Trigeminal Schwannoma Resection

Trigeminal sensory root resection is first advocated by Dandy, also known as Dandy surgery. It cuts the trigeminal sensory root at the cerebellopontine angle of the cerebellum, and it is not easy to damage the movement root. It can preserve the tactile part of the face and has a low recurrence rate (4.7% to 9%). Etc., is its advantage. However, the risk is high, the mortality rate is high (about 3.4% to 4%), postoperative reactions such as headache, dizziness and heavier, can damage other cranial nerves such as the trochlear nerve, facial nerve and auditory nerve, it is difficult to encounter bleeding during surgery. Control, etc., is a shortcoming of this surgery. Treating diseases: trigeminal neuralgia Indication Trigeminal sensory root resection is suitable for patients with suspected cerebellar cerebral horn lesions who need to be explored for secondary neuralgia or microvascular decompression surgery or postoperative pain recurrence. Contraindications Those who are old and have important organ diseases or coagulation disorders should be considered carefully. 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 12.1 1. Incision The occipital barb incision is better (Fig. 4.12.5-2A). According to the surgeon's habits, a straight or transverse incision after the mastoid can also be used, similar to the trigeminal vascular decompression. 12.2 2. Bone window The diameter is about 5cm, the dura mater is cut in a curved shape, and the base is turned to the transverse sinus. 3. Exposing the trigeminal nerve root The cerebellar hemisphere is retracted inward and downward, the arachnoid membrane of the cerebellar cerebral horn pool is torn open, and the cerebrospinal fluid is aspirated. After the cerebellum tissue collapses, the face and the auditory nerve are found, and the wet cotton piece is properly protected. In front of the two nerves, it can be seen that the rock vein leaves the cerebellar surface and enters the superior sinus of the rock, and is cut off after coagulation near the cerebellum to avoid tearing at the upper sinus of the rock and causing massive bleeding. Such as rock sinus bleeding, with a small piece of gelatin sponge can be pressed. The trigeminal sensory root from the brainstem, which enters the trigeminal nerve hole, is 1 to 1.5 cm long. 4. Feel the root cut Identify the motor roots located on the anterior medial side of the sensory root. After hooking the sensory root with a nerve hook, cut 3/4 of the outer side of the sensory root near the pons (Fig. 4.12.5-2B). Sometimes small arteries are close to or coiled to oppress the sensory roots, and must be separated to avoid damage to the blood, or to stop the brain stem due to hemostasis. Since the fiber of the sensory root is close to the bridge brain, the pain temperature is on the posterior side of the root, and the touch is on the anterior side. Therefore, cutting the 3/4 fiber on the posterolateral side of the sensor root can make the pain distribution of the entire distribution of the trigeminal nerve disappear. While still retaining some of the tactile sensations. 5. Guan skull After the operation, the blood should be rinsed with normal saline, the dura mater should be tightly sutured, and then the muscle, subcutaneous tissue and skin should be sutured. The cover is covered with a thick dressing and pressure. complication Susceptible facial nerves cause peripheral facial paralysis, such as injury and brain stem can cause coma. Symptoms of vestibular nerve disorders such as dizziness and vomiting may occur after surgery.