Teflon cotton sheet implantation for treatment of microvascular compression symptoms of VII, VIII cranial nerves

doi:10.3969/j.issn.2095-4344.2015.08.021

Abstract

Abstract:

BACKGROUND: Teflon cotton sheets have good biological characteristics and histocompatibility, and the intracranial implantation of teflon cotton sheets cannot lead to severe rejection, which, at present, has been widely applied in the microvascular decompression.

OBJECTIVE:To explore the therapeutic efficacy of the intracranial implantation of teflon cotton sheets via VII, VIII cranial nerves in the microvascular decompression treatment of hemifacial spasm combined with vertigo and tinnitus.

METHODS: Ten patients with the VII, VIII cranial nerve compression syndromes were enrolled, including six cases of hemifacial spasm combined with tinnitus, two cases of hemifacial spasm combined with vertigo, two cases of hemifacial spasm combined with tinnitus and vertigo. All patients were subject to the intracranial implantation of teflon cotton sheets for decompression treatment, among whom, five cases underwent trap type placement, and the other five cases underwent flocculent type placement. During the follow-up, the biocompatibility of Teflon cotton sheets and improvement in facial twitching, tinnitus, vertigo, and complications were observed.

RESULTS AND CONCLUSION: The implanted cotton sheets showed good biological characteristics and histocompatibility. After implantation of cotton sheets, facial twitching symptoms disappeared completely in 7 of 10 cases, symptoms relieved in 3 of 10 cases; after 1 week of implantation, facial twitching symptoms disappeared completely in all patients, tinnitus symptoms disappeared in 5 of 8 cases, tinnitus relieved level 2 in 2 of 8 cases, and there was no improvement in 1 of 8 cases; vertigo was eased in 2 of 4 cases, but the other 2 cases showed no improvement in symptoms of dizziness. During the follow-up of 6 to 48 months, symptoms of facial twitching were not recurrent in all patients; tinnitus symptoms disappeared in 6 cases, relieved in 1 case, but had no improvement in 1 case; vertigo symptoms disappeared in 3 cases, but showed no improvement in 1 case. Results demonstrate that the implantation of teflon cotton sheets is safe and effective in the treatment of microvascular compression symptoms of VII, VIII cranial nerves.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: Polytetrafluoroethylene, Vertigo, Tinnitus, Spasm

CLC Number:

R318

Feng Zhao-hai, Shi Xin, Jiang Lei, Hao Yu-jun. Teflon cotton sheet implantation for treatment of microvascular compression symptoms of VII, VIII cranial nerves [J]. Chinese Journal of Tissue Engineering Research, 2015, 19(8): 1261-1266.

Figures/Tables 1

2.1 参与者数量分析 10例患者均进入结果分析。 2.2 术中可见解剖学变化 7例为小脑前下动脉压迫第Ⅶ、Ⅷ颅神经，2例为椎动脉合并小脑前下动脉压迫第Ⅶ、Ⅷ颅神经，1例为小脑前下动脉压迫在Ⅷ根部合并一小动脉在Ⅶ、Ⅷ之间穿行压迫Ⅶ。8例为动脉压迫颅神经神经根出脑干区，1例动脉压迫颅神经Ⅶ、Ⅷ中段，1例动脉压迫颅神经Ⅶ、Ⅷ远端近内听道口处。 2.3 聚四氟乙烯棉片置入后的生物相容性及不良反应 10例均未出现排斥反应，验证了聚四氟乙烯棉片具有良好的生物学特性和组织相容性，置入颅内不会导致严重排异反应，不诱发组织粘连和肉芽肿形成，不会随时间的推移而吸收变形。采用圈套式垫入聚四氟乙烯棉片的患者有2例术后发生感染，1例通过支持对症治疗，加强营养支持和提高患者免疫力，行腰椎穿刺脑脊液生化+常规检查，抗感染使用三代头孢类抗生素，隔日行腰椎穿刺释放异常脑脊液，病愈；1例行腰大池持续引流，结合静点万古霉素，4 d后病愈。而采用絮状式将聚四氟乙烯棉片撕成絮状，厚厚的铺在神经及压迫血管之间，并尽量避开之前神经被压迫部位，术后并未出现感染患者。 2.4 面部抽搐、眩晕及耳鸣改善情况 10例面部抽搐患者中，棉片置入后7例面抽症状完全消失，3例面抽症状减轻，置入后1周所有患者面抽症状均消失。棉片置入后1周，8例伴有耳鸣症状患者中，5例自觉耳鸣消失，2例自觉耳鸣减轻2级，1例耳鸣症状无改善；置入后随访6-48个月，6例耳鸣症状消失，1例减轻，1例无改善。4例合并眩晕患者中，棉片置入后即刻眩晕症状减轻2例，2例症状眩晕无改善；置入后1周，3例眩晕症状消失，1例眩晕症状减轻(表1)。 2.5 听觉功能测试结果 10例患者治疗前后均进行了纯音测听，用配对样本的t检验分析，显示治疗前后纯音平均听阈比较差异无显著性意义(t=0.009 8，P > 0.05)。在脑干听觉诱发电位检测中，其中3例患者治疗后 Ⅰ-Ⅴ波潜伏期较治疗前缩短：治疗前Ⅴ波阈值分别为30，45，35 dB，治疗1个月后分别为30，45，40 dB；治疗前Ⅰ-Ⅴ波潜伏期分别5.2，5.5，5.7 ms，治疗1个月后分别为4.5，5.0，5.1 ms。 2.6 术后并发症 1例患者听力丧失(此患者治疗前面抽合并眩晕、耳鸣，听力差)，1例患者术后听力下降；所有患者面神经功能均正常，未出现迟缓性面瘫等其他手术相关并发症。 2.7 随访情况随访6-48个月，10例面部抽搐患者均无复发；5例耳鸣消失患者无复发，1例术后自觉耳鸣减轻患者6个月后耳鸣消失，1例术后自觉耳鸣减轻患者症状进一步改善，1例术后自觉耳鸣减轻患者症状无变化；2例术后眩晕减轻患者术后3个月至半年眩晕症状消失，1例眩晕无改善患者症状6个月后消失，1例眩晕症状无改善(表1)。"

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