半月神经节射频治疗复发型三叉神经痛的显微外科治疗

Microsurgery of the Recurrent Trigeminal Neuralgia after Gasserian Ganglion Radiofrequency Therapy

探讨了三叉神经痛半月神经节射频热凝术后复发病例三叉神经根部的变化和手术方式。回顾玉泉医院神经外科从2004年10月至2007年12月间行显微血管减压术和三叉神经感觉根选择性切断术治疗的152例三叉神经痛患者,对其中11例曾行半月神经节射频热凝术治疗过的患者术中观测三叉神经根部的变化,并对其手术方式及疗效进行分析。11例射频复发病例中,5例行感觉根选择切断术,4例行微血管减压术+感觉根选择切断术,1例行单纯微血管减压术,1例行桥小脑角胆脂瘤全切除+感觉根选择性切断术。镜下解剖观察发现,三叉神经感觉根有周径变细的变化。再次开颅手术的在院有效率为100%,长期随访治愈率为80%。结果显示,射频治疗的无效和复发,与首次治疗时间、毁损的靶点及程度相关。半月节射频毁损术可改变三叉神经根的解剖结构,在选择切断时应予以注意。三叉神经微血管减压术对于射频治疗无效复发的病例也有良好的疗效。

The Microvascular Decompression （MVD） of the recurrent trigeminal neuralgia treated with the Gasserian ganglion Radiofrequency Therapy （RT） is studied in this paper. 11 recurrent cases from 152 MVD operations of trigeminal neuralgia from Oct. 2004 to Dec. 2007 are analyzed. Among the 11 cases, there are 5 Partial Rhizotomy （PR） of trigeminal sensory root, 4 MVD plus PR, 1 MVD and 1 cholesteatoma ectomy plus PR. Under microscope, the circumference of trigeminal root is changed compared with the normal. The in-hospital effective rate is 100%, and the long-term cure rate is 80% . The results show that the recurrence of radiofrequency therapy seems to be related to the first treatment time, the target and extent of radiofrequency damage. The MVD of trigeminal neuralgia is still an effective treatment to recurrent cases of radiofrequency therapy, but the changed anatomy needs more attention of PR.