微血管减压术治疗原发性三叉神经痛

目的提出微血管减压术是治疗原发性三叉神经痛的最佳手术方式。方法报告了12例原发性三叉神经痛患者行微血管减压术,其中11例发现三叉神经入脑干区动脉压迫神经根,将压迫血管与神经根分离,在其间植入纤维蛋白海绵或聚四氟乙烯片维持分离状态,术后除1例疼痛减轻外,其余疼痛完全缓解,另1例术中未发现责任血管,但在神经根远侧段发现有粘连,将粘连松解,使神经根游离。结果所有患者术后疼痛减轻或缓解,所有病例无并发症。结论微血管减压术治疗原发性三叉神经痛是去除病因的手术方式,对已行微血管减压术后复发的患者再次行微血管减压术亦可获得满意疗效,作者还认为,神经内镜辅助微血管减压术顺应了当今微侵袭外科的趋势,将有望被更多地用来治疗原发性三叉神经痛。     

显微血管减压治疗三叉神经痛复发因素探讨(附24例报告)

报告２４例显微血管减压（ＭＶＤ）后复发的三叉神经痛（ＴＮ）患者,分析其复杂的原因主要是：①责任血管错认、漏认;②减压材料选择或使用不当;③“新生”的责任血管;④减压区的炎症反应。首次提出对于术中未发现责任血管及三叉神经远端有血管压迫的患者,也应行三叉神经人脑区（ＲＥＺ）围套式减压或ＭＶＤ。     

三叉神经痛微血管减压术的手术疗效分析

目的探讨微血管减压术（MVD）治疗原发性三叉神经痛（ITN）的手术疗效，总结不同类型责任血管的处理技巧。方法回顾性分析125例接受MVD的ITN的临床资料。对手术操作的要点进行介绍。结果术中见124例三叉神经根部有接触或压迫的血管，占99．2％，最常见的责任血管是小脑上动脉（SCA，占68％）其次为小脑前下动脉（AICA，占30．4％）。动脉性责任血管占96．8％，岩上静脉作为责任血管占8．8％。所有病例均有效（100％），总治愈率为96．8％。结论微血管减压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。     

提高颅神经显微血管减压术疗效的临床研究(附1950例报告)

目的探讨微血管减压术治疗三叉神经痛、面肌痉挛、舌咽神经痛方法的改进措施和提高治疗效果的临床经验.方法自1984年12月至2004年6月采用微血管减压术治疗1950例颅神经血管压迫综合征病例,其中三叉神经痛1 515例,面肌痉挛400例,舌咽神经痛35例.结果全部病例术中均发现有明确的压迫血管,总有效1 886例,有效率为96.7%,无死亡病例.由于显微外科技术的应用及手术技巧的提高,并发症发生率由8年前的10.55%下降到近8年的2.88%.结论显微血管减压术是三叉神经痛、面肌痉挛和舌咽神经痛最有效的治疗方法.术中颅神经根部的显露、责任血管的识别及减压材料的放置等是影响手术效果的关键.提高微血管减压术的治愈率、减少并发症及复发率有多方面因素值得考虑.     

显微血管减压及神经松解手术治疗颅神经疾病1956例

目的 探讨显微血管减压及神经松解手术治疗颅神经疾病的方法及经验。方法 总结自1986至2005年12月以来局麻下共实施显微血管减压及神经松解手术治疗颅神经疾病1956例，其中三叉神经痛1465例，面肌痉挛428例，舌咽神经痛63例。患者平均年龄62．5岁，病史3至37年不等。介绍了显微血管减压及神经松解手术技巧及术中寻找责任血管及部分神经根切断的注意事项。结果 手术确定了1462例三叉神经痛、428例面肌痉挛和51例舌咽神经痛患者的压迫责任血管，并以teflon垫棉置于其间；对1876例局部蛛网膜和颅神经间的粘连行神经松解手术；对45例行神经根部分切断。手术效果满意。术后总有效率100％。31例复发，其中23例行二次手术治疗后病愈。结论 显微血管减压及神经松解手术是治疗颅神经疾病的有效手段，疗效确切。     

