显微手术治疗原发性三叉神经痛的临床体会

Clinical experience of microsurgery in the treatment of primary trigeminal neuralgia

目的探讨原发性三叉神经痛的病因及显微血管减压术的治疗效果。方法回顾分析2010年1月至2014年12月收治的原发性三叉神经痛患者81例，行微血管减压术80例，同时行感觉根部分切断术22例，感觉根部分切断术加蛛网膜粘连松解1例，术中均严密缝合硬膜，术后随访半年以上，分析治疗效果。结果81例患者中，术中发现有血管压迫80例，蛛网膜粘连1例，术后1天疼痛完全消失70例，术后1周疼痛完全消失8例，另外3例延迟缓解，术后无颅内感染及皮下积液等并发症，平均随访15个月。结论显微手术行微血管减压术是治疗原发性三叉神经痛的最佳方法，根据情况可同时行感觉根部分切断术，疗效好，安全可靠，应作为原发性三叉神经痛患者的首选治疗方法。

Objective To investigate the causes of primary trigeminal neuralgia and the efficacy of microvascular decompression （MVD）. Methods 81 cases of primary trigeminal neuralgia in our hospital from January 2010 to December 2014 were retrospectively analyzed, of whom 80 cases underwent microvascular decompression, 22 cases underwent selective trigeminal neurectomy, 1 case underwent selective trigeminal neurectomy and arachnoid adhesions debonding, sutured the cerebral dura mater during the operation, follow- up cohort study for more than six months, and analyzed the treatment effect. Results Vascular compression was found in 80 cases, and 1 case of arachnoid adhesions. Pain disappeared completely in 70 cases in 1 day after operation, pain disappeared completely in 8 cases in 1 week after operation, 3 cases of insufficient relief. There were no postoperative complications such as intracranial infection or subcutaneous hydrops. The average follow- up period was 15 months. Conclusion Microvascular decompression is the preferred treatment method of primary trigeminal neuralgia, selective trigeminal neurectomy can be selected according to the situation in operation. The treatment method is safe and reliable, should be the preferred method of primary trigeminal neuralgia.