Trigeminal meniscus sensory fiber amputation

Trigeminal semilunar sensory fibrosis has two surgical methods: epidural and intradural: Frazier surgery performed outside the epidural. The dura mater can also be cut through the base of the skull, into the dura mater to find the semilunar section at the bottom of the cranial fossa, and then the dura mater and the semilunar intima membrane are cut, and the second and third sensory fibers are found, and the ones are cut off one by one. This method also clearly identifies the first branch and the moving root. The advantage is that the risk is small, but it is rarely used because of the facial numbness left after surgery. Treating diseases: trigeminal neuralgia Indication Trigeminal semilunar sensory fibrectomy is suitable for patients with painful recurrence after treatment with trigeminal neuralgia. Contraindications There are important organ diseases or coagulation mechanisms, and the general condition is not suitable for surgery. 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 On the pain side, the upper edge of the midpoint of the zygomatic arch begins to be 70° upward, inclined (about 2 cm in front of the ear), and a straight incision 5 to 6 cm long. The lower end of the incision does not exceed the zygomatic arch to avoid damage to the facial nerve branch and cause frontal muscle spasm. The fascia, diaphragm and periosteum were cut through the skin incision and reached the skull. At the lower end of the fascia incision, the attachment was pushed forward and forward by 1.5 cm to reveal the base of the cranial fossa. 2. Bone window formation The humerus was drilled 1.5 to 2 cm above the zygomatic arch. Use the rongeur to enlarge the bone hole and make a 3.5~4cm bone window in the squamous scale of the humerus. The anteroposterior diameter of the bone window is slightly larger than the longitudinal diameter, and the lower edge reaches the base of the skull to facilitate exposure. 3. Fill the spine The dura mater was separated from the cranial fossa with a brain plate and an aspirator, and the temporal lobe was lifted with a cerebral platen to find the spine along the dura mater. The spine can be found at about 2 to 3 cm through the bottom of the bone window or a little ahead of this point. The dura mater is separated from the skull before and after the spine, and the middle meningeal artery is released. A small cotton granule with a diameter of 3 to 4 mm was tightly inserted into the spine hole with a dental filler to block the blood flow of the middle dura. The dura mater artery was electrocoagulated and then cut. For example, when looking for a spine hole or separating the middle meningeal artery, the arteries rupture and hemorrhage. The middle meningeal artery can be pushed to the inner edge of the ratar hole by the top of the brain platen, and the spinous hole is filled with small cotton particles. 4. Reveal the half moon festival The foramen ovale can be found a few millimeters inside the spine hole, and the dura mater is pushed away from the dural space of the dura mater and the mandibular nerve. If the adhesion is not easy to separate at this point, a small amount of adhesion tissue is cut at the outer edge of the foramen ovale, and then separated to reveal the half moon section. The dura mater on the outside of the semilunar tract should not be separated too much to avoid damage to the superficial nerves of the rock, resulting in decreased secretion of facial nerve spasms and lacrimal glands. 5. Cut off the 2nd and 3rd sensory fibers The semilunar and posterior root laminae were cut perpendicularly to the direction in which the nerve fibers traveled, and the sensory roots and fan-shaped semilunar fibers were immersed in the cerebrospinal fluid. It is felt that the root fiber is grayish yellow, about 0.2-0.4 mm fine line, three branches are arranged in position, and the eye branch fiber has a small gap between the inner side and the maxillary branch fiber. Lifting the 3rd and 2nd posterior root fibers with a blunt nerve hook, such as under local anesthesia, can cause severe pain in the distribution area of the silk. The patient can clearly inform the pain position, cut or cut the sharp object, and avoid pulling. So as not to affect the adjacent root wire. Cut off the nerve root wire, should be 5mm above the half moon section, close to the rock bone (Figure 4.12.6-4), in order to transcend the ectopic ganglion cells in the posterior root. The root of the movement is located in the deep part of the sensory branch, and the inside is inclined forward and outward. It is white, and it must be clearly identified when it is thick, so that it is not damaged. Stop bleeding thoroughly. After the operation, it is necessary to repeatedly check the facial sensation until the 2, 3 branch distribution area feels disappeared. To recognize the first branch, if there is damage, it will cause loss of corneal sensation and cause visual impairment. Some people advocate that the second fiber is cut at the hole and filled into the hole with a small cotton ball. When the first fiber and the second fiber are unclear, the second branch of the two mixing points can be slightly Cut inside, this will prevent the first branch from being cut off. 6. Guan skull Suture the diaphragm, tendon fascia, subcutaneous tissue and skin. Dural external rubber hollow drainage. 7 dural meniscus root resection The extracranial operation was performed in the same manner as the epidural method, and then the dura mater was cut in an arc along the base of the skull, or the dura mater was cut through the epidural middle of the dura mater. Lift the temporal lobe and reveal the bottom of the skull. The blunt-headed scorpion is used to probe the semilunar and posterior roots. The dura mater does not cling to the base of the skull, which is soft and compressive. After the cerebrospinal fluid was removed by puncture and confirmed as the semilunar section, the dura mater and the semilunar membrane were cut open to reveal the sensory fibers, and 2/3 of the nerve fibers were cut off as needed. The skull base dural incision should not be too far behind or too close to avoid damage to the cranial nerves of the superior sinus or cavernous sinus and its outer wall. complication May damage the shallow nerves of the rock, causing peripheral facial paralysis. Injury to the first branch caused keratitis and corneal ulcers. Injury and exercise can cause chewing dysfunction. If the fiber is not properly cut, there is still pain after surgery.