继发性三叉神经痛的诊断与手术治疗——附36例临床分析

Diagnosis and surgical treatment of secondary trigeminal neuralgia(clinical analysis of 36 cases)

目的探讨颅内肿瘤继发三叉神经痛的临床特点、发病机制、治疗方案及手术要点。方法回顾性分析我院2000年9月至2010年4月间收治的36例继发性三叉神经痛病人的临床资料及手术治疗效果。结果 21例肿瘤全切除,11例肿瘤及1例蛛网膜囊肿次全切除,3例肿瘤部分切除。5例患者还行三叉神经感觉根部分切断术,1例行三叉神经微血管减压术。术后35例病人面部疼痛消失,1例疼痛明显减轻。术后新增并发症包括面部麻木8例,暂时性面瘫6例,听力下降3例,口唇疱疹3例,眼球轻度外展受限2例,无菌性脑膜炎1例。术后平均随访33个月,无疼痛复发病例。结论桥小脑角区肿瘤是继发性三叉神经痛的最常见原因,发病机制可能为三叉神经传导通路受压及脱髓鞘改变。显微手术切除病灶是继发性三叉神经痛的首选治疗方案。手术原则是保护颅神经功能的前提下争取病灶全切以及三叉神经的充分减压。

Objective To discuss the clinical characteristics,mechanism,treatment and surgical key points of trigeminal neuralgia secondary to tumors.Methods The clinical data and operative results of 36 cases with secondary trigeminal neuralgia treated in our neurosurgery department between September 2000 and April 2010 were analyzed retrospectively.Results Total resection was achieved in 21 tumors,subtotal in 11 tumors and 1 arachnoid cyst,and partial in 3 tumors.5 patients accepted additional sensory rhizotomy of trigeminal nerve,1 received microvacular decompression.Pain disappeard in 35 patients and alleviated in 1 after operation.The operative complications were 8 facial numbness,6 transient facial paralysis,3 reduction of hearing,3 herpes labialis,2 abducent paralysis,1 aseptic meningitis.No recurrences were found during follow-up for average 33 months.Conclusion The cerebellopontine angle tumor is the commonest cause of secondary trigeminal neuralgia.The mechanism may be compression and demyelination of the trigeminal conduction path.Removing space-occupying lesion is the first choice of treatment.The key points of operation is complete removal of lesion and complete decompression of trigeminal nerve with precondition of reserving the function of cranial nerves.