显微血管减压术治疗三叉神经痛术后复发与再手术

Recurrence of trigeminal neuralgia after microvascular decompression and its microsurgical management

目的探讨显微血管减压术治疗三叉神经痛术后复发的因素和再手术治疗方法。方法对苏州九龙医院神经外科自2006年1月至2011年12月收治的21例显微血管减压术后复发患者行手术治疗，术中辅助性应用神经内镜，17例行显微血管减压术，2例行单纯蛛网膜松解术，1例行三叉神经感觉根部分切断术．1例行显微血管减压术加三叉神经感觉根部分切断术。结果21例患者平均随访28．5月，随访再手术有效率为95．2％，术后面部麻木2例，轻度面瘫1例。结论显微血管减压术后复发原因是多样的，血管压迫仍是主要病因；再手术仍应首选显微血管减压术，神经内镜辅助可提高手术疗效及安全性。

Objective To study the influencing factors of recurrence of trigeminal neuralgia after microvascular decompression and its microsurgical management. Methods Twenty one patients with recurrent trigeminal neuralgia after microvascular decompression （MVD）, admitted to our hospital from 2006 to 2011, were treated by microsurgical operations assisted by neuroendoscope. MVD was performed again in 17 patients, arachnoid membranes reflaxation in 2, partial rhizotomy （PR） in 1, and both MVD and PR in 1. Results All patients were followed up for about 28.5 months （mean duration）. The total effective rate during the follow-up period was 95.2%. Facial numbness was found in 2 patients and light facial paralysis in 1. Conclusion Many factors were responsible for the recurrence of trigeminal neuralgia after MVD; and vascular compression is still the main cause; MVD should be the first choice; curative effect and safety would be improved by the assistance of neuroendoscope.