三叉神经痛微血管减压术的手术体会

目的探讨三叉神经痛微血管减压（MVD）术的疗效与责任血管的解剖特点。方法回顾性分析25例接受三叉神经痛MVD术患者的临床资料及手术体会。结果术中见21例三叉神经根部有接触或压迫的血管，占84％，最常见的责任血管是小脑上动脉，共13例（52％），其次为小脑前下动脉，共6例（24％）。动脉性责任血管占76％，岩上静脉作为责任血管2例（8％）；附近无任何血管压迫但术中发现三叉神经覆盖的蛛网膜明显增厚者4例占16％。手术治愈率为96％。结论MVD是治疗三叉神经痛安全、微创、有效的方法。提高显微外科操作技巧，不遗漏责任血管，是提高手术疗效和减少并发症的关键。

Surgery experience in microvascular decompression for trigeminal neuralgia

Objective To explore the efficacy of microvascular decompression （MVD）on trigeminal neuralgia and the anatomical characteristics of the responsible blood vessels. Methods The clinical data of 25 patients with idiopathic trigemine neuralgia（ITN） undergoing MVD were analyzed retrospectively. The origins of the responsible blood vessels and sites of compression at the trigeminal root were observed and determined. Meanwhile,the anatomical characteristics of the responsible blood vessels and the efficacy of MVD were investigated. Results The offending vessels which were responsible for ITN were identified at root exit zone （REZ） in 21 cases （84%）. The most common responsible vessel was the superior cerebellar artery in 13 cases （52%） ,followed by anterior inferior cerebellar artery in 6 cases （24%）. Seventy six percent of the offending vessels were arteries and 8% were rock vein. No vascular compression but evident increase in the＇thickness of arachnoid mater covered by the trigeminal nerve was observed in 4 cases （ 16% ）. All patients were relieved for the acute pain and the overall cure rate was 96%. Conclusion MVD is a safe, microinvasive and effective surgical modality for ITN. The key for better outcomes and less complications of MVD is to improve microsurgical techniques and deal with all the involved vessels.