三叉神经痛微血管减压术中岩静脉的处理

目的总结三叉神经痛微血管减压术中岩静脉的处理经验。方法回顾性分析207例行微血管减压术治疗的三叉神经痛病人的临床资料。根据岩静脉与手术入路的关系,将其分成4种情况：①岩静脉不阻挡入路;②岩静脉的主干阻挡入路;③岩静脉的属支阻挡入路;④岩静脉为责任血管。根据4组不同情况,总结处理方法。结果手术有效率为99.03%;平均随访25个月,复发率4.89%。岩静脉不阻挡入路82例;岩静脉主干阻挡入路28例,予以切断5例（2.42%）;属支阻挡入路62例,予以切断1～3支30例（14.49%）;岩静脉压迫三叉神经35例（16.91%）,均电凝后切断。术后发生严重并发症1例（0.48%）,无死亡病例。结论岩静脉的处理是三叉神经痛微血管减压术中重要的操作环节,是保障手术成功的基础。

Maliagement of Superior petrossl vein in microvascular decompression for trigeminall neuralgia

Objective To review the treatment experience of the superior petrosal vein in microvascular decompression for trigeminal neuralgia. Methods The clinical data on treatment of the superior petrosal veins in 207 trigeminal neuralgia patients undergoing microvascular decompression. According to the relationship between the superior petrosal vein and surgical approach, the patients were divided into four groups： the group without the vein as a barrier in the approach, the group with the trunk of the vein in the approach, the group with branches of the vein in the approach, and the group in which the superior petrosal vein was the vessel responsible for trigeminal neuralgia. The treatment methods used in the 4 groups were summarized. Results The surgical efficacy rate for patients with trigeminal neuralgia was 99.03%. Follow-up was made for an average of 25 months with a recurrence rate of4.89%. In 82 patients, the surgical approach or field had no obstruction from the superior petrosal vein during the operation. In 28 patients, the surgical approach or field was obstructed by the trunk of the superior petrosal veins, and which should be cut in 5 cases （2.42%）. The surgical approach or field was obstructed by the branches of the superior petrosal veins in 62 patients, and 1 to 3 branches was cut in 30 cases （14.49%）. Trigeminal nerve compression by the superior petrosal vein was observed in 35 patients （16.91%） and all the veins were coagulated and cut. Server complication was observed in 1 case （0.48%）. No death occurred in the group. Conclusion The treatment of the superior petrosal vein is a very important step in microvascular decompression for trigeminal neuralgia and also a basis on which the surgical success can be achieved.