高龄老人原发性三叉神经痛的特点及治疗策略

Characteristics and Treatment Strategy of Idiopathic Trigeminal Neuralgia in Older People

目的探讨高龄老人原发性三叉神经痛的特点及治疗策略。方法整群选取苏州九龙医院神经外科自2006年3月—2014年6月收治的20例高龄老人患者临床特点进行回观性分析,并且采取相应的治疗策略,术中全部患者分离粘连蛛网膜,行微血管减压术联合感觉根部分切断术进行治疗15例,仅进行微血管减压术5例。结果术后症状完全消失者15例,5例明显减轻。术后面部麻木5例,伤口局部皮下积液2例,伤口脑脊液漏1例,肺部感染1例,小脑肿胀1例,听力下降者1例,病毒性疱疹4例。予以相关治疗后好转。随访5~36个月,无复发病例,面部麻木患者生活不受影响。结论应用三叉神经微血管减压术联合感觉根部分切断术方案,充分分离蛛网膜粘连,三叉神经入脑干连接处(REZ区)充分减压,对改善患者预后起到决定性作用。

Objective To explore the characteristics and treatment strategy of idiopathic trigeminal neuralgia in older people.Methods The clinical characteristics of idiopathic trigeminal neuralgia in 20 older people admitted in Department of Neurosurgery,Suzhou Kowloon Hospital from March 2006 to June 2014 were observed and corresponding treatment strategy was given to the patients. The adhesion in arachnoid was separated in all the patients during surgery. 15 cases underwent microvascular decompression combined with sensory root partial amputation, only 5 cases underwent microvascular decompression. Results After surgery,the symptoms disappeared completely in 15 cases, markedly alleviated in 5 cases. After surgery, 5 cases had facial numbness, 2cases had wound subcutaneous effusion, 1 case had wound cerebrospinal fluid leakage, 1 case had pulmonary infection, 1 case had cerebellar swelling, 1 case had hearing loss, 4 cases had viral herpes. All the patients improved after corresponding treatment. All the patients were followed up for 5 months to 36 months, and the result showed that no recurrent cases, and the life of patients with facial numbness is not affected. Conclusion Application of microvascular decompression combined with sensory root partial amputation, fully separated arachnoid adhesion, REZ full decompression, are the key to improving the prognosis of patients.