微血管减压术治疗典型及非典型三叉神经痛的疗效比较

目的比较微血管减压术治疗典型及非典型三叉神经痛的疗效,探讨其机制.方法对比分析62例经微血管减压术治疗的三叉神经痛病人的临床特征、术中所见和手术疗效.其中45例为典型者,17例为不典型者.结果典型病人平均病程3.1年,平均年龄60.3岁;20例（44.4%）疼痛累及三叉神经的单一分支,25例为2～3支痛;术中见39例（86.7%）为动脉压迫,6例为动静脉混合压迫;术后44例（97.8%）疼痛缓解,1例无效.非典型病人平均病程8.7年,平均年龄55.5岁;均为多支疼痛病人;术中见10例（58.8%）为动脉压迫,7例为动静脉混合压迫;术后疼痛缓解5例（29.4%）,减轻10例（58.8%）,无效2例.结论微血管减压术治疗典型三叉神经痛的疗效明显优于非典型者,可能与其病程较短,发病年龄较晚,疼痛多呈单支分布,以动脉压迫为主,且术中能够实现充分减压有关.     

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。     

微血管减压术治疗三叉神经痛的疗效分析

目的总结原发性三叉神经痛的手术治疗,探讨微血管减压术治疗三叉神经痛的临床效果。方法回顾性分析80例三叉神经痛患者的临床资料,均行微血管减压术治疗,电话或门诊随访。结果术后2周内疼痛症状消失75例,2例手术及药物治疗无效,有效率为97.5%。根据电话随访,术后2年内2例复发,1例发生皮下积液,1例听力下降,2例头晕、耳鸣,2例轻度面神经功能障碍,无一例死亡。结论微血管减压术在治疗三叉神经痛方面效果明显,在手术过程中应谨慎、规范操作,防止复发。     

三叉神经痛微血管减压术的疗效分析

三叉神经痛是面部三叉神经分布区域内短暂性、反复发作的阵发性剧痛,目前多数临床资料证实血管压迫三叉神经根入脑干区（root entry zone,REZ区）是原发性三叉神经痛的主要病因,三叉神经微血管减压术已成为目前公认的治疗三叉神经痛的有效治疗手段,但术后仍有一定的复发率。我们对收治的29例三又神经痛患者进行术后随访,并就影响疗效的因素进行分析。     

微血管减压术治疗三叉神经痛182例

目的观察微血管减压术治疗三叉神经痛的疗效和安全性。方法采取微血管减压手术治疗182例患者,对手术入路及血管神经隔离方法进行改良。结果手术早期的总有效率为97.3%,无一例发生脑脊液漏、颅内感染等严重并发症。结论微血管减压术是治疗三叉神经痛的安全、有效方法,手术方法的改良有利于提高手术治疗的有效率和防止并发症生。     

微血管减压术治疗三叉神经痛74例疗效分析

目的 探讨微血管减压术治疗三叉神经痛(TN)的临床疗效和并发症.方法 武警江苏总队南京医院口腔科自2002年8月至2009年4月共行微血管减压术治疗TN患者74例,回顾性分析患者的临床资料和疗效.结果 本组患者术后均临床治愈出院,无死亡病例.术后颅内血肿1例(1.35%),术侧小脑水肿致非交通性脑积水1例(1.35%),颅内感染2例(2.7%),均经积极对症治疗后缓解.全部患者随访3个月～6年,无复发病例,遗留术侧轻微面瘫2例(2.7%),听力轻度下降1例(14%).结论 微血管减压术解除了TN的常见病因,保留三叉神经的功能,是治疗TN的首选方法.

