三叉神经痛微血管减压术中对非单纯动脉压迫因素处理的临床分析

Clinical analysis on management of not purely arterial compression factors in treatment of trigeminal neuralgia with MVD

目的探讨三叉神经痛(TN)微血管减压(MVD)术中对非单纯动脉压迫因素的处理方式及其临床疗效。方法回顾性分析69例非单纯动脉压迫致三叉神经痛行MVD术患者的临床资料。其中责任血管为小脑上/前下动脉及其分支合并岩静脉压迫的患者34例,单纯静脉压迫患者17例,椎-基底动脉扩张延长症合并分支血管压迫患者10例,无责任血管压迫者8例;老年(大于60岁)患者18例(其中动静脉合并压迫者8例、单纯静脉压迫7例、无责任血管压迫3例),老年患者除常规MVD术外,另再增加三叉神经根部选择性部分切除(PR)术。术后对所有患者进行长期随访,采用Brisman的标准进行疗效评估。结果本组患者的术后疗效,治愈60例(87%),显效7例(10.1%),有效1例(1.4%),无效1例(1.4%);总有效率为98.6%(68/69)。18例老年患者另加行三叉神经感觉根部分离断术(PSR)后,疗效显著。术后5例患者发生神经损伤并发症,其中咀嚼无力2例、复视1例、耳鸣1例、听力下降1例;随访6~52个月(平均30个月),患者经药物和功能康复治疗均恢复。结论三叉神经痛的致病因素已不再仅是单纯的动脉压迫。对非单纯动脉压迫因素导致的三叉神经痛患者行MVD术,通过术中仔细探索责任血管或无责任血管的其他因素,行有效减压,同时对老年(>60岁)患者增加选择性PR的外科策略,术后疗效显著,未增加并发症的风险,值得在临床推广应用。

Objective To investigate the treatment of not purely arterial compression factors in microvascular decompression(MVD)of trigeminal neuralgia(TN)and its clinical efficacy.Methods The clinical data of 69 patients with TN caused by not purely arterial compression who underwent MVD were analyzed retrospectively.There were 34 patients with superior/anterior inferior cerebellar artery and its branches combined with petrous vein compression,17 with simple venous compression,10 with vertebrobasilar artery dilation and elongation combined with branch vascular compression,and 8 without vascular compression.There were 18 elderly patients(over 60 years old),including 8 of arteriovenous compression,7 of simple venous compression and 3 of irresponsible vascular compression.In addition to conventional MVD,selective partial resection(PR)of trigeminal nerve root was added in elderly patients.All patients were followed up for a long time after operation,and the curative effect was evaluated according to Brisman’s standard.Results In this group,60(87%)were cured,7(10.1%)were markedly effective,1(1.4%)was effective and 1(1.4%)was ineffective.The total effective rate was 98.6%(68/69).18 of elderly patients with additional trigeminal sensory root separation(PSR),the effect was significant.Postoperative complications of nerve injury occurred in 5 patients,including 2 cases of masticatory weakness,1 case of diplopia,1 case of tinnitus and 1 case of hearing loss.The patients were followed up for 6-52 months(average 30 months),and recovered after medication and functional rehabilitation.Conclusions The etiological factor of TN is no longer simply arterial compression.MVD was performed in patients with trigeminal neuralgia caused by non simple artery compression factors.Through careful exploration of other factors of responsible or non responsible vessels,effective decompression was performed.At the same time,selective PR was added to elderly patients(>60 years old).The postoperative effect is significant,and the risk of complications is not increased.It is worthy of clinical application.