神经血管减压术治疗原发性三叉神经痛的长期疗效

Long term effects of neurovascular decompression for primary trigeminal neuralgia

目的 :总结 15年经手术证实的病例 ,从临床上解释原发性三叉神经痛的病因和神经血管减压术的长期疗效。方法 :1985年以来采用乙状窦后和迷路后进路手术治疗原发性三叉神经痛 76 5例 ,对获得信访和门诊复查、手术时间超过 3年、资料完整的 5 87例进行总结。结果 :5 87年术中未见血管压迫者 49例 (8.35 % ) ,余 5 38例 (96 .6 5 % )有血管压迫 ,多数病例可见神经根有明显的血管压迹或神经根扭曲 (静脉压迫无此现象 )。疗效 :5 38例神经血管减压术者治愈5 2 9例 ,治愈率 98.33% ,有效 3例 (0 .5 6 % ) ,无效 6例 (1.12 % ,其中 1例为顽固性面痛 )。治愈者中复发 48例 (9.0 7% ,静脉压迫者基本全部复发 )。感觉根部分切断 49例 ,2例复发 ,1例顽固性面痛。结论 :三叉神经痛主要病因为血管压迫神经根 ,神经血管减压术是一种有效的治疗方法 ,治愈率高 ,长期疗效稳定。静脉不应视为压迫血管。

Objective:To verify the etiology of primary trigeminal neuralgia and long term effects after neurovascular decompression,the results of postoperative of 587 patients with primary neuralgia were summarized.There were 322 males and 255 females,ranging in age from 30 to 84 years old.Methods:Since 1985,the 765 patients with primary trigeminal neuralgia were treated by surgery of retrosigmoid approach or retrolabyrinthine approach.Among 765 cases,587 were fully recorded by follow up over 3 years.Results:Among 587 cases,49 cases (8.35%,49/587)were without obvious vessel pressing,538 cases (91 65%,538/587)with vascular pressing (obvious vessel pressed marks at the nerve root or distorted nerve root were demonstrated).The procedure of neurovascular decompression were completed in 538 cases,the cure rate was 98 33%(529/538),the effective rate 0 56%(3/538),and no relief rate 1 12%(6/538).The recurrence rate was 9 07%(48/529).Conclusion:The compression of nerve root by vessel was main etiology of the trigeminal neuralgia ,and the surgery of vascular decompression was an effective method,which was demonstrated by long term follow up.Venus should not be considered to be responsible vessels for primary trigeminal neuralgia.