三叉神经痛和舌咽神经痛外科治疗

Surgical treatment of trigeminal neuralgia,hemifacial spasm and glossopharyngeal neuralgia

目的探讨三叉神经痛、半面痉挛和舌咽神经痛的显微手术方法及疗效。方法回顾分析桥小脑角Ⅴ、Ⅶ、Ⅸ颅神经手术211例,其中原发性三叉神经痛178例,半面痉挛27例,舌咽神经痛6例。对桥小脑角探查有血管压迫神经的三叉神经痛、半面痉挛患者,以显微血管减压术为主,辅以神经梳理术;无血管压迫神经的三叉神经痛、半面痉挛患者,只作神经梳理术;对显微血管减压和/或神经根梳理术后无效或复发的三叉神经痛患者,作三叉神经感觉根部分切断术;舌咽神经痛患者,均作舌咽神经切断术。结果术后随访6～24个月,三叉神经痛、半面痉挛和舌咽神经痛的治愈率分别是94.3%、92.6%和100%。结论神经梳理术是显微血管减压术治疗三叉神经痛、半面痉挛的必要补充,神经切断术仍为治疗神经痛的有效方法。

OBJECTIVE To explore the microsurgi- cal treatment of trigeminal neuralgia,hemifacial spasmand glossopharyngeal neuralgia. METHODS The clini-cal data of 211 patients who were operated on Ⅴ,Ⅶ,Ⅸcranial nerve in cerebellopontine angle were studiedretrospectively.There were 178 cases with primarytrigeminal neuralgia,27 cases with hemifacial spasmand 6 cases with glossopharyngeal neuralgia.If thetrigeminal neuralgia,hemifacial spasm patients with vas-cular compression in cerebellopotine angle,microvas-cular decompression and nerve combing were carriedout. Trigeminal neuralgia,hemifacial spasm patientswithout vascular compression in cerebellopotine angle,only nerve combing was carried out. No effectivenessor recurrence patients with trigeminal neuralgia afteroperation,partial trigeminal rhizotomy were performed.Intracranial section of the glossopharyngeal nerve wasperformed for all the glossopharyngeal neuralgia patients.RESULTS The cure rates of trigeminal neuralgia,hemifacialspasm and glossopharyngeal neuralgia were 94.3 %,92.6 %and 100 % respectively after follow up for 6 to 24 months.CONCLUSION Nerve combing is supplement of intrac-ranial microvascular decompression for patients withtrigeminal neuralgia and hemifacial spasm. Rhizotomyis also an effective surgical treatment for neuralgia.