微血管减压术治疗椎-基底动脉延长扩张症致三叉神经痛患者的效果分析

Effect analysis of microvascular decompression for patients with trigeminal neuralgia caused by vertebrobasilar dolichoectasia

目的初步探讨微血管减压术治疗椎-基底动脉延长扩张症(VBD)导致三叉神经痛患者的安全性和有效性。方法回顾性连续纳入2013年1月至2016年8月在首都医科大学宣武医院神经外科收治由VBD导致的三叉神经痛患者16例。所有患者术前接受MR血管成像检查,明确三叉神经与周围血管的解剖关系。采用枕下乙状窦后入路行微血管减压术,术后随访12~52个月。采用巴罗神经学研究所三叉神经痛评分(BNI)标准,评价患者的术前、术后及随访期间的疼痛程度。结果 16例患者中,15例术后即刻疼痛消失,BNI疼痛分级为Ⅰ级;1例术后疼痛无明显缓解,术后半年疼痛逐渐消失;1例术后听力较术前下降。随访时间为12~52个月,有3例分别于术后6、12、36个月疼痛复发,经射频治疗后疼痛消失。结论微血管减压术治疗VBD导致的三叉神经痛具有较好的安全性和手术疗效,但有一定疼痛复发率,其原因有待进一步研究。

Objective To preliminarily discuss the safety and efficacy of microvascular decompression for patients with trigeminal neuralgia caused by vertebrobasilar dolichoectasia（VBD）. Methods From January 2013 to August 2016,16 patients with trigeminal neuralgia caused by vertebrobasilar dolichoectasia admitted to the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively. All patients received preoperative magnetic resonance angiography examination. The anatomical relationship between the trigeminal nerves and the peripheral vessels was identified. Microvascular decompression was conducted via suboccipital retrosigmoid approach. They were followed up for 12-52 months after procedure.The trigeminal neuralgia score standard of Barrow Neurological Institute was used to evaluate the degree of pain of the patients before procedure,after procedure,and during the follow-up period. Results Of the 16 patients,the pain disappeared immediately in 15 after procedure,and the pain was not obviously relieved in 1 case after procedure,and the pain disappeared gradually at 6 months after procedure. One patient had hearing loss after operation compared with pre-operation. The follow-up time ranged from 12 months to 52 months. Three patients had recurrent pain at 6,12,and 36 m onths,respectively after procedure.C onclusion M icrovascular decompression treatment of trigeminal neuralgia caused by VBD has better safety and surgical efficacy,but there was a certain pain recurrence rate,which needed further research.