Microvascular decompression for glossopharyngeal neuralgia

Glossopharyngeal neuralgia Since Laha and Jannetta believed that vascular compression was the cause of pain in 1977, many scholars have found that the vertebral artery or the inferior cerebellar artery straddles the lingual pharynx and the vagus nerve into the brainstem segment (root entry zone). ). At present, microvascular decompression has become the preferred surgical method for glossopharyngeal neuralgia. Treatment of diseases: glossopharyngeal neuralgia Indication Gynecologic neuralgia microvascular decompression is suitable for: 1. Apply 5% tetracaine solution to the pharyngeal pain site or the plate machine point, the pain can be relieved, and the card is clearly defined as the patient. 2. Treatment with carbamazepine can not be alleviated. Contraindications 1. Found as a tumor during surgery and can be removed. 2. The patient's body is weak and cannot tolerate the operator. Preoperative preparation 1. Skin preparation, wash the head with soap and water 1 day before the operation, and shave the hair on the morning of the operation. You can also shave your head on the eve of surgery. 2. Fasting the morning of surgery. 3. Oral 0.1g can be given to phenobarbital before surgery to ensure a quiet rest. One hour before the operation, 0.1 g of phenobarbital, 0.4 mg of atropine or 0.3 mg of scopolamine were intramuscularly injected. Surgical procedure Incision A midline incision or a barbed incision in the posterior cranial fossa. 2. Bone window and dural incision The bone window is about 3 cm in diameter and the lateral edge is up to the sigmoid sinus edge. The dura mater is turned over to the sigmoid sinus. 3. Reveal the jugular foramen and pharyngeal, vagus, and accessory nerves The cerebellar hemisphere is retracted inward and upward, the arachnoid membrane is pierced, and the cerebrospinal fluid is released. After the pressure is lowered, the cerebellar hemisphere is retracted inward and upward to find the jugular foramen and the pharyngeal, vagus, and accessory nerves. Craniotomy. After the lingual and vagus nerves are emitted from the brain stem, they move forward and inward to the jugular foramen, and the accessory nerve roots move forward at the cerebral angle of the cerebellar bridge. There is only one glandular nerve, and it is thicker than the vagus nerve. It is wrapped by arachnoid membrane alone and passes through a dural hole alone. It is easy to distinguish it from the root of the vagus nerve. 4. Exposing the vasospasm of the oppressive nerve Most of the pharyngeal and vagus nerves are found in the brainstem, and the vertebral artery or the inferior cerebellar artery is compressed (Fig. 4.12.8-3A). Under the microscope, the nerves of the nerves were freely compressed, and Teflon cotton was filled between the nerves and blood vessels (Fig. 4.12.8-3B). The thickened arachnoid and cerebellum adherent to the glossopharyngeal nerve should also be loosened. Then the patient is allowed to swallow or drink a little liquid, and if the pain disappears, the operation is successful. 5. Guan skull The dura mater is tightly sutured, and the muscles, deep fascia, subcutaneous tissue and skin are sutured. complication Dura mater and muscle suture are not strict, the operation area is not tightly wrapped, can cause cerebrospinal fluid leakage or pseudocyst, can cause intracranial and / or intraoperative infection, the mouth does not heal, the treatment is very difficult. Once found, the leak should be sutured in time. The posterior cranial nerve injury can cause hoarseness, coughing, and difficulty swallowing.

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