三叉神经微血管减压术中静脉压迫的处理策略

Surgical nanagement of venous compression in trigeminal nerve microvascular decompression

目的探讨采用三叉神经微血管减压术(microvascular decompression,MVD)治疗原发性三叉神经痛(primary trigeminal neuralgia,PTN)术中处理静脉压迫的策略。方法回顾分析57例原发性三叉神经痛患者的临床资料。所有患者均在术中发现静脉压迫,对比分析术中情况与术后疗效。结果所有责任静脉均为岩静脉属支,24例患者(42. 1%)为单纯静脉压迫,33例患者(57. 9%)为动静脉混合压迫。术后,55例患者(95. 5%)疼痛完全消失或明显减轻,2例患者(4. 5%)无改善;其中3例患者(5. 4%)出现复发;总有效率为91. 2%。术中保留责任静脉者42例,其中术后发生小脑水肿者3例(7. 1%);切断责任静脉者15例,术后发生小脑水肿者5例(33. 3%);两者的差异有统计学意义(P <0. 05)。结论三叉神经微血管减压术是治疗原发性三叉神经痛有效途径之一,合理处理术中静脉压迫有助于提高手术的效果。

Objective To explore the surgical strategy of treating venous compression in trigeminal nerve microvascular decompression （ MVD ） for primary trigeminal neuralgia （ PTN ）. Method The clinical data of 57 patients with PTN who were found venous compression intraoperatively were analyzed retrospectively, intraoperative findings and postoperative efficacy were also analyzed comparatively. Results All the responsible veins were branches of the petrosal veins. 24 （42.1%） were simple venous compression, and 33 （57.9%） were mixed arteriovenous compression. 55 （95.5% ） patients obtained complete remission or significant reduction and 2 （4.5%） had no improvement after operation. During 5 years follow-up,3 （5.4%） cases were recurrence. Total effective rate was 91.2%. 42 responsible veins were preserved, and 3 （7. 1% ） ocurred postoperative cerebellar edema. 15 responsible veins were cut off, and 5 （33.3%） ocurred postoperative cerebellar edema. The difference was statistically significant （P 〈 0.05 ）. Conclusion MVD is one of effective treatment metheds for PTN. Reasonable surgical management of venous compression contributes to the improvement of sugical quality.