微球囊压迫治疗三叉神经痛术后滑车神经麻痹的临床分析

Trochlera nerve palsy occurred after percutaneous microsphere compression treatment for trigeminal neuralgia:a clinical analysis

目的分析微球囊压迫法治疗三叉神经痛术后滑车神经麻痹的原理,以改进手术方法,减少并发症的发生。方法回顾性分析2001年6月至2010年6月采用微球囊压迫法治疗原发性三叉神经痛患者术后出现滑车神经麻痹的16例患者的临床资料,分析术中摄片压迫神经节时的球囊形状,同时随机选取2010年1月至2010年6月间术后未出现滑车神经麻痹的50例患者资料作为对照。结果术后出现滑车神经麻痹症状的16例患者术中所拍摄的压迫三叉神经节时的球囊形状均为哑铃型(100%),而不是理想的"梨形",而对照组出现哑铃型者仅3例,两组比较差异有统计学意义(P<0.05)。滑车神经麻痹症状经营养神经治疗后均完全恢复。结论术后出现滑车神经麻痹症状,是因手术操作不当导致球囊突入后颅窝压迫到滑车神经所致,故应注意操作方法可减少该并发症的发生。

Objective To discuss the possible causes of trochlear never palsy occurred after percutaneous microsphere compression therapy for trigeminal neuralgia in order to improve the operative procedure and reduce the incidence of complications.Methods Sixteen patients（study group） who developed postoperative trochlear never palsy after microsphere compression therapy for idiopathic trigeminal neuralgia,encountered during the period from June 2001 to June 2010,were enrolled in this study.The clinical data were retrospectively analyzed.The shape of the microsphere which compressed the trigeninal ganglion was observed.Another fifty patients who received microsphere compression therapy and didn＇t develop postoperative trochlear never palsy,encountered during the period of Jan.2010-June 2010,were randomly collected as the control group.Results In all the 16 patients of the study group the microsphere took the form of the dumbell shape not the ideal ＇pear＇ shape,while the dumbell shape appeared only in 3 patients in the control group.The difference in the frequency of dumbell shape between the two groups was statistically significant（P〈0.05）.All patients in study group completely recovered from trochlear never palsy after they received neural nourishment therapy.Conclusion Postoperative trochlear never palsy is caused by inappropriate manipulation,which leads to the protrusion of the microsphere into posterior cranial fossa.In this way,the microsphere presses its wall against the troclear never and results in never palsy.Proper and careful manipulation can reduce the occurrence of this complication.