显微神经外科手术治疗高龄三叉神经痛病例的术式选择

目的探讨显微神经外科手术治疗高龄三叉神经痛病例的术式选择.方法对54例高龄三叉神经痛病例按选用术式不同分为3组:A组37例,行单纯三叉神经显微血管减压术(MVD);B组5例,术中未发现血管压迫,行三叉神经感觉根部分切断术(PR);C组12例,压迫血管不明确,均在MVD后加行PR.结果平均随访51个月.A组总有效率86.5%,复发率10.8%,无效率2.7%;4例复发病例中2例再次行PR治愈.B、C组总有效率100%,无复发.并发症:行PR者术后均有面部麻木,随访期间均见不同程度好转;术后发生听力障碍1例,复视1例,无菌性脑膜炎1例.结论高龄三叉神经痛病人行显微神经外科手术治疗的术式选择应根据术中探查的实际情况而定.

Microsurgical treatment of elder patients with trigeminal neuralgia

Objective To study the microsurgical treatment of elder patients with trigeminal neuralgia. Methods 54 cases of elder patients with trigeminal neuralgia were treated by microsurgical operations and were divided into 3 groups: 37 cases (group A) were treated by microvascular decompression (MVD); there was no compressing vessel in 5 cases (group B) and partial rhizotomy (PR) of sensory root of trigeminal nerve was performed; there was no obvious compressing vessels in 12 cases (group C) then MVD and PR were performed. Results All cases were followed up for about 51 months (mean duration). The total effective rate of group A was 86.5%, the recurrent rate was 10.8%, and the non-effective rate was 2.7 %. PR was performed in 2 of 4 recurrent cases and the effects were good. Total effective rate of group B and C was 100%. There was no recurrent case in-group B or C. The complications included: facial anaesthesia was found in all cases with PR; 1 case of auditory dysfunction; 1 case of diplopia and 1 case of non-bacterial meningitis. Conclusion The method of microsurgical treatment of elder patients with trigeminal neuralgia depends on the exploration results during operations. Decreasing the recurrent and non-effective rate is the key to avoid secondary operation for elder patients.