三叉神经感觉根切断术治疗非典型三叉神经痛的疗效研究

目的探讨三叉神经感觉根切断术治疗非典型三叉神经痛的效果。方法回顾性分析57例于2013-2016年期间在我科行三叉神经微血管减压术或三叉神经感觉根切断术治疗的非典型三叉神经痛患者的临床表现、术中所见、手术疗效。结果 57例患者中,单纯行微血管减压术33例,19例患者术后疼痛症状立刻消失,14例术后疼痛症状未明显好转,其中7例患者为改善症状在之后接受了三叉神经感觉根切断术;行三叉神经感觉根切断术24例,19例患者术后疼痛缓解或消失。结论三叉神经感觉根切断术治疗非典型三叉神经痛的疼痛症状效果好于单纯三叉神经微血管减压术,但该手术仍存在术后患者不可逆的面部感觉减退的问题。     

锁孔微血管减压手术治疗颅神经疾病(附112例报道)

目的探讨锁孔微血管减压手术治疗颅神经疾病的疗效和安全性。方法本组男35例,女77例,年龄27～79岁,病程1～10年,其中三叉神经痛62例,面肌痉挛48例,三叉神经痛合并面肌痉挛1例,舌咽神经痛1例。所有患者术前行CT和MRI检查,排除颅内占位性病变后,在全麻下行锁孔微血管减压手术。结果 62例三叉神经痛患者中58例术后疼痛症状消失,手术有效率为93.55%,48例面肌痉挛患者中44例术后痉挛停止或显著减轻,手术有效率为91.67%,1例三叉神经痛合并面肌痉挛术后疼痛及痉挛均消失,1例舌咽神经痛术后疼痛症状消失。本组术后出现听力下降10例,口唇疱疹5例,迟发性面瘫2例,一过性头晕、耳鸣2例,脑脊液耳漏2例,蛛网膜下腔出血1例,幕上双侧硬膜下血肿1