Abstract：

Objective To investigate the clinical effect of microvascular decompression on patients with trigeminal neuralgia (TN) and its complications. Methods A retrospective analysis of 74 patients with microvascular decompression, admitted to our hospital from August 2002 to April 2009,was performed; the clinical data and thc treatment efficacy were analyzed. Results The total effective rate was 100% without death. Intracranial hematoma appeared in 1 patient (1.35%); edema of the cerebellum in the operated side caused 1 patient (1.35%) having non-communicating hydrocephalus and 2 (2.7%) having intracranial infection, and all were relieved symptoms after treatment. All patients were followed up for 3 months to 6 years; no recurrence was noted; facial paralysis in 2 (2.7%) and slight hearing-loss in 1were found. Conclusion Microvascular decompression, lifting the common cause of TN and fully retaining the function of trigeminal nerve, is the preferred method for treatment of TN.     

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：微血管碱压术是治疗三叉神经痛的较为理想的方法。     

微血管减压术治疗原发性三叉神经痛的疗效观察

目的 总结微血管减压术（MVD）治疗原发性三叉神经（PTN）的经验。方法 回顾性分析2016年1月至2017年12月MVD治疗的90例PTN的临床资料。结果 术中发现,65例为单纯动脉压迫（动脉组）,17例动静脉共同压迫（混合组）,8例单纯静脉压迫（静脉组）。术后1 d、6个月、1年、2年,治愈率分别为82.2%、87.8%、90.0%、87.8%;其中动脉组治愈率分别87.7%、92.3%、93.9%、93.9%、85.3%;混合组分别为70.6%、76.5%、82.4%、76.5%;静脉组分别为62.5%、75%、75%、62.5%。三组治愈率均无统计学差异（P>0.05）。结论 MVD治疗PTN效果良好。     

微血管减压术治疗原发性典型与不典型三叉神经痛对比研究

目的探讨原发性典型与不典型三叉神经痛微血管减压术治疗的临床效果。方法选择原发性典型与不典型三叉神经痛患者各40例,在全身麻醉气管插管下完成微血管减压术,比较2组术中所见血管压迫来源、压迫程度及血管压迫位置。结果典型三叉神经痛组压迫血管来源为单纯动脉占85.0%,显著高于非典型三叉神经痛组的57.5%(P0.05);来源为动静脉混合占15.0%,显著低于非典型三叉神经痛组的42.5%(P0.05);典型三叉神经痛组血管与神经位置接触者显著高于非典型三叉神经痛者(P0.05),术中发生三叉神经出现萎缩者比例显著少于非典型三叉神经痛者(P0.05),典型三叉神经痛者其压迫血管在近端者显著多于非典型三叉神经痛者(P0.05),压迫血管在远端者显著少于非典型三叉神经痛者(P0.05)。结论原发性三叉神经痛实施血管减压术,术前鉴定其发病特点,在预测其压迫血管类型、位置及其与神经的关系具有一定临床价值。     

微血管减压术治疗三叉神经痛的预后影响因素研究

目的　探讨影响微血管减压术治疗三叉神经痛手术疗效的因素。方法　分析 6 2例经微血管减压术治疗的三叉神经痛患者的临床特征、术中所见和术后疗效。血管对神经根的压迫程度分为单纯接触、接触和移位、单纯粘连、粘连和移位、萎缩五种。手术疗效包括术后疼痛立即缓解、延迟缓解、明显减轻和无效。结果　 6 2例患者起病时均表现为典型三叉神经痛 ,但在术前 17例已经转变为不典型。术中发现压迫血管与三叉神经根之间单纯接触 14例、接触和移位 7例、单纯粘连 15例、粘连和移位 18例、萎缩 8例。术后平均随访 14个月 ,疼痛在术后立即缓解 32例 (5 1 6 % ) ,延迟缓解 17例 (2 7 4 % ) ,明显减轻 11例 (17 7% ) ,无效 2例。结论　病程短、症状典型、以动脉压迫为主且能够充分减压的患者 ,术后多能获得好的疗效。相反 ,以静脉压迫为主 ,病程长及症状不典型的患者 ,术后疗效多不理想     

