异常椎基底动脉压迫致三叉神经痛的临床特点及显微手术治疗(附16例分析)

Clinical features and microsurgical treatment of trigeminal neuralgia caused by abnormal vertebrobasilar artery compression(report of 16 cases)

目的探讨异常椎基底动脉压迫所致原发性三叉神经痛(ITN)的临床特点、可能发病机制及微血管减压术治疗效果。方法回顾性分析2010年1月至2015年6月收治的16例术中证实的异常椎基底动脉压迫所致ITN患者的临床资料。结果16例患者术后随访3个月至2年,14例术后1d疼痛立即消失且随访无复发,1例术后3个月随访时疼痛完全消失,1例术后3个月随访时疼痛较术前缓解。结论异常椎基底动脉压迫所致的ITN多见于老年患者,多伴有高血压、脑卒中病史;术前3D-TOF-MRA有助于明确责任血管及制定适宜的手术方案,术中针对不同的病因行不同的细节处理,充分松解三叉神经入脑干区及环池段周围蛛网膜有助于避免遗漏责任血管;围手术期应控制血压平稳,防治血管痉挛,防治急性卒中事件。

Objective To explore the possible pathogenesis and microvascular decompression （MVD） strategy of the trigeminal neuralgia （TN） caused by abnormal vertebrobasilar （VB） artery compression. Methods The clinical data of 16 TN caused by abnormal VB artery compression, who were treated by microvascular decompression from January, 2010 to June, 2015, were analyzed retrospectively, including imaging data, records of surgical procedures, following-up data and so on. Results TN disappeared immediatelytafter the operation and there was no recurrence of TN during following-up in 14 patients. TN disappeared 3 months after the operation in 1 patient. TN was partially relieved 3 months after the operation in 1 patient. Conclusions Each kind of VB artery anomalies can result in TN, which mostly occurs in old people with history of hypertension and stroke. Preoperative MRI and MRA examinations are helpful to affirming responsible vessel and formulating appropriate operation strategy in the patients with TN. It is suitable to take different details processing intracperatively according to different causes. The complete relaxation of arachnoid mater in the root enter zone and anbient cistern segments can prevent responsible blood vessel being missed. Perioperative management such as keeping stable blood pressure and preventing artery vasospasm is also important in the patients with TN.