静脉相关型三叉神经痛术后面部麻木的研究分析

Facial numbness in patients after surgery for vein-associated trigeminal neuralgia

目的探讨与岩上静脉相关的三叉神经痛病人术中处理方法及术后面部麻木的发生原因及预防。方法回顾性分析780例原发性三叉神经痛的病人,根据术中观察岩上静脉是否压迫三叉神经,分为单纯静脉型(n=49)、动静脉混合型(n=272)及单纯动脉型(n=459),比较术后疗效和并发症。结果单纯静脉型、动静脉混合型和单纯动脉型治愈率分别为93.88%、98.90%、98.91%,术后面部麻木的发生率分别为73.5%、46.3%、30.5%。单纯静脉型和动静脉混合型面部麻木的发生率均显著高于单纯动脉型(均P<0.05)。结论三叉神经显微血管减压术后出现面部麻木是最常见的并发症,根据发生率依次为:单纯静脉型>动静脉混合型>单纯动脉型,术中充分暴露小脑水平裂及三叉神经根部、充分保护岩静脉、减少神经和血管的牵拉可降低面部麻木的发生率。

Objective To investigate the surgical treatment of patients with trigeminal neuralgia associated with the superior petrosal vein and the causes and prevention of facial numbness after surgery. Methods Clinical data of 780 patients with primary trigeminal neuralgia were analyzed retrospectively. The patients were divided into simple vein type （n=49）, arterial-venous mixed type （n=272）, simple artery type （n=459） according to the superior petrosal vein-caused compression of the trigeminal nerve or not. The postoperative outcome and complications were compared among the three types. Results The recovery rates of simple vein type, arterial-venous mixed type and simple artery type were 93.88%, 98.90%, 98.91% respectively. And the facial numbness rates of simple vein type, arterial-venous mixed type and simple artery type were 73.5%, 46.3%, 30.5%respectively. The facial numbness rate was significantly higher in simple vein type and arterial-venous mixed type than in simple artery type （both P〈0.05）. Conclusions Facial numbness is one of the most common complications of trigeminal neuralgia after microvascular decompression. The rate of facial numbness is as follows： simple vein type higher than arterial-venous mixed type higher than simple arterial type. The full exposure of the cerebellar horizontal fissure and the trigeminal nerve root, protection of the petrosal vein, reduction of nerve and vessel traction are the effective means for decreasing incidence of facial numbness.