围套式显微血管减压术治疗三叉神经痛912例

MICROVASCULAR DECOMPRESSION WITH AN ENCIRCLING METHOD FOR TRIGEMINAL NEURALGIA IN 912 CASES

目的 :总结 19年以来采用围套式显微血管减压术治疗 912例三叉神经痛的经验教训。方法 :耳后横切口 ,开骨窗 ,切开硬脑膜。牵开小脑半球 ,找到岩静脉后电凝并切断。根据三叉神经与“责任血管”的关系 ,分为贯穿型与非贯穿型。非贯穿型的病人 ,动脉或较粗的静脉要使之与三叉神经分开 ,细小静脉则分开后电凝并切除与三叉神经并行的部分。最后进行神经血管减压。将减压材料自血管与神经之间插入并包绕三叉神经一周后前后两断端对合 ,以两银夹固定 ,这称为“围套式减压” ;贯穿型病人 ,尽可能将血管推向三叉神经远端 ,再行“围套式减压”。结果 :术后当日止痛90 2例 (98.90 % )。得到随访者 80 7例 (88.4 9% ) ,远期复发 2 0例 (2 .4 8% ) ,随访时间 0 .5～ 18年 ,平均 6 .5年。结论 :“围套式减压”可避免减压材料的滑脱、吸收 ,或新生血管重新压迫 ,还易于发现被神经根挡住的“责任血管” ,疗效好 ,远期复发率低。

Objective: To summarize the experience and lessons learned from 912 cases of trigeminal neuralgia treated by microvascular decompression with an encircling method for 19 years. Methods: A small transverse incision was made behind the ear, then a bony window was open and the dura mater cut off. The cerebellar hemisphere was retracted, and then electrocoagulate and sever the petrosal vein after the vein was found. According to the relations of the trigeminal nerves and the 'responsible vessels', the disease can be grouped into two types: the transfixing type and the non transfixing type. For the non transfixing type, arteries and large veins should be separated from the trigeminal nerve, and small veins be separated and electrocoagulated, and the vessels parallel with the nerve should be excised. Finally, the neurovascular decompression was carried out with an encircling method. The decompression material was inserted between the vessel and the initial segment of the nerve root and fixed with silver clip after wrapping the nerve root. It was called 'microvascular decompression with an encircling method'. For the patient with a transfixing type, the vessel should be pushed to the distal part of the nerve and then to carry through the 'microvascular decompression with an encircling method'. Results: Pain relieved immediately after operation in 902 cases (98.90%). 807 cases (88.45%) were followed up with an average of 6.5 years (0.5 to 18 years), with a recurrence rate of 2.48% (20 cases). Conclusion: Microvascular decompression with an encircling method could avoid the surge and/or absorbing of the microvascular decompression material, or the recompression of a renascence vessel, and could more easily find the 'responsible vessels' which was usually hidden behind the root of the trigeminal nerve. Therefore, the curative effect was good and the recurrence rate was low.