神经内镜经小脑绒球下入路面神经显微血管减压术治疗面肌痉挛的临床疗效

目的初步探讨神经内镜经小脑绒球下入路面神经显微血管减压术治疗面肌痉挛的临床疗效。方法回顾性分析山东大学齐鲁医院神经外科2019年6月至2021年3月收治的97例面肌痉挛患者的临床资料。97例患者术前均行影像学检查,以明确责任血管与面神经出脑干区的关系。所有患者均采用神经内镜经小脑绒球下入路面神经显微血管减压术,术中在神经电生理监测下充分解剖后组脑神经背侧的蛛网膜,从而显露面神经出脑干区,明确责任血管,并准确置入垫片。术后疗效评估分为即刻治愈、延迟治愈、复发和未治愈。结果97例患者术中发现责任血管为小脑前下动脉59例;小脑后下动脉3例;椎-基底动脉35例,其中单纯椎-基底动脉8例,椎-基底动脉联合小脑前下动脉24例,椎-基底动脉联合小脑后下动脉3例。术后即刻治愈68例(70.1%)。术后发热13例,听力减退4例,耳鸣2例,一过性面瘫5例。97例患者的术后中位随访时间为9个月(1~19个月),末次随访显示,93例(95.9%)患者的面部抽动完全消失,其中延迟治愈者25例;未治愈者4例;无复发病例。结论神经内镜经小脑绒球下入路面神经显微血管减压术治疗面肌痉挛,不仅可以提高手术治愈率,而且可以减少术后并发症。     

神经内镜经小脑绒球下入路面神经显微血管减压术治疗面肌痉挛的临床疗效

目的初步探讨神经内镜经小脑绒球下入路面神经显微血管减压术治疗面肌痉挛的临床疗效。方法回顾性分析山东大学齐鲁医院神经外科2019年6月至2021年3月收治的97例面肌痉挛患者的临床资料。97例患者术前均行影像学检查,以明确责任血管与面神经出脑干区的关系。所有患者均采用神经内镜经小脑绒球下入路面神经显微血管减压术,术中在神经电生理监测下充分解剖后组脑神经背侧的蛛网膜,从而显露面神经出脑干区,明确责任血管,并准确置入垫片。术后疗效评估分为即刻治愈、延迟治愈、复发和未治愈。结果97例患者术中发现责任血管为小脑前下动脉59例;小脑后下动脉3例;椎-基底动脉35例,其中单纯椎-基底动脉8例,椎-基底动脉联合小脑前下动脉24例,椎-基底动脉联合小脑后下动脉3例。术后即刻治愈68例(70.1%)。术后发热13例,听力减退4例,耳鸣2例,一过性面瘫5例。97例患者的术后中位随访时间为9个月(1~19个月),末次随访显示,93例(95.9%)患者的面部抽动完全消失,其中延迟治愈者25例;未治愈者4例;无复发病例。结论神经内镜经小脑绒球下入路面神经显微血管减压术治疗面肌痉挛,不仅可以提高手术治愈率,而且可以减少术后并发症。     

Recurrence of trigeminal neuralgia due to an acquired arachnoid cyst

We present the case of a 55-year-old female with pain recurrence after microvascular decompression for trigeminal neuralgia due to development of an arachnoid cyst. Radioimaging studies were inconclusive for vascular compression but showed evidence of fifth nerve distortion. The patient underwent surgical re-exploration, and a cystic lesion of thickened arachnoid containing cerebrospinal fluid was identified and excised. Postoperatively, the patient obtained pain relief. Arachnoid cyst formation may be a possible reason for pain recurrence after microvascular decompression for trigeminal neuralgia, especially when repeat neuroimaging does not show clear evidence of fifth nerve vascular compression. Direct compression from the cyst or arterial pulsation transmission through the cyst to the nerve may be the cause of recurrence.     

