rate was 0.3%(n = 2).The total effective rate was 95.4%.The differences between two groups were not statistically significant(P>0.05).Conclusion There was no apparently correlations between compressive degree of facial nerve and the effect of MVD in patients with HFS.

Objective: Optimization of modeling of delayed facial paralysis.The neuroprotective effect of several drugs were observed.Methods: Forty-eight rabbits were assigned to A,B,C,D 4 experimental groups,with one side of the facial nerve to the experimental treatment,and the other side of self-control.A: The cisternal section of the facial nerve was injured by clamp.B: Injection of arterial blood to the cerebellopontine angle to induce vasospasm.C: treatment factor = group A + group B.D group: C group plus the application of drug(prednisone + SM + vitamin B1 + vitamin B12) intervention.The rabbit facial paralysis was observed.And facial nerve biopsy was done.The incidence of delayed facial paralysis,duration and prognosis were compared.Results: The incidence of facial paralysis: in group A 6 rabbits(6 / 11,54.5%) had delayed facial paralysis;the average duration of facial paralysis was 13.2 days.In group B,2(2 / 12,16.7%) had delayed facial paralysis,the average duration was 8 days.In group C 6(6 / 12,50%) had delayed facial paralysis,and the average duration was 14.3 days.In group D 4(4 / 12,33.33%) had delayed facial paralysis,the average duration was 6 days.There was no facial paralysis in all self-control sides.Pathology: Nerve fiber edema was seen in each group;groups A,C showed a high degree of edema,with nerve bundles around the structural disorder;group B showed small blood vessels within the nerve,and mild edema com-pared with groups A,C;group D showed a slight edema change.Conclusion: Group C had higher risk of delayed facial paralysis,so it is a better model.Combination of prednisone,Salvia,vitamin B1,vitamin B12,although not able to prevent the occurrence of delayed fa-cial paralysis,but the duration of the delayed facial paralysis was significantly shortened.

PURPOSE:To summarize our experience and lessons of microvascular decompression surgery for trigeminal neuralgia caused solely by venous compression.METHODS:Fifteen patients with idiopathic trigeminal neuralgia caused by venous compression only underwent microvascular decompression. The entire course of the trigeminal root was explored thoroughly; and coagulating and cutting techniques were preferred in decompressing the culprit veins. Their clinical features, outcomes and operative complications were analyzed.RESULTS:The compressing veins included the transverse pontine vein in five cases (33.3%), the transverse pontine vein and the vein of middle cerebellar peduncle in one (6.7%), the transverse pontine vein and the vein of cerebellopontine fissure in one (6.7%), the superior petrosal vein in three (20%), the pontotrigeminal vein in one (6.7%), the vein of the cerebellopontine fissure in two (13.3%), and the plexus venosus or venule in two (13.3%). After microvascular decompression, 11 cases (73.3%) had "excellent" or "good" pain relief. Four cases (26.7%) failed the first surgery; and two of them underwent re-operation and got "excellent" pain relief. Postoperative facial numbness appeared in four cases, due to injury to trigeminal nerve when coagulation.CONCLUSION:The transverse pontine vein is the most common offending vein. For this type of trigeminal neuralgia, coagulating and cutting techniques are preferred in decompressing the culprit veins. The entire course of the trigeminal root should be explored and decompressed. Following these principles, excellent or good pain relief could be achieved in most cases; and recurrence is rare. However, sometimes injury to the nerve is unavoidable when coagulating the culprit vein.

面肌痉挛(hemifacial spasm, HFS)是一种无痛性、间歇性、不自主的、无规律的同侧面神经所支配范围内的肌肉强直或阵挛发作.目前其发病机制仍存在争议.微血管减压术(microvascular decompression, MVD)目前逐渐成为治疗面肌痉挛的首选治疗方式,临床疗效较好.