三叉神经痛近、远颅端患支神经的电镜观察

目的　研究三叉神经痛患者不同节段末梢神经的超微结构变化 ,探讨三叉神经痛手术治疗效果 　 方法　术中切取 6例三叉神经痛患者的下齿槽神经 (近颅端 )和颏神经 (远颅端 ) ,2 %戊二醛固定 ,1%锇酸后固定 ,环氧树脂包埋 ,制作超薄切片 ,并以醋酸双氧铀、枸橼酸铅双重染色 ,在电镜下比较其脱髓鞘程度。结果　三叉神经痛患者的近颅端神经和远颅端神经均有病理改变 ,有髓神经纤维结构紊乱、髓鞘松解 ,出现脱髓鞘变 ,雪旺氏细胞胞浆内有脂滴沉积、髓鞘碎片 ,近颅端神经的脱髓鞘变的程度比远颅端的神经稍轻。结论　神经脱髓鞘变与三叉神经痛发病有关 ,手术治疗时尽量在高位切除可减少复发

ELECTRON MICROSCOPIC OBSERVATION ON PERIPHERAL BRANCHES BEING PROXIMAL OR BEING DISTAL TO CRANIAL CAVITY OF TRIGEMINAL NEURALGIA

Objective To study the ultrastructure of peripheral branches in different section of trigeminal neuralgia, discussing the operational effect of trigeminal neuralgia. Methods Specimens of the affected inferior alveolar nerve branches and chin nerve branches from 6 patients suffering from trigeminal neuralgia during operation, fixed in 2% glutaraldehyde, postfixed in 1% osmium tetroxide, dehydrated through graded alchols, and then embedded in spurr resin. Ultrathin sections were stained with both lead citrate and uranyl acetate, then examined under the election microscope. Results Pathologic changes were found in all specimens. Myelin sheath of the myelinated fibers presented disorganization, loosening up of the lamellae, and demyelination in some area. Myelin sheath fragments, lipid deposit were seen in the Schwann's cell cytoplasm. The pathologic change of the branches of cranial cavity proximal was a little slight then those distal to cranial cavity. Conclusion Demyelination of peripheral branches is closely related to trigeminal neuralgia. Rhizotomy of trigeminal nerve should be cut in the higher lever so as to remove more degenerative nervous tissue and reduce recurrence.