磁共振断层血管成像在三叉神经痛手术治疗及其病因学研究中的作用

目的探讨磁共振断层血管成像在指导三叉神经痛手术治疗及其病因学研究中的作用。方法对84例三叉神经痛患者行颅脑MRI扫描并使用三维时间飞跃破坏性梯度回聚回波序列观察三叉神经的走行与邻近血管的关系。对其中68例行手术治疗。观察MRI结果与术中所见一致程度，并观察三叉神经痛与局部血管压迫的关系。结果MRI显示患侧血管与三叉神经接触79例．健侧12例。手术治疗的68例中MRI扫描62例阳性与手术相符，4例为较细小动脉压迫三叉神经．2例为岩静脉压迫并与蛛网膜粘连。结论三叉神经人根区血管压迫是三叉神经痛发病的主要原因，磁共振断层血管成像能够确定三叉神经痛患者的血管与神经关系，有益于三叉神经痛的病因诊断和指导手术治疗。     

微血管减压治疗三叉神经痛

目的:观察微血管减压术对三叉神经痛的治疗效果。方法:将30例患三叉神经痛的病人行微血管减压术。术中发现26例有明确压迫血管。将压迫神经的血管用小绦纶片隔开,使之距神经5mm以上,未发现明确压迫血管的4例将附着在神经表面的静脉电灼切断之,同时将三叉神经感觉根的2/3切断。结果:26例疼痛完全消失,4例疼痛明显减轻。结论:微血管减压术是治疗三叉神经痛的较为理想的方法。     

Management of different kinds of veins during microvascular decompression for trigeminal neuralgia: technique notes

Objective: During microvascular decompression surgery for trigeminal neuralgia, surgeons will encounter various kinds of veins that block the approach to or compress the trigeminal nerve. The aim of this study was to present our experience in managing different kinds of veins.

Methods: This was a retrospective study of 21 patients with trigeminal neuralgia, in whom one or more veins were encountered during surgery. The techniques used in treating 4 types of veins during microvascular decompression were assessed, and the surgical outcomes and operative complications were analysed.

Results: For the first type, large veins blocking the approach towards the root entry zone (REZ) of the trigeminal nerve were bypassed via cerebellar fissure approach. Second, veins lying on the brainstem surface and compressing the REZ were detached using a gelatin-assisted dissecting technique and then interposed. Third, veins rising from the surface of the brainstem and crossing the cisternal portion of the trigeminal nerve were interposed. Fourth, intraneural veins, which were generally small, were coagulated and cut. In this series, there was no intentional sacrifice or unintentional rupture of large veins, and the sacrifice rate of medium and small veins was only 19.0%. Thirteen patients (61.9%) gained complete pain relief immediately after surgery (i.e. “excellent” result), while the remaining eight patients (38.1%) achieved “good” pain relief.

Conclusion: Different surgical techniques were used based on the different kinds of veins encountered. This allowed preservation of almost all the large veins. There were no serious complications postoperatively.     

微血管减压术治疗三叉神经痛的疗效分析

目的介绍乙状窦后锁孔入路微血管减压术（MVD）治疗三叉神经痛（TN）的手术经验,探讨影响手术疗效的因素。方法回顾分析2697例TN患者的临床资料,重点介绍手术操作及注意事项。结果治愈2541例,显效76例,有效48例,无效31例,死亡1例。2190例接受3～240个月的随访,1965例治愈,91例显效,40例有效,30例无效,64例疼痛复发（其中37例行2次手术治愈）。结论异常血管压迫三叉神经入根区并合并局部蛛网膜增厚粘连是TN的主要病因。行MVD同时松解蛛网膜,做到彻底减压。依据病人的不同情况采取相应的减压措施是提高MVD治疗TN效果的重要手段。     

