Sj-qvist surgery

Sj-qvist surgery is also known as the medullary trigeminal spinal cord tomectomy. This method can preserve facial sensation, it is difficult to operate, and there are many complications. Because of the high risk of operation on the medulla oblongata, the mortality rate of a group of 926 foreigners is 1.6% to 2.4%. The recurrence rate is 13% to 37%. In recent years, this method has been rarely applied. The pain, thermophilic fibers and part of the tactile fibers of the three branches of the trigeminal nerve terminate in the caudal nucleus of the nucleus of the spinal nucleus through the trigeminal spinal cord. The first branch terminates in the middle of the caudal nucleus and lies in the plane of the second cervical segment; the second and third branches terminate in the tail of the caudal nucleus and are located in the third to fourth neck plane. When the spinal cord of the trigeminal nerve passes through the lower end of the medulla, it is located in the superficial part of the dorsolateral, and the 1, 2, and 3 pain fibers are arranged in the direction of the ventral side to the dorsal side in the spinal cord. The corneal reflected fibers terminate in the midpolar nucleus and the apical nucleus above the plane of the latch. Treating diseases: trigeminal neuralgia Indication Sj-qvist surgery is suitable for young patients with first pain, three full or two sides of pain. Other surgical methods may also be considered for failure. 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 Do a midline incision in the posterior fossa. The occipital bone window is slightly biased to the diseased side, and the occipital foramen and the posterior arch of the atlas are bitten. 2. revealing the lower end of the medulla After the dural incision, the cisterna magna is exposed and the arachnoid is punctured to release the cerebrospinal fluid. After the tension is lowered, the cerebellar tonsil is lifted up, and the cerebellum is pulled upwards and upwards to reveal the lower part of the medulla and the lower end of the fourth ventricle. . The accessory nerve root and the vagus nerve root are emitted from the posterior lateral sulcus. 3. Cut off the trigeminal spinal cord The medullary lug plane is 8-10 mm from the midline, which is the outer side of the rod and the wedge nodule. There is a longitudinally raised gray nodule, also known as the trigeminal ridge, which is the trigeminal spinal cord and its nucleus. The surgical incision should be selected between the vagus and accessory nerve roots and the posterior root of the first cervical nerve, and the avascular region about 4 mm below the plane of the lug, making a 3 mm deep, 4 mm transverse incision. Before cutting, an acupuncture needle can be flexed to a right angle at a distance of 3 mm from the tip of the needle, and pierced at the predetermined incision to observe the facial pain response of the patient to achieve a more accurate selection of the designed incision position. Then take a corner of the broken safety razor blade, clamp it with a vascular clamp, and use a bone wax as a restrictive mark at 3mm to avoid accidentally injuring the deep structure of the medulla. After a cut, a review is needed. When the cut is insufficient, the cut is made in the original incision. 4. Guan skull After cutting, the patient's face was examined for painlessness, and the dura mater, neck occipital muscles, deep fascia, subcutaneous tissue, and skin were tightly sutured.