老年人三叉神经痛的病因和微血管减压手术治疗

Etiology of trigeminal neuralgia in elderly patients and its management with microvascular decompression

目的探讨老年人三叉神经痛微血管减压手术的安全性和疗效。方法回顾性分析82例经保守治疗无效的65岁以上老年三叉神经痛患者全麻下行手术治疗的临床资料。结果77例患者经磁共振断层血管成像(MRTA)检查,显示责任血管压迫三叉神经63例(81.8%),肿瘤压迫神经5例(6.1%)。术后70例(85.4%)疼痛消失,8例(9.7%)症状明显减轻,手术有效率95.1%。治疗有效中的66例获随访2～106个月,平均31个月。术后3年内复发5例,复发率7.6%。结论本组未出现与年龄相关的术后并发症,预后较好,只要操作熟练和围手术期的处理规范,手术的安全性和有效性是有保障的。继发性病因在老年三叉神经痛患者中并非少见。特殊序列的磁共振检查不仅有助于发现继发性病因,而且能够显示压迫责任血管,对指导手术和患者筛选都有重要价值。

Objective To explore the etiology of trigeminal neuralgia in patients over 65 years of age and the effectiveness and safety of microvascular decompression operation(MDO). Methods Eighty-two patients with ages ranging from 65~94(average 72.8 years) were included in this study. A high-resolution magnetic resonance imaging was incorporated into preoperative algorithm to select successful candidates for microvassular MDO. Results Five cases of secondary causes were found including 2 cases of meningioma, 2 cholesteatoma and one acoustic neuroma . In 77 cases of so-called 'primary' trigeminal neuralgia, however, offending vessels were discerned on MRTA by 81.8%. Operations were uneventful with no major complications. The effective rate was 95.1%, with 85.4% immediate complete cure and 9.7% little residual pain with no further medication. Four point nine percent patients were not benefited from operation. Follow-up was made in 66 successful cases for an average of 31 months. 5 cases recurred within 3 years after operation. Conclusions There is no serious morbidity or mortality that could be ascribed to old age and the operative result is favorably compared with the outcome in a younger age group. Intensive perioperative care and matured microsurgical technique are the musts in carrying out such kind of delicate functional operation. Intracranial tumor as a cause of trigeminal neuralgia is not rare in elderly patients. A thorough MRI check-up is mandatory in order not to miss the secondary cause and find offending vessel definitely.