三叉神经痛并神经源性高血压的病因及手术方法探讨

The etiology and methods of surgicd treatment oftrigeminal neuralgia and neurogenic hypertension

目的探讨三叉神经痛并神经源性高血压的病因及手术治疗方法。方法对71例该病患者经乙状窦后入路显微镜下探查三叉神经根部及腹外侧延髓(VLM)的、颅神经入脑干区(REZ),进行微血管减压(MVD)、神经血管梳理、肿瘤切除、三叉神经感觉根部分切断等。结果高血压治愈43例,显效11例,有效7例,无效10例;右侧三叉神经痛者5例及左REZ无责任血管者10例中,高血压治愈2例,显效5例,有效5例,无效3例;随访5.6年,高血压治愈41例,显效10例,有效9例,无效11例。三叉神经痛术后1周63例疼痛症状消失;8例疼痛症状明显减轻,未服用药物能忍受;随访:62例术侧疼痛消失,6例仅服少量卡马西平,3例于两年后再次行MVD。结论三叉神经痛并神经源性高血压的主要病因为责任血管压迫第V神经根和左侧VLM的REZ,三叉神经疼痛的长期反复刺激和情绪紧张为其另一病因,MVD是治疗三叉神经痛并神经源性高血压的有效方法。

Objective To study the etiolony and methods of surgical treatment of trigeminal neuralgia and neurogenic hypertension.Methods The root of trineminal nerve and rootentryzone(REZ) Ⅸ and Ⅹ ofventrolate ralmedulla(VLM) of 71 cases of trigeminal neuralgia were examined through posterior fossa microsurgery to perform microvascular decompression(MVD),combing of nerve and blood vessel,tumor excision and partial retrogasserian rhizotomy.Results Hypertension was cured in 43cases And the theatment was significantly effective in 11 cases,effective in 7 and ineffective in 10.Of the 5 cases of right trigeminal neuralgia and 10 cases without responsible blood vessells in left REZ,hypertension was cured in 2 cases and the treatment was significantly effective in 5 cases effective in 5 and ineffective in 3.5.6 years of followup showed that hypertension was cured in 41 cases and the treatment was significantly effective in 10 cases effective in 9 and ineffective in 11.The symptom of pain disappeared in 63 cases one week after surgery of trigeminal neuralgia and notably relieved in 8 cases whose pain was tolerable without takiny drugs.Followup showed that the pain of the side of surgery disappered in 62 cases and 6 cases only took a small dose of carbamazepine,MVD was performed on 3 cases two years later.Conclusions The main etiology of trigeminal neuralgia and neurogenic hypertension is the compression of responsible vessells on the root of nerve V and the REZ of left VLM,with the prolonged repeated stimulation of trigeminal neuralgia pain and stress being another cause.MVD is an effective method in the treatment of trigeminal neuralgia and neurogenic hypertension.