微血管减压术治疗原发性三叉神经痛的临床分析

Clinical analysis on the microvascular decompression for primary trigeminal neuralgia

目的:总结原发性三叉神经痛行微血管减压术治疗的临床经验。方法:回顾分析2013年2月~2014年2月在我科行微血管减压术治疗原发性三叉神经痛21例患者临床资料特点、术中所见责任血管及术后疗效。结果:术前21例患者均行三叉神经MRI薄层扫描,20例患侧可见三叉神经与血管关系密切,1例患侧未见明显异常。术中所见责任血管为:岩静脉及其分支2例,小脑上动脉16例,动静脉混合2例,无名小动脉1例。术后疗效:症状立即消失19例,缓解2例。术后出现眩晕3例,口周疱疹1例,面部麻木1例,无严重并发症及死亡病例,随访12~18个月,复发1例,其余均无疼痛发作。结论:微血管减压术是治疗原发性三叉神经痛的有效方式,术中精确处理责任血管及娴熟的显微外科技巧是提高疗效及减少术后并发症的关键。

Objective： To summarize the clinical experience of applying microvascular decompression to treatment of primary trigeminal neuralgia.Methods： Clinical data,responsible vessels seen in surgery and postoperative outcomes were reviewed in 21 cases of primary trigeminal neuralgia treated by microvascular decompression in our department between February of 2013 and 2014.Results： All patients received magnetic resonance angiography for the trigeminal nerve with thin-layer technique before operation. The angiography revealed close relationship of the trigeminal nerve with blood vessels at lesions in 20 patients,and no visible abnormality at the lesion in another 1. The common responsible vessels seen in operation included petrosal vein and its branches in 2 cases,superior cerebellar artery in 16,mixed arteriovenous branches in 2,and unknown small artery in 1. Postoperative outcomes included immediate symptom disappearance in 19 cases,remission in 2,dizziness in 3,mouth herpes in 1,and facial numbness in 1. No serious complications and death occurred. Follow-up from 12 to 18 months in all patients showed no pain attack except for relapse in 1 patient.Conclusion： Microvascular decompression is effective for primary trigeminal neuralgia,and careful intraoperative management of the responsible vessels and skillful operation can improve the treatment outcomes and reduce the postoperative complications.