血管压痕对微血管减压治疗原发性三叉神经痛近期效果的影响

Microvascular decompression for primary trigeminal neuralgia： short-term follow-up results and influence of vascular indentation in it

目的 探讨血管压迫程度对微血管减压治疗原发性三叉神经痛近期效果的影响.方法 选择临沂市人民医院神经外科自2011年1月至2013年12月收治的95例原发性三叉神经痛患者,患者术前磁共振微血管成像检查提示均存在血管接触或压迫三叉神经根部,在常规全麻下行微血管减压,术中根据血管压迫神经根的程度进行分组并行不同处理（对存在明显血管压迫且有压痕的患者设为有压痕组,行单纯微血管减压;对有血管存在且无压痕的患者设为无压痕组,先行微血管减压,为避免遗漏再行三叉神经颅内段探查术行三叉神经颅内脑池段全程松解减压）.采用统计学方法对有压痕组和无压痕组术后第1天和第7天临床恢复情况进行分析. 结果 95例患者术中均证实存在相应血管,MRI诊断敏感性为100％.95例患者术后第1天有效率为92.63％,94例患者术后第7天有效率为93.62％.56例有压痕组患者术后第1天疗效Ⅰ级48例,Ⅱ级5例,Ⅲ级3例,Ⅳ级0例,Ⅴ级0例;39例无压痕组患者术后第1天疗效Ⅰ级27例,Ⅱ级3例,Ⅲ级2例,Ⅳ级3例,Ⅴ级4例,分析发现差异有统计学意义（Z=-2.215,P=0.027）.55例有压痕组患者术后第7天疗效Ⅰ级49例,Ⅱ级4例,Ⅲ级2例,Ⅳ级0例,Ⅴ级0例;39例无压痕组患者术后第7天疗效Ⅰ级27例,Ⅱ级4例,Ⅲ级1例,Ⅳ级4例,Ⅴ级3例,分析发现差异有统计学意义（Z=-2.595,P=0.009）.结论 微血管减压治疗原发性三叉神经痛效果确切,其中血管压迫三叉神经根部有明显压痕的患者疗效较血管接触神经但无压痕的患者更好.

Objective To investigate the impacts of extents of vascular compression in short-term follow-up results of primary trigeminal neuralgia treated by microvascular decompression （MVD）.Methods Ninety-five patients with primary trigeminal neuralgia,admitted to our hospital from January 2011 to December 2013,were chosen in our study; preoperative microvascular MR imaging （MRI） showed that all patients existed vascular contact or compression on the trigeminal nerve roots.MVD was conducted after conventional general anesthesia; these patients were divided into two groups according to the degrees of vascular compression on the nerve roots and different groups adopted different surgical treatments.Patients with significant vascular compression and indentation were regarded as indentation group,and they adopted MVD only; those with vascular compression but no indentation were regarded as non-indentation group,and MVD was conducted and intracranial trigeminal nerve was fully released by intracranial trigeminal nerve exploration surgery to avoid missing vascular compression.The postoperative recovery results on the first and seventh day of these two groups were tested by chi-square test.Results Ninety-five with primary trigeminal neuralgia existed vascular contact or compression on the trigeminal nerve roots during microvascular MRI examination before operation and the vessels were confirmed during surgery,with a MRI diagnostic sensitivity of 100%.The effective rate of the first day after operation was 92.63% and that of the seventh day was 93.62%.In 56 patients from indentation group,the efficacy of the first day was as follows：grade Ⅰ was noted in 48 patients,grade Ⅱ in 5,grade Ⅲ in 3,Ⅳ in 0 and Ⅴ in 0; in 39 patients from non-indentation group,the efficacy of the first day was as follows：grade Ⅰ was noted in 27 patients,grade Ⅱ in 3,grade Ⅲ in 2,grade Ⅳ in 3,and grade Ⅴ in 4; significant differences were noted between the two groups （Z=-2.215,P=0.027）.In 55 patients from indentation group,the efficacy of the seven day was as follows：grade Ⅰ was noted in 49 patients,grade Ⅱ in 4,grade Ⅲ in 2,Ⅳ in 0 and Ⅴ in 0; in 39 patients from non-indentation group,the efficacy of the seven day was as follows：grade Ⅰ was noted in 27 patients,grade Ⅱ in 4,grade Ⅲ in 1,Ⅳ in 4 and grade Ⅴ in 3; significant differences were noted between the two groups （Z=-2.595,P=0.009）.Conclusions It has exact effect to treat primary trigeminal neuralgia by MVD.Patients with significant vascular compression and indentation on the trigeminal nerve roots have better outcomes than those patients with vascular compression but no indentation.