微血管减压及感觉根梳理术治疗三叉神经痛

目的综合评价乙状窦后径路三叉神经微血管减压梳理术治疗原发性三叉神经痛的近远期疗效及手术风险。方法随访分析经三叉神经微血管减压梳理术治疗的原发性三叉神经痛138例患者临床资料，随访时间3-58个月。结果术后总体有效率98．6％。术后25个月累积有效率降至91．4％，术后33-58个月为85．8％。结合术后累积风险函数图，提示本组复发病例多集中于术后2年内。术后患侧面部轻、中度浅感觉障碍分别占63．8％（60／94例）和19．1％（18／94例）。3-58个月后改善明显（P〈0．01）：20例（21．3％）面部浅感觉恢复正常，38例（40．4％）轻度感觉障碍，11例（11．7％）中度感觉障碍，无重度感觉障碍发生。术后ISl周疱疹、脑脊液漏、高颅压头痛发生率分别为26．09％（36／138例）、2．9％（4／138例）、2．2％（3／138例），死亡率1．4％（2／138例）。结论三叉神经显微血管减压感觉根梳理术临床适应证广泛，对神经损伤小，临床疗效满意，但手术风险不容忽视。

Surgical treatment of trigeminal neuralgia with microvascular decompression sensory root of trigeminal nerve combing

OBJECTIVE: To evaluate the short-term and long-term curative effect of microvascular decompression sensory root of trigeminal nerve combing (MVD + SRTNC) by post-sigmoid approach as well as the complications in these operations. METHODS: The data from 138 idiopathetic trigeminal neuralgia (TN) patients treated with MVD + STRNC that followed up 33 months to 58 months was analyzed. RESULTS: Immediate relief from pain occurred in 136 patients (98.6%). On Kaplan-Meier analysis, cumulative proportion effectiveness at the end of 25 months decreased to 91.4%, and 85.8% from 49 months to 58 months. There were cases of 63.83% and 19.15% with slight and midrange hypoesthesia after surgery but majority recovered at the end of 3-58 months (P < 0.01). No serious hypoesthesia occurred. The complications including leakage of cerebrospinal fluid, herpes and headache caused by high intracranial pressure, were observed in 4 cases (2.90%), 36 cases (26.09%) and 3 cases (2.17%), respectively. Two cases (1.43%) died of cerebral hemorrhage. CONCLUSIONS: The proposed surgical strategy of standard MVD plus sensory root of trigeminalnerve combing was a good strategy option for TN, but It was important for surgeons to think highly of the risks of the surgery.