微血管减压术治疗三叉神经痛的临床分析

目的探讨微血管减压术治疗三叉神经痛的疗效及桥脑旁区血管与三叉神经“敏感区”的关系。方法回顾性分析微血管减压术治疗的96例三叉神经痛病人的临床资料。术中探查发现“敏感区”责任血管92例（95．83％），其中小脑上动脉20例（21．74％），小脑前下动脉13例（14．13％），椎动脉及基底动脉11例（11．96％），其他多根血管压迫7例（7．61％），起源不清楚的动脉19例（20．65％），岩静脉21例（22．83％），脑血管畸形1例（1．09％），未见责任血管为动脉瘤者。按文献报道的标准将这些血管与三叉神经的关系进行分型：无接触型4例，接触型32例，压迫型27例，粘连包绕型32例，贯穿型1例。根据不同分型，采取不同方法对血管进行处理。结果手术总有效率98．96％（95例）。主要并发症包括听力下降及消失4例，轻-中度面肌障碍8例，轻度后组颅神经症状1例，小脑症状3例，脑脊夜漏1例，术后切口枕大神经痛1例，伤口延迟愈合2例，无死亡与致残病例。术后随访3个月。4年，平均2．7年，未见疼痛复发患者。结论微血管减压术是目前外科治疗三叉神经痛的有效方法，术中正确识别桥脑旁区三叉神经“敏感区”的责任血管并充分减压，是确保微血管减压术成功的关键。     

Long Time Efficacy and Safety of Microvascular Decompression Combined with Internal Neurolysis for Recurrent Trigeminal Neuralgia

ObjectiveTo explore the clinical efficacy and safety of microvascular decompression (MVD) combined with internal neurolysis (IN) in the treatment of recurrent trigeminal neuralgia (TN) after MVD. MethodsSixty-four patients with recurrent TN admitted to the hospital from January 2014 to December 2017 were divided into two groups according to the surgical method. Twenty-nine patients, admitted from January 2014 to December 2015, were treated with MVD alone, whereas 35 admitted from January 2016 to December 2017 were treated with MVD+IN. The postoperative efficacy, complications, and pain recurrence rate of the two groups were analyzed.ResultsThe efficacy of the MVD+IN and MVD groups were 88.6% and 86.2%, and the cure rates were 77.1% and 65.5% respectively. There was no statistically significant difference between the two groups (p>0.05). The cure rate (83.3%) of patients in the MVD+IN group, who were only found thickened arachnoid adhesions during the operation that could not be fully released, was significantly higher than that of the MVD group (30.0%) (p<0.05), while the efficacy (91.7% vs. 70%) of the two groups was not statistically different (p>0.05). For patients whose arachnoid adhesions were completely released, there had no significant difference (p>0.05) in the efficacy (87% vs. 94.7%) and recurrence rate (5.0% vs. 11.1%). The incidence of postoperative facial numbness (88.6%) in the MVD+IN group was higher than that in the MVD group (10.3%) (p<0.01). The long-term incidence of facial numbness was not statistically significant (p>0.05). In the 18–36 months follow-up, the recurrence rate of patients in the MVD+IN group (9.7%) and in the MVD group (16%) were not statistically different (p>0.05). ConclusionA retrospective comparison of patients with recurrent TN showed that both MVD and MVD combined with IN can effectively treat recurrent TN. Compared with MVD alone, MVD combined with IN can effectively improve the pain cure rate of patients with recurrent TN who have only severe arachnoid adhesions. The combination does not increase the incidence of long-term facial numbness and other complications.     

Microvascular Decompression for Primary Trigeminal Neuralgia : Short-Term Follow-Up Results and Prognostic Factors

Objective

The aim of this prospective study was to demonstrate the influence of some factors on the prognosis of microvascular decompression in 37 patients with trigeminal neuralgia.

Methods

The results of microvascular decompression (MVD) in 37 patients with trigeminal neuralgia were evaluated at 6 months after surgery and were compared with clinical and operative findings.

