三叉神经根表层纤维束切断术治疗三叉神经痛的可行性研究

Clinical anatomy of the surface tractotomy of trigeminal nerve sensory root: a new tractotomy for the treatment of trigeminal neuralgia

目的:探讨三叉神经感觉根（TNSR）的解剖学结构,及其表层神经纤维束切断术治疗三叉神经痛（TN）的可行性。方法:对10例尸体的三叉神经根标本取材、并对TNSR石蜡包埋及连续切片,进行较系统的观察。为2例TN患者行TNSR表层神经纤维束切断术的治疗与随访。结果:解剖及组织学上显示了TNSR的中央部分有一根巨大的神经纤维束,而在表层环绕着细小的神经纤维束。术中的观察与组织学一致,2例TN患者术后,面部疼痛等症状消失,分别随访1年6个月及1年4个月,症状未复发,且保留了温、触觉功能、角膜反射及形态正常。结论:TNSR中央区域有一巨束神经纤维,表层分布着小神经纤维束。表层神经纤维束切断术能够治疗TN,且保留了温、触觉及角膜反射,本手术方法是一种治疗TN有效的、且很有应用前景的治疗方法。

Objective: To explore the detailed clinical anatomy of trigeminal nerve sensory root (TNSR) in order to establish a new tractotomy for the treatment of trigeminal neuralgia (TN) . Methods: Trigeminal nerve and the TNSRs obtained from 10 anatomic cadaveric specimens were paraffin-embedded. A detailed examination was then performed on HE stained serial sections. Clinically, 2 patients with TN were operated on using the new TNSR tractotomy in which surface nerve fiber bundles of TNSR were cut. Results: Histological examination revealed that the portion of the TNSR was composed of two major parts: (1) many tiny nerve fiber bundles located in the surface layer and (2) a big nerve fiber bundle in the center of the root. Clinically, observation on the TNSR structure during the operation was consistent with those histological findings in vitro. After the surface nerve fiber bundles of the TNSR were cut off, the patients symptoms, such as face ache, disappeared.These two patients were followed up for 18 and 16 months respectively, and their symptoms did not recur. In addition, functions such as sensations of heat and touch, and corneal reflex were retained. Conclusion: Our anatomic findings and clinical observations suggest that numerous nerve fiber bundles in the surface layer of the TNSR would be the principal structures which are responsible for the conduction of pain while the big bundle of nerve fibers in the TNSR center would be responsible for the conduction of sensations of the heat and touch. Therefore, the new TNSR tractotomy, which only cuts the surface nerve fiber bundles and is now referred to as surface tractotomy of TNSR, would be an effective, advanced surgical model for TN treatment.