微血管减压术合并梳理术治疗复发三叉神经痛

Efficacy of microvascular decompression combined with internal neurolysis for recurrent trigeminal neuralgia and its recurrent causes

目的探讨微血管减压术合并梳理术治疗复发三叉神经痛的疗效,分析复发原因。方法自2010年6月至2014年12月13例微血管减压术(microvascular decompression,MVD)术后复发患者行MVD术合并梳理术(internal neurolysis,IN)。对其临床资料、影像资料、手术资料回顾性分析。结果三叉神经MVD术后复发原因主要为血管压迫和蛛网膜粘连,其次为Teflon肉芽肿。随访期结束时,疼痛强度分级(the Barrow neurological institute pain intensity scale,BNI)为BNI I级9例,BNI II级2例,BNI III级1例,BNI IV级1例。术后细菌性脑膜炎1例,头皮延迟愈合1例和面部麻木13例。结论三叉神经MVD术后复发原因主要为血管压迫和蛛网膜粘连,其次为Teflon肉芽肿。对于复发三叉神经痛患者来说,MVD术合并梳理术是可行的治疗选择。

Objective To investigate the effect of microvascular decompression combined with internal neurolysis （MVD＋IN） on recurrent trigeminal neuralgia（TN） and to discuss the recurrent causes. Methods 13 patients underwent MVD procedure for idiopathic TN and then underwent MVD plus IN for recurrent TN at our institute from 2010. 6 to 2014. 12. They were retrospectively reviewed and analyzed. Results The causes of recurrent trigeminal neuralgia after MVD were mainly arachnoid adhesion and vascular compression, followed by Teflon granuloma. And after the MVD plus IN, almost all patients （12/13,92.3%） achieved pain relief after 36.1 months,9 patients （69. 2%） achieved pain free （BNI score I） and 3 patients （23. 1%） achieved pain relief （BNI II--Ⅲ）. One patients got a pain of BNI IV. Although all patients experiencing some degree of numbness, it did not influence their quality of life in patients with successful pain relief. Conclusion The study certifys that the causes of recurrent trigeminal neuralgia after MV-D were mainly arachnoid adhesion and vascular compression, followed by Teflon granuloma. MVD plus IN is a feasible therapeutic option for recurrent TN.