Results

The sex of the patient, the patient''s age at surgery, the side of the pain, and the duration of symptoms before surgery did not play any significant roles in prognosis. Also, the visual analogue scale (VAS) of the patient, the duration of each pain attack, and the frequency of pain over 24 hours did not play any significant roles in prognosis. In addition, intraoperative detection of the type of conflicting vessel, the degree of severity of conflict, and the location of the conflict around the circumference of the root did not play any roles in prognosis. The only factors affecting the prognosis in MVD surgery were intraoperative detection of the site of the conflict along the root and neuroradiological compression signs on preoperative magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA).

Conclusion

These findings demonstrated that if neurovascular compression is seen on preoperative MRI/MRA and/or compression is found intraoperative at the root entry zone, then the patient will most likely benefit from MVD surgery.     

经乙状窦后入路三叉神经微血管减压术125例临床分析

目的 总结微血管减压术治疗三叉神经痛的临床经验。方法 术前对125例三叉神经痛患者进行磁共振断层血管成像（MRTA）检查，手术时经乙状窦后锁孔入路，在神经出脑干区寻找责任血管，进行神经、血管的充分游离减压，血管与脑干间置入Teflon棉。结果 术后125例三叉神经痛患者中，121例术后疼痛消失或明显减轻；4例术后症状无明显改善，经射频治疗后疼痛消失。121例随访1～7年，2例两年后复发，总有效率95、2％，其余均无疼痛发作。术后2例出现颅内感染，无永久性并发症出现。结论 头颅MRTA检查有助于术前判断责任血管与神经的关系，手术时在神经出脑干区发现责任血管并进行充分游离减压是手术成功的关键。     

颅神经血管压迫综合征微血管减压术治疗探讨

目的探讨用微血管减压术治疗三叉神经痛、面肌痉挛、舌咽神经痛等颅神经血管压迫综合征的临床经验。方法系统回顾1999年至2005年我们采用微血管减压术治疗神经血管压迫综合征病例420例，其中三叉神经痛282例，面肌痉挛120例．舌咽神经痛18例。结果总有效406例，有效率96．67％，本组无死亡病例。结论微血管减压术是治疗颅神经血管压迫综合征的有效方法。     

Trigeminal Neuralgia Caused by Persistent Primitive Trigeminal Artery

A 66-year-old man presented with typical trigeminal neuralgia (TN). Magnetic resonance angiography (MRA) revealed a primitive trigeminal artery (PTA) that came into contact with the trigeminal nerve. Based on MRA, we performed microvascular decompression (MVD). In the operational field, we confirmed the PTA location and performed MVD successfully. Postoperatively, the patient''s pain subsided without any complications.     

显微外科手术治疗三叉神经痛的随访研究

目的探讨显微外科手术治疗三叉神经痛的临床效果。方法181例三叉神经痛患者中，121为典型性三叉神经痛，60例为非典型性三叉神经痛：160例存在血管神经压迫者采用微血管减压术（MVD）治疗，21例无明显血管压迫者采用三叉神经部分感觉根切断术（PSR）治疗；术后随访1～6年（平均42个月）。结果随访期末，行MVD者15例（9．4％）三叉神经痛复发，行PSR者6例（28．6％）复发；两者复发率相差显著（P〈0．05）。典型性三叉神经痛患者预后明显好于非典型性患者（P〈0．05）；老年组（〉60岁）和年轻组（〈60岁）患者术后并发症的发生率无明显差别（P〉0．05）；病程、临床症状、神经血管压迫与术后三叉神经痛复发呈正相关（P〈0．05）。结论对于有明显血管压迫的三叉神经痛患者MVD治疗是安全有效的，对于没有血管压迫的三叉神经痛患者手术策略仍需进一步的研究。病程、临床症状、神经血管压迫可能在三叉神经痛复发中起重要作用。