褐色斑点型三叉神经痛行显微血管减压术及改良术式的疗效比较

Observati on of the curative effect of MVD and its modified operation on trigeminal neuralgia with brown spots of nerve root

目的探讨三叉神经根部有褐色斑点的三叉神经痛亚组患者的疾病特异性,采用"显微血管减压术(MVD)+三叉神经感觉根大部分切断术"相比传统的"单纯MVD术"是否可更有效降低三叉神经痛的复发率。方法选取符合国际头痛学分类委员会确定的原发性TN诊断标准并且在常规MVD手术显微镜下可见三叉神经根伴有褐色斑点的患者,随机分为观察组和对照组。观察组患者采用"MVD+三叉神经感觉根大部分切断或梳理术",而对照组采用"单纯MVD术"。统计分析三叉神经根有褐色斑点的2组患者的疗效差异。结果观察组中的患者共16例,经过"MVD联合术中三叉神经根感觉支大部分切断术或梳理术"治疗,患者的三叉神经痛在术后均立即得到缓解,2年内复发的有2例,复发率12.5%。对照组患者总共14例,经单纯的MVD手术治疗,即时有效的14例,2年内复发的12例,复发率高达85.7%。结论三叉神经根部有褐色斑点的患者仅予MVD治疗,其复发率高,行"MVD+三叉神经感觉根大部分切断术或梳理术"可明显减少三叉神经痛的术后复发率,疗效确切,且安全性高。

Objective To investigate the trigeminal neuralgia trigeminal nerve root brown spot disease specific subgroups of patients,with microvascular decompression（MVD） ＋ of trigeminal nerve sensory root rhizotomy compared to traditional ＂pure MVD＂ is more effective in reducing the rate of recurrence of trigeminal neuralgia.Methods According to the International Headache Classification Committee to determine the primary trigeminal neuralgia diagnostic criteria and see with brown spots of trigeminal nerve root in the conventional MVD microscope were randomly divided into observation group and control group.Patients in the observation group were treated with ＂MVD ＋ trigeminal sensory root cutting or carding＂,while the control group was treated with simple MVD ＂.The difference in efficacy between the 2 groups of patients with brown spots on the trigeminal nerve roots was statistically analyzed.Results The observation group of patients with a total of 16 cases after trigeminal nerve root combined with intraoperative MVD branch amputation or feel most combing for the treatment of patients with trigeminal neuralgia after operation were immediately relieved within 2 years,2 cases relapse,the recurrence rate was 12.5%.A total of 14 patients in the control group were treated with simple MVD surgery,14 cases were immediate effective,12 cases relapsed within 2 years,and the recurrence rate was 85.7%.Conclusion Trigeminal nerve root brown spots patients only received MVD treatment,the recurrence rate is high and the effect of ＂MVD＋ of trigeminal nerve sensory root rhizotomy or most combing for trigeminal neuralgia＂ can significantly reduce the postoperative recurrence rate,accurate,and high safety.