MVD(Microvascular decompression, 미세혈관감압술)

 

MVD (Microvascular decompression, 혈관감압술) 이란? 

 

-적응증: 안면경련

안면신경을 누르는 뇌혈관들 사이에 의료용 스펀지를 넣어, 안면 떨림을 치료하는 미세혈관감압술

 (MVD, microvascular decompression)

 

Microvascular decompression (MVD) is a surgical procedure that relieves abnormal compression of a cranial nerve.

It is performed to treat trigeminal neuralgia, vagoglossopharyngeal neuralgia, and hemifacial spasm.

These conditions are often caused by an artery or vein compressing the nerve root as it leaves the brainstem.

When compressed, normal nerve impulses can recruit nearby nerve fibers and send faulty messages.

Medications often provide relief to patients with these conditions,

but when medications become ineffective or cause serious side effects, one treatment option is MVD. 

 

 

​

 

MVD is a surgical procedure to relieve the symptoms (pain, muscle twitching) caused by compression of a nerve by an artery or vein. MVD involves surgically opening the skull (craniotomy) and exposing the nerve at the base of the brainstem to insert a tiny sponge between the compressing vessel and the nerve.

This sponge isolates the nerve from the pulsating effect and pressure of the blood vessel.

 

Trigeminal neuralgia is an irritation of the fifth cranial nerve causing severe pain that usually affects one side of the face, normally in the forehead, cheek, jaw, or teeth . To treat trigeminal neuralgia,

a sponge is placed between the trigeminal nerve and the superior cerebellar artery or a branch of the petrosal vein.

By removing the compression, the painful symptoms are relieved

 

(출처:Mayfield)

 

 

 

 

 

 

 

 

 

 

<MVD시 주로 사용하는 pick 기구>

micro dissector (Micro penfield #4)

주걱모양의 가장 작은 dissector

1자 모양

45도 꺽인 모양

ㄱ자 모양

 

<micro 3번 set>

fcp 2

st micro scs

bipolar irrigation

 

 

 

 

<수술 setting 할 것>

micro bayonet fcp, micro bipolar, fukusima suction 

 

 

<procedure>

 

1.incision & craniotomy

 local injection

 ->#20mess incision : 3-inch skin incision is made behind the ear

 ->skin, muscle : bovie, bipolar, metz, periosteal

 ->clip사용안함(2015.06.09)

 ->mastoid retraction

 ->occipital bone : 6mm drilling -> sawing-> bone 뗀 후 -> 정리 4mm cutting burr

 ->dura와 bone 사이 suture 안함(2015.06.09)

 

2.dura incision

 15mess incisin

 ->dura suture 4-0 black silk

 ->st dura scs, micro penfield, dissector, penfield 4

 ->suture는 mosquito로 tagging해놓는다

 ->편솜 여러개로 dura,brain보호 해놓음

 

3.exposure

 green berg retractor 가장 얇은거 사용

 ->trigerminal nerve 노출 : micro dissector 등 여러 pick으로 노출

 ->micro metz bayonet type으로 dissection

   (처음 incision시에는 micro3번set에 있는 titanium blue st scs를 사용함)

->artery 와 trigeminal nerve사이 decompression : teflon sponge 넣음(micro bayonet fcp)

->micro penfield 로 펴놓음

 

4.closure

 tissel, tachocomb사용

 bone detach 있는 부분 hydro set사용

 hemovac사용 안함

 

 

 

 

 

 

micro bayonet fcp으로 sponge넣고 suction과 penfield로 펴냄

 

 

 

 

 

 

 

 

 

 

<기타>

navigation, doppler사용안함