显微血管减压术后复发三叉神经痛的手术治疗

目的探讨显微血管减压术后复发三叉神经痛的手术治疗方法。方法1998年1月至2005年12月采用显微神经外科手术治疗37例显微血管减压术后复发三叉神经痛患者，30例患者行三叉神经感觉根部分切断术，单纯三叉神经显微血管减压术3例，显微血管减压术加行感觉根部分切断术4例。结果95％患者术中发现有CPA局部蛛网膜明显增厚粘连。全部患者获平均38．2个月的随访。随访期间总有效率97％。并发症：行三叉神经感觉根部分切断术者术后均有面部麻木，随访期间均见不同程度好转；术后发生听力障碍合并轻度面瘫1例，复视1例，随访期间好转；术后发生化脓性脑膜炎1例，出院时治愈；1例高龄患者术后发生小脑半球出血，量约5ml，经保守治疗后好转出院。结论CPA局部蛛网膜严重粘连是导致显微血管减压术后疼痛复发的最重要原因，二次手术时的术式选择应以三叉神经感觉根部分切断术为主。     

原发性三叉神经痛的病因及显微血管减压治疗(附91例临床分析)

目的探讨原发性三叉神经痛病因及显微血管减压治疗的手术技巧。方法回顾性分析显微血管减压术治疗的91例原发性三叉神经痛病例资料。结果三叉神经入脑干区有血管压迫者89例。术后疼痛立即消失或显著减轻者78例,1周内明显减轻者11例。随访3~48个月(平均32个月),疼痛消失86例(94.5%),明显缓解、服得理多能够控制满意者5例,无复发病例。结论三叉神经入脑干区血管压迫是原发性三叉神经痛的常见病因。显微血管减压术是有效的治疗方法。准确判定责任血管并采取适当材料及方法使入脑干区减压是提高有效率,减少复发的主要措施。     

小脑水平裂-小脑脑桥裂入路治疗三叉神经痛

目的 介绍一种经小脑水平裂-小脑脑桥裂治疗三叉神经痛的手术入路.方法 回顾性分析经小脑水平裂-小脑脑桥裂人路治疗的17例三叉神经痛病例.结果 所有患者均可顺利分开小脑水平裂外侧部和小脑脑桥裂上肢,均发现有责任血管压迫,术后立即止痛15例,2例疼痛分别于术后第2、3天完全消失.术后1例出现口唇疱疹,1例患侧面部轻微麻木.结论 经小脑水平裂-小脑脑桥裂入路治疗三叉神经痛,可以避免传统的枕下乙状窦后人路三叉神经感觉根人脑桥处显露不良的缺陷,减少听力下降、面瘫等并发症的发生.     

微血管减压术治疗舌咽神经痛的手术体会及解剖学发现

目的 总结舌咽神经痛微血管减压术经验,探讨舌咽神经疼痛发生的解剖学基础.方法 所有病例均采用全身麻醉,乙状窦后入路微血管减压术.结果 首次12例患者术后疼痛症状完全消失,2例症状无明显缓解.12例患者术中发现血管压迫,责任血管为一根或多根;该12例患者中,10例责任血管接触神经根,但神经根无明显压痕;2例神经根出脑干部位有明显压痕.11例术中发现后组脑神经局部蛛网膜增厚并与神经粘连,其中8例舌咽神经走行正常,3例神经根移位、扭曲,蛛网膜粘连使其固定.有血管压迫的12例患者中,责任血管压迫神经根出脑干区5例,在神经中部4例,靠近颈静脉孔3例.结论 微血管减压术能有效治疗舌咽神经痛,血管压迫存在于舌咽神经颅内段全段,蛛网膜粘连使神经根固定,促进血管压迫形成,血管压迫舌咽神经多无明显压痕.     

3-dimensional computer graphics model elucidating involvement of intraparenchymal venous malformation in trigeminal nucleus of brachium pontis with intractable trigeminal neuralgia

Venous malformation (VM) in the posterior cranial fossa occasionally cause trigeminal neuralgia (TN), which were treated with microvascular decompression of its drainer, whereas it was effective only in the limited cases, and its pathological mechanism causing TN is controversial.A 72-year-old man had a 20-year history of typical but severe TN in his left face. Without radiographic evidence of vascular compression on the root entry zone (REZ) of the trigeminal nerve, he underwent stereotactic radiosurgery in previous hospital, resulting in only temporary improvement. On T1-wighted magnetic resonance image with enhancement, the left trigeminal nerve was focally enhanced, which was typical finding after high dose irradiation for TN. Simultaneously, it disclosed small “caput medusa” within the pontine tegmentum, indicated existence of VM in brachium pontis.A 3-dimensional computer graphics model created by fusion of magnetic resonance angiography, diffusion tensor tractography, and fast imaging employing steady-state acquisition elucidated VM was located in the trigeminal nucleus of brachium pontis, which will be very useful for understanding the anatomic correlation of VM and pontine trigeminal nucleus. Since there was no vascular compression at the REZ of the trigeminal nerve, microvascular decompression was not indicated. With minimum dose of gabapentine and carbamazepin, his facial pain completely disappeared and controlled for more than 5 years.     

