[1]王晶,姜成荣,种玉龙,等.舌咽神经联合迷走神经显微血管减压术治疗舌咽神经痛的疗效分析[J].中国临床神经外科杂志,2024,29(01):12-15,18.[doi:10.13798/j.issn.1009-153X.2024.01.004]
　WANG Jing,JIANG Cheng-rong,CHONG Yu-long,et al.Clinical efficacy of microvascular decompression of glossopharyngeal nerve combined with vagus nerve for patients with primary glossopharyngeal neuralgia[J].,2024,29(01):12-15,18.[doi:10.13798/j.issn.1009-153X.2024.01.004]
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舌咽神经联合迷走神经显微血管减压术治疗舌咽神经痛的疗效分析()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
29
期数:
2024年01期
页码:
12-15,18
栏目:
论著
出版日期:
2024-01-30

文章信息/Info

Title:
Clinical efficacy of microvascular decompression of glossopharyngeal nerve combined with vagus nerve for patients with primary glossopharyngeal neuralgia
文章编号:
1009-153X（2024）01-0012-04
作者:
王晶; 姜成荣; 种玉龙; 陆天宇; 梁维邦
210008南京，南京鼓楼医院神经外科（王晶、姜成荣、种玉龙、陆天宇、梁维邦）
Author(s):
WANG Jing;  JIANG Cheng-rong;  CHONG Yu-long;  LU Tian-yu;  LIANG Wei-bang
Department of Neurosurgery, Nanjing Drum Tower Hospital, Nanjing 210008, China
关键词:
原发性舌咽神经痛; 显微血管减压术; 疗效
Keywords:
Glossopharyngeal neuralgia;  Microvascular decompression;  Postoperative complications;  Clinical efficacy
分类号:
R 745.1+3; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2024.01.004
文献标志码:
A
摘要:
目的 探讨舌咽神经联合迷走神经显微血管减压术（MVD）治疗原发性舌咽神经痛（GPN）的技术要点及疗效。方法 回顾性分析2013年1月至2021年10月MVD治疗的50例原发性GPN的临床资料。术前行颅神经3D-TOF-MRA检查及丁卡因试验诊断GPN，术中对舌咽神经、迷走神经进行减压，未行神经根切断术。结果 根据术前MRI及术中所见，除1例（2%）外，其余49例可见舌咽神经和（或）迷走神经的根部与血管有接触或压迫，其中椎动脉参与压迫14例（28%），小脑后下动脉和（或）其分支压迫28例（56%），小脑前下动脉6例（12%），静脉1例（2%）。术后即刻治愈47例（94%），明显改善1例，无效2例。术后随访7~105个月，平均（46.7±28.8）个月，中位数48.5个月；1例明显改善，随访55个月无明显改变；1例即刻无效，术后1周延迟治愈；1例即刻治愈术后2个月再次出现疼痛，但程度较术前明显改善；1例术后出现咽部异物感，随访28个月未改善；1例术后出现短暂性吞咽困难，随访6个月症状消失。结论 术前影像学检查及丁卡因试验对原发性GPN的诊断非常重要。舌咽神经联合迷走神经MVD是治疗原发性GPN的安全有效的方法，不建议行舌咽神经及迷走神经根切断术。
Abstract:
Objective To investigate the surgical techniques and efficacy of microvascular decompression (MVD) of glossopharyngeal nerve combined with vagus nerve for patients with primary glossopharyngeal neuralgia (GPN). Methods The clinical data of 50 patients with primary GPN treated by MVD from January 2013 to October 2021 were retrospectively analyzed. Cranial nerve 3D-TOF-MRA examination and tetracaine test were performed in all the patients before the surgery. Glossopharyngeal nerve and vagus nerve were decompressed, and rhizotomy was not performed in all the patients during the operation. Results According to preoperative MRI and intraoperative findings, except 1 patient (2%), the roots of glossopharyngeal nerve and/or vagus nerve were contact to or compressed by blood vessels in 49 patients, of which the vertebral arteries were responsilble vessels in 14 patients (28%), the posterior inferior cerebellar arteries and/or their branches in 28 (56%), the anterior inferior cerebellar arteries in 6 (12%), vein in 1 (2%). Of 50 patients, 47 patients (94%) were cured immediately, 1 was significantly improved, and 2 were ineffective after the surgery. The postoperative follow-up ranged from 7 months to 105 months, with an average of (46.7±28.8) months and a median of 48.5 months. One patient with significant improvement immediately after the surgery had no significant change after 55 months of follow-up. One patient who was ineffective immediately after the surgery was cured one week after the surgery. One patient cured immediately after the surgery had pain again 2 months after the surgery, but the degree of pain was significantly improved compared with that before the surgery. One patient had a foreign body sensation in the pharynx after the surgery, which did not improve after 28 months of follow-up. One patient had transient dysphagia after the operation, and the symptoms disappeared 6 months after the operation. Conclusions Preoperative imaging and tetracaine test are very important for the diagnosis of primary GPN. Glossopharyngeal nerve combined with vagus nerve decompression is a safe and effective method for the treatment of primary GPN, and glossopharyngeal nerve and vagus nerve rhiotomy is not recommended.

