三叉神经痛病因及治疗的探讨

The pathogeny and treatment of trigeminal neuralgia

目的:探讨三叉神经痛的病因,研究三叉神经痛的手术治疗原理及方法。方法:观察了30例成人脑标本三叉神经与周围血管的显微解剖关系。对80例三叉神经痛患者行乙状窦后进路桥小脑角探查术。其中62例行三叉神经感觉根部分切断术,18例行三叉神经感觉根梳理术。结果:解剖发现60侧三叉神经中有33根神经共39次与动脉接触,神经接触率为55%。80例手术中发现43例有动脉压迫三叉神经,13例三叉神经周围蛛网膜粘连,6例未发现异常。手术止痛效果肯定,随访3～6年未复发。结论:血管压迫是三叉神经痛的病因,但不是唯一原因。三叉神经显微血管减压术有一定的局限性,三叉神经感觉根部分切断术并发症较多,三叉神经感觉根梳理术须进一步研究。因此,对不同的病人要选择不同的手术方法以达到最佳疗效。

Objective:To find out the etiopathogenesis of trigeminal neuralgia,and research the principles and methods of surgical treatment.Methods :The micro-surgical relationships between trigeminal nerve and adjacent vessels were examined in30adult cadavers.Eighty cases of trigeminal neuralgia were treated through posterior fossa mi crosurgery,sixty-two of which received partial retrogasserian rhizotomy and eighteen by retrogasserian combing.Results:33out of the60trigeminal nerves in30adult ca davers were observed to have been in touch with arteries for39times,accounting for55%of the cases.In80operation s,43trigeminal nerves were found to be compressed or distorted by the arteries.All the cases were cured through the operations.Conclusion:Vascular compression is a cause of trigeminal neuralgia,but not the only one.The paper pointed out the im portance of se lecting suitable treatment for the patient individually.