脑干三叉神经诱发电位对三叉神经痛微血管减压术的应用研究

目的 评价三叉神经痛微血管减压术前、后三叉神经的传导功能变化，探讨脑干三叉神经诱发电位对三叉神经痛微血管减压术的指导及其对手术预后的评估，探讨微血管减压术的可能机制。方法 14例经术前核磁共振斜矢状位成像证实有神经血管压迫的三叉神经痛的病人，在微血管减压过程中，通过术前、中、后记录早期头皮诱发电位监测三叉神经传导功能。结果 所有病例的术前头皮诱发电位均呈潜伏期延长与波幅降低的改变，显示三叉神经根部的传导功能损害。脑干三叉神经诱发电位证实微血管减压术后，14例病人三叉神经传导功能迅速恢复，术后疼痛均缓解。结论 微血管减压术后三叉神经痛的改善，常与神经生理学数值恢复正常有关，提示神经传导功能的恢复。微血管减压术后电生理参数值的迅速恢复及疼痛缓解，证明这两种现象与髓鞘再生无关。脑干三叉神经诱发电位预测微血管减压术的效果是可靠的。     

Treatment of atypical trigeminal neuralgia with microvascular decompression

AIM: To explore the methods for achieving pain relief in patients with atypical trigeminal neuralgia (TN) using microvascular decompression (MVD). STUDY DESIGN AND SETTINGS: Retrospective study of 26 patients treated during the years 2000 to 2004. MATERIALS AND METHODS: Twenty-six patients in whom vascular compression of the trigeminal nerve was identified by high definition magnetic resonance tomographic angiography (MRTA) were treated with MVD for atypical TN in our department. Clinical presentations, surgical findings and clinical outcomes were analyzed retrospectively. RESULTS: In this study, single trigeminal division was involved in only 2 patients (8%) and two or three divisions in the other 24 patients (92%). Of prime importance is the fact that in 46.2% of the patients, several conflicting vessels were found in association. Location of the conflicts around the circumference of the trigeminal root was supero-medial to the root in 53.5%, supero-lateral in 30.8% and inferior in 15.7%. MVD for atypical TN resulted in complete pain relief in 50% of the patients with complete decompression, partial pain relief in 30.8% and poor pain relief or pain recurrence in 19.2% of the patients without complete decompression postoperatively. CONCLUSIONS: Complete decompression of the entire trigeminal root plays an important role in achieving pain relief in patients with atypical TN with MVD.     

三叉神经痛微血管减压术后疼痛不缓解的治疗体会

目的 探讨三叉神经微血管减压(MVD)术后患者疼痛不缓解的治疗方法 . 方法 对北京大学人民医院神经外科自2005年1月至2009年6月收治的50例原发性三叉神经痛患者行MVD术后手术效果进行回顾性分析.对术后疼痛不缓解的患者应用经皮卵圆孔三叉神经池甘油封闭术治疗. 结果 50例患者MVD术后有3例疼痛不缓解.3例患者中对责任血管实施减压者2例,无责任血管仅行梳理者1例;3例患者均有蛛网膜粘连增厚.应用经皮卵圆孔三叉神经池甘油封闭术治疗后疼痛消失. 结论 尽管实施有效的MVD术仍不能保证所有患者术后疼痛缓解,特别是无责任血管者,术后持续疼痛可能性更大.荧屏监视下经皮卵圆孔穿刺半月节甘油封闭术为MVD术后疼痛不缓解者提供了一种避免再次开颅、简便易行、安全有效的方法 .