微血管减压或并感觉根部分切断术治疗三叉神经痛

Surgical treatment of primary trigeminal neuralgia by MVD or MVD ＋ PSR

目的 探讨单纯微血管减压术（MVD）与微血管减压并感觉根部分切断术（PSR）治疗原发性三叉神经痛的手术方法及疗效。方法回顾性分析210例原发性三叉神经痛患者的临床资料。其中142例行MVD手术，68例行MVD＋PSR手术。结果MVD组：术后128例（90．1％）疼痛消失，9例（6．4％）疼痛明显减轻，手术有效率达96．5％。随访期大于2年的82例患者中，74例疼痛完全消除，5例时有疼痛可药物控制，3例药物不能有效控制。MVD＋PSR组：术后67例疼痛消失，1例疼痛无任何改善。随访期大于2年的47例患者中，45例疼痛完全消除，2例时有疼痛可药物控制。MVD＋PSR手术近期疼痛完全消除率（98．5％）明显高于单纯MVD手术（90．1％），P〈0．05；术后2年MVD＋PSR手术疼痛完全消除率（95．7％）仍高于单纯MVD手术（90．1％），但差异无统计学意义。结论MVD＋PSR手术近期疼痛完全消除率明显优于单纯MVD手术，术后2年仍较后者有更高的疼痛消除率，远期效果有待更长时间的随访；对责任血管的准确判断及合理处置是两种手术方式成功的关键；手术方式应根据术中情形并结合患者的个体因素、主观要求进行选择。

Objective To explore the technique and effectiveness of microvascular decompression （MVD） or microvascular decompression ＋ partial sensory rhizotomy （PSR） on the treatment of primary trigeminal neuralgia （TN）. Methods 210 TN patients undergoing posterior fossa craniotomies for TN were retrospectively studied, among which there＇re 142 cases underwent MVD and the other 68 cases underwent MVD ＋ PSR Results Of the MVD group, pain vanished in 128（90. 1% ）, obviously relieved in 9, and a total of 137（96.5% ） cases were profited from MVD after operation. In the 82 cases with a follow - up mere than 2 years, pain vanished in 74, pain sometime occurred in 5 which could be relieved by oral medicine （carbamazepine）, the last 3 cases could not be controlled effectively by medicine. Of the MVD ＋ PSR group, pain completely vanished in 67 eases, not changed in 1 case. In the 47 cases with a follow-up mere than 2 years, pain sometime occurred in 2 which could be relieved by earbamazepine, the others were completely pain - free. The short - term pain - free rate in MVD ＋ PSR group （98. 5% ） was obviously higher than the MVD group （ 90. 1% ）, P 〈 0. 05. After a follow - up mere than 2 years, the former was still higher than the later in the rate of 95. 7% and 90. 1% respectively, but there was no significant difference in statisties Conclusions MVD ＋ PSR was obviously superior to MVD in completely eliminating pain in short -term period after operation, the former still has a higher pain -free rate than the later in two years after operation, however,longer painfree rate need even longer time to follow up;identifying the responsible vascular exactly and handling it reasonably were the key to both groups; there are both merits and shortcomings in MVD or MVD ＋ PSR, so how to choose a more suitable surgical method depends on the findings in operation, the patient＇s own opinion and conditions should also be considered prudently before operation.