静脉压迫性三叉神经痛的手术治疗（附33例临床分析）

Surgical treatment for idiopathic trigeminai neuralgia caused by venous compression： analysis of 33 cases

目的探讨静脉压迫性三叉神经痛的手术治疗特点和疗效。方法回顾性分析8年间33例原发性三叉神经痛患者术中静脉压迫的处理及结果。对静脉压迫的处理采取细小静脉予以电凝阻断，岩上静脉复合体分支可部分阻断，保留主干；全程解剖分离血管压迫后予以Teflon围套式包裹三叉神经。结果静脉压迫可位于三叉神经脑池段全程；33例中22例既有静脉压迫也有动脉责任血管，11例责任血管为单纯静脉．其中3例为无名静脉．8例为靠近Meckel’S腔的岩上静脉复合体；岩上静脉复合体按其引流模式分三种类型；微血管减压术后有效率为100％，平均随访2．5年无复发；术后主要并发症是三叉神经和小脑功能障碍，但经治疗后均明显改善。结论岩上静脉复合体是三叉神经痛最常见的责任静脉，静脉压迫无论是主要还是次要压迫因素时，均需要妥善处理，对三叉神经充分有效减压。微血管减压术避免了遗漏静脉压迫，减少了复发．但术后并发症的发生率稍偏高。

Objective To explore the operative features and results of idiopathic trigeminal neuralgia （TN） caused by venous compression. Methods Surgical management technique and outcomes in 33 TN patients were retrospectively analyzed. Compressing venules were electrically coagulated and blocked, and the offending branches of superior petrosal vein complex （SPVC） were partially blocked with the vein trunk preserved. After the veins were divided away from the compressed nerve and the entire cistemal trigeminal nerve were exposed, Teflon graft was properly interpositioned to encircle the whole range of it. Results Location of the vein compression can be at all along the cistemal trigeminal nerve. In the 33 TN patients, 22 were attributed to vein compression associated with artery offence, and 11 to simple vein conflict venous compression, among them 3 to anonymous veins and 8 to SPVC near Meckel＇s cave. The drainage patterns of the SPVC were classified into 3 groups. The pain get completely relieved in all patients after microvascular decompression（MVD）. No recurrence was found during the follow-ups of 2.5 years on average. Four patients developed trigeminal nerve impairment and 2 suffered fi＇om disordered cerebellum function after operation, but these complications were all improved through treatment. Conclusions SPVC is the most common offensive vein. Whether the venous compression is main compressing factor or not, it was essential to deal with them properly to get the trigeminal nerve completely decompressed from veins. MVD can accurately identify the venous compression and reduce the recurrence, however, it may result in higher postoperative complications.