冠状切口额下入路手术后神经痛的发生及治疗

Characteristics and Treatment of Neuralgia after Subfrontal Craniotomy

目的观察冠状切口经额下入路术后神经痛的临床特点，并探讨有效的治疗方法。方法132例择期行冠状切口经额下入路的神经外科患者，排除切口局部疼痛后记录神经痛的发生时间、程度和性质；所有拟诊为术后神经痛的患者首先应用非甾体类消炎镇痛药物口服及脱水治疗，对经药物治疗后疼痛视觉模拟评分（VAs）仍高于7分的患者行类固醇激素神经阻滞疗法。比较药物和神经阻滞对不同类型神经痛的治疗效果。结果眶上神经痛和颞浅神经痛均出现于冠状切口经额下入路术后第3-4天，第4-7天逐渐加重达到高峰，均为中、重度疼痛，呈持续性伴阵发性加重，向同侧额部、顶部、颞部或眶周放散，眶上切迹或颞浅动脉处压痛明显。本组患者术后发生眶上神经痛13例（9．8％），除1例药物治疗有效外，其余12例经神经阻滞治疗后疼痛明显减轻（P〈0．01）；颞浅神经痛4例（3％），3例经药物治疗、1例经神经阻滞治疗后痊愈。结论冠状切口经额下入路术后出现头痛时应注意鉴别眶上神经和颞浅神经痛，颞浅神经痛对非甾体类消炎镇痛药物反应良好，而大多数眶上神经痛需要神经阻滞治疗。

Objective To explore the clinical features and therapeutic strategies of neuralgia after subfrontal craniotomy. Methods 132 neurosurgical patients undergoing selective subfrontal craniotomy without the pain of the incision of scalp were involved. The onset, severity, and characters of the neuralgia were recorded. The therapeutic effects of medicine and nerve block on neuralgia were observed. Results Supraorbital neuralgia （9.8%） and superficial temporal neuralgia （3 % ） occurred 3-4 days and aggravated 4-7 days after subfrontal craniotomy. The headache could be persistent and become more serious intermittently and irradi- ated to frontal, parietal, temperal, and para-orbital region. Physical examination revealed homolateral tenderness of supraorbital notch and para-arteria temporalis superficialis. Severity of headache improved dramatically after nerve block therapy. Conclusion It is important to identify whether supraorbital neuralgia and superficial temporal neuralgia are onset after subfrontal craniotomy. Nerve block therapy gets excellent clinical result in treating post-craniotomy neuralgia.