三叉神经痛微血管减压梳理术随访疗效分析

Microvascular decompression combined with nerve combing surgery in the treatment of idiopathic trigeminal neuralgia:results of follow-up

目的探讨三叉神经微血管减压梳理术治疗原发性三叉神经痛的疗效及临床应用价值。方法对155例经乙状窦后入路实施的三叉神经微血管减压梳理术治疗的原发性三叉神经痛患者临床资料进行随访分析,总结疗效及术后并发症情况。结果术后10d155例患者中疼痛消失150例(96.77%),显效3例(1.94%),死亡2例(1.29%)。术后对153例患者随访3～60个月,随访治愈132例(93.62%),显效6例(4.25%),有效2例(1.42%),无效1例(0.71%)。6例(4.26%)患者复发,复发时间16个月至3.5年。术后并发症的发生率由高到低依次为:面部麻木、口唇疱疹、头痛、眩晕、枕神经痛、听力障碍、耳鸣、脑脊液漏。其中术后面部感觉正常69例(45.10%),轻度面部麻木57例(37.25%),中度麻木27例(17.65%)。随访发现其中22例(15.6%)恢复正常,19例(13.48%)减轻。出现口唇疱疹、头痛、眩晕、枕神经痛的比例分别为37.26%、23.53%、19.61%和9.8%,住院期间均痊愈;暂时性听力下降15例,随访未发现持续听力下降病例。住院期间死亡2例(1.29%),均因当日和2d继发脑出血死亡。未观察到复视、面瘫、颅内积气、硬膜下血肿等并发症。结论三叉神经显微血管减压感觉根梳理术适应证广,临床疗效良好而稳定,术后并发症轻微。

Objective To evaluate the effect and clinical value of microvascular decompression combined with nerve combing in the treatment of idiopathic trigeminal neuralgia （TN）. Methods The clinical data of 155 cases of idiopathic TN treated with microvascular decompression and nerve combing via post-sigmoid approach were analyzed. Surgical effects and complications were also discussed. Results There were 150 cases of complete pain free 10 days after surgery （96. 77% ）, 3 cases （ 1.94% ） with excellent results and 2 dead cases. A total of 153 cases were followed-up 3 to 60 months, of which 132 cases of complete recovery （93.62%）, 6 eases with excellent results, 2 cases with efficacy and 6 cases （4.26%） presented recurrence 16 months to 3.5 years after surgery. The post-operatlve complications included： facial numbness, oral herpes, headache, vertigo, deafness, tinnitus and leakage of cerebrospinal fluid. A total of 69 cases presented with normal facial feeling, 57 and 27 cases with the mild and moderate facial numbness respectively. Twenty cases recovered and 19 cases felt better during follow-up. The occurrence rate of oral herpes, headache, vertigo and occipital neuralgia was 37.26%, 23.53%, 19. 61% and 9. 8% respectively, all successfully recovered during hospitalization. The transient hearing loss occurred in 15 cases and none had continuous deafness. Two cases （ 1.29% ） died during hospitalization because of post-operative cerebral hemorrhage. Conclusion The microvascular decompression （MVD） combined with trigeminal root combing is a good option for TN because of its wider adaptation, good and stable outcomes and mild post-operative complications.