Revision surgery of the posterior fossa cranial nerves disease
10.3760/cma.j.issn.1673-0860.2009.05.005
- VernacularTitle:后颅窝神经根疾病再手术
- Author:
Zhao-Min FAN
1
;
Yue-Chen HAN
;
Jian-Feng LI
;
Zhong FAN
;
Lei XU
;
Hai-Bo WANG
Author Information
1. 山东大学附属省立医院
- Keywords:
Cranial nerves diseases;
Reoperation;
Cranial fossa,posterior;
Recurrence
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2009;44(5):364-368
- CountryChina
- Language:Chinese
-
Abstract:
Objective To report the clinical manifestations and the revision surgery principles of recurrent diseases of the posterior fossa nerves after primary surgery. Methods Between 2000 to 2007, fourteen patients with recurrent diseases of the posterior fossa nerves in Shandong provincial hospital were recruited in this study, all of whom were subjected to revision surgery. The clinical manifestations and surgical findings were retrospectively reviewed. Results Of the five patients with recurrent trigeminal neuralgia primarily, two underwent microvascular decompression (MVD); the remaining three firstly received the Ⅰand Ⅲ branches partial sensory rhizotomy and, subsequently, the pain reoccurred in the Ⅰbranch distribution area. The remnant sensor fibre was resected in the reoperation by which the sufferings were controlled completely in four of these patients during 2 to 11 years of follow-up. In five patients with hemifacial spasm underwent re-exploration, there appeared obvious fibrosis, conglutination, and the formation of new vessels around the facial nerve, with which the result of reoperation for this disorder was unsatisfied. In four glossopharyngeal neuralgia patients, reanstamosis of the glossopharyngeal nerve were found in two patients, adhesion between the glossopharyngeal nerve and the vagus nerve was found in one patient, but occurred in none of the another one. In the revision surgery, the regeneration of nerve fibre and two adjacent branches of vagus nerve fibre were resected, with no occurrence during 2 to 5 years of follow-up. The pathological changes found in revision were severe adhesion between cerebellum, meninges, terylene slim and structures around. Also, the formation of new vessels, cerebellum malacia, and bleeding could be found in the procedures. Conclusions The cause of recurrent of trigeminal neuralgia and hemifacial spasm are unclear. Recurrent giossopharyngeal neuralgia may attribute to the nerve fibers reanstamosis, adhesion or the communicating branches with vagus nerve. With respect to the treatment of the recurrence of trigeminal neuralgia, glossopharyngeal neuralgia after primary surgery, the effectiveness of nerve fibre resection is definite, whereas, the result of revision surgery for hemifacial spasm is poor.
