继发性三叉神经痛诊疗策略

Diagnostic and therapeutic strategies for secondary trigeminal neuralgia

目的探讨继发性三叉神经痛的诊断及治疗策略。方法回顾使分析北京大学人民医院神经外科2017年1月至2022年3月临床收治的继发性三叉神经痛患者,共34例,并参考相关文献。结果34例继发性三叉神经痛病例均由占位性病变引起,所有患者均接受手术治疗,31例肿瘤完全切除,3例部分切除,其中10例术中发现血管压迫三叉神经,行三叉神经微血管减压术。术后33例患者的疼痛症状消失,1例患者明显减轻。结论相应CPA区占位性病变是继发性三叉神经痛的首要病因,原发性因素可同时存在,头颅CT及MRI检查必不可少,手术是治疗继发性三叉神经痛的首选治疗手段。术中切除肿瘤后,应注意是否存在血管压迫神经情况,做到三叉神经充分减压。

Objective To explore the diagnostic and therapeutic strategies for secondary trigeminal neuralgia(STN).Methods The clinical data of 34 STN cases admitted to our hospital from January 2017 to March 2022 were retrospectively analyzed in combination with the relevant literature.Results All the 34 cases of STN were caused by space-occupying lesions.All patients received surgical treatment;total excision was achieved in 31 cases,and subtotal excision achieved in 3.Ten cases were found with vascular compression of the trigeminal nerve during operation and underwent microvascular decompression.Postoperatively,pain disappeared in 33 cases and was significantly relieved in 1.Conclusions Space-occupying lesions in the CPA area is the primary cause of STN,and classic trigeminal neuralgia may coexist.CT and MRI of the head are essential for STN diagnosis.Surgery is the first choice of treatment for STN.Attention should be paid to vascular compression intraoperatively.