显微血管减压术中单纯应用涤纶垫棉治疗基底动脉压迫所致三叉神经痛的临床疗效

Efficacy analysis of microvascular decompression for trigeminal neuralgia caused by basilar artery with only polyester materials

目的初步探讨显微血管减压术中单纯应用涤纶垫棉治疗基底动脉压迫所致三叉神经痛的临床疗效。方法回顾性分析2012年1月至2019年12月陆军军医大学大坪医院神经外科收治的31例基底动脉压迫引发三叉神经痛患者的临床资料。31例患者在显微血管减压术中均单纯使用涤纶垫棉作为减压材料,且未使用其他减压方式。手术采用经乙状窦后入路,于脑干和责任动脉之间放置涤纶垫棉实现减压。采用巴罗神经学研究所(BNI)提出的疼痛分级评估手术效果。结果31例三叉神经痛患者中,27例(87.1%)术后疼痛即刻完全缓解(BNI分级Ⅰ级),3例在术后3个月内完全缓解(BNI分级Ⅰ级),1例疼痛部分缓解(BNI分级Ⅲ级)。5例(16.1%)患者术后出现面部感觉减退,其中3例自愈;1例患者出现渐进性听力下降。31例患者的随访时间为6~85个月(中位时间为40个月),随访期间有4例(12.9%)复发(BNI分级Ⅳ~Ⅴ级),其中2例再次接受手术治疗,另外2例采用立体定向放射治疗配合药物治疗可部分控制面部疼痛。结论显微血管减压术中单纯应用涤纶垫棉治疗基底动脉所致三叉神经痛的术后即刻效果显著,但其复发率及并发症的发生率较高。

Objective To investigate the clinical effect of microvascular decompression(MVD)with polyester pad in the treatment of trigeminal neuralgia(TN)caused by basilar artery(BA).Methods A retrospective analysis was conducted on the clinical data of 31 patients with TN caused by BA who were admitted to Department of Neurosurgery,Daping Hospital,Army Military Medical University from January 2012 to December 2019.All 31 patients were treated with polyester as the only decompression material during MVD,and no other decompression methods were used.The posterior sigmoid approach was used for MVD to place pads between the brain stem and the offending artery.Surgical outcomes were assessed using the Barrow Neurological Institute(BNI)pain scale.Results Of 31 patients,complete pain remission immediately post operation(BNI classⅠ)was reported in 27(87.1%),complete pain remission within 3 months post surgery(BNI classⅠ)in 3,and partial pain relief(BNI classⅢ)in 1.Five patients(16.1%)developed facial hypoesthesia after surgery,and 3 of them recovered later.One patient presented with progressive hearing loss.The 31 patients were followed up for 6 to 85 months(median:40 months),and recurrence(BNI classⅣ-Ⅴ)was reported in 4(12.9%)patients during follow-up,of which 2 underwent a second surgery and the other 2 cases were treated with stereotactic radiotherapy combined with medication resulting in partial control of facial pain.Conclusion Microvascular decompression with polyester pad alone for TN caused by BA is associated with significant effect immediately post operation,while the recurrence rate and incidence of complications may be high.