参考文献/References:

[1] WANG XS, MENG DW, CHEN GQ. The clinical characteristics andsurgical treatment of glossopharyngeal neuralgia with pain radiatingto the innervated area of the trigeminal nerve [J]. J Oral MaxillofacSurg, 2021, 786: e1-e8.
[2] LI ZH, ZHANG J, CHEN YH, et al. Efficacy and safety of microvascular decompression for glossopharyngeal neuralgia: a meta-analysis study [J]. Chin J Neurosurg, 2019, 35(2): 197-202.李宗豪，张　洁，陈永汉，等. 显微血管减压术治疗舌咽神经痛的有效性和安全性的Meta分析[J]. 中华神经外科杂志，2019，35（2）：197-202.
[3] KRüGER MT, DONG CCJ, HONEY CR. Defining the anatomy ofthe vagus nerve and its clinical relevance for the neurosurgicaltreatment of glossopharyngeal neuralgia [J]. Stereotact Funct Neurosurg, 2019, 4: 244-248.
[4] DU T, NI B, SHU W, et al. Neurosurgical choice for glossopharyngeal neuralgia: a benefit-harm assessment of longterm quality of life[J]. Neurosurgery, 2020, 88: 131-139.
[5] TEIXEIRA MJ, DE SIQUEIRA SR, BOR-SENG-SHU E. Glossopharyngeal neuralgia: neurosurgical treatment and differential diagnosis [J]. Acta Neurochir (Wien), 2008, 150(5): 471-475.
[6] RUSHTON JG, ATEVEN JC, MILLER RH. Glossopharyngeal (vagoglossopharyngeal) neuralgia: a study of 217 cases [J]. Arch Neurol,1981, 38: 201-205.
[7] JANI RH, HUGHES MA, LIGUS ZE, et al. MRI findings and outcomes in patients undergoing microvascular decompression forglossopharyngeal neuralgia [J]. J Neuroimaging, 2018, 28: 477-482.
[8] ABDEREHIM TURSUNNIYAZI, SHI X, HAO YJ, et al. Therapeuticeffects of glossopharyngeal nerve microvascular decompression onglossopharyngeal neuralgia [J]. Chin J Brain Dis Rehabil（ElectronicEdition）, 2021, 11(2): 74-78.阿布地热合曼·吐尔孙尼牙孜，石　鑫，郝玉军，等. 显微血管减压术治疗舌咽神经痛疗效分析[J]. 中华脑科疾病与康复杂志（电子版），2021，11（2）：74-78.
[9] TUBBS RS, MORTAZAVI MM, LOUKAS M, et al. Intraoperativeand anatomical descriptions of intracranial connections between theglossopharyngeal and vagus nerves: clinical implications [J]. JNeurosurg, 2011, 115(1): 179-181.
[10] LIANG JT, LI MC, CHEN G, et al. Microvascular decompression forglossopharyngeal neuralgia with posterior inferior cerebellar arteryas offending artery [J]. Chin J Cerebrovasc Dis, 2017, 14(2): 94-97.梁建涛，李茗初，陈　革，等. 显微血管减压术治疗责任血管为小脑后下动脉的舌咽神经痛[J]. 中国脑血管病杂志，2017，14（2）：94-97.
[11] ZHU GD, ZHAO ZY, MEN XZ, et al. Microneurosurgery for glossopharyngeal neuralgia（report of 33 cases）[J]. Chin J Clin Neurosurg,2016, 21(2): 76-78.朱贵东，赵振宇，门学忠，等. 原发性舌咽神经痛的显微手术治疗（附33例分析）[J]. 中国临床神经外科杂志，2016，21（2）：76-78.
[12] DONG XW, WANG N, WANG XS, et al. Clinical influence of excision of vagus nerve rootlets in vagus-glossopharyngeal neuralgia [J].Chin J Neuromed, 2020, 19(7): 695-699.董烜玮，王　宁，王晓松，等. 迷走神经根丝切断术治疗迷走-舌咽神经痛的临床疗效分析 [J]. 中华神经医学杂志，2020，19（7）：695-699.
[13] RUI Y, JI W, CHUNCHENG Q, et al. Efficacy comparison of microvascular decompression and rhizotomy in the treatment of glossopharyngeal neuralgia: a retrospective analysis of 37 cases [J]. TurkNeurosurg, 2019, 29(4): 493-496.
[14] BERNARD F, MERCIER P, SINDOU M. The tethered effect of thearachnoid in vago-glossopharyngeal neuralgia: a real associatedalternative mechanism [J]. Acta Neurochir (Wien), 2018, 160(1):151-155.

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备注/Memo

备注/Memo:
（2023-05-28收稿，2023-09-15修回）
更新日期/Last Update: 2024-01-30