显微血管减压治疗椎基底动脉相关性三叉神经痛

Microvascular Decompression Treatment of Vertebrobasilar Related Trigeminal Neuralgia

目的探讨原发性三叉神经痛显微血管减压(microvascular decompression,MVD)术中对以椎基底动脉为责任血管或主要责任血管的处理方法。方法回顾性分析2008年10月~2016年6月我院28例以椎基底动脉为责任血管或主要责任血管的原发性三叉神经痛患者行MVD的临床资料。行MVD 25例,MVD+感觉根部分离断3例。结果 28例术后疼痛均立即消失。3例行MVD+感觉根部分离断者术侧面部麻木。随访3~24个月,平均18.6月,无复发。结论对于以椎基底动脉为责任血管或主要责任血管的原发性三叉神经痛,MVD术中充分神经减压并恢复神经的自然走行是术后疗效的保证,对于张力大、无法一次性推移的血管,可以采用多点减压的方法完成。

Objective To summarize the microvascular decompression（ MVD） surgery of vertebrobasilar blood vessel for primary trigeminal neuralgia patients. Methods Clinical data of 28 primary trigeminal neuralgia patients caused by vertebrobasilar blood vessel from October 2008 to June 2016 in our hospital were retrospectively analyzed. There were 25 patients receving MVD and 3patients receiving MVD and trigeminal sensory-root partial rhizotomy. Results The neuralgia in all the 28 patients immediately disappeared after surgery. Facial hypesthesia on the operation side occurred in 3 patients receiving MVD and trigeminal sensory-root partial rhizotomy. During follow-ups for 3-24 months（ mean,18. 6 months）, none of the trigeminal neuralgia relapsed.Conclusions For primary trigeminal neuralgia patients caused by vertebrobasilar blood vessel,adequate nerve decompression and restoration of normal nerve anatomy are the guarantee for the efficacy of MVD surgery. For vessels with tensions and can not be passaged by one-time,multi-point decompression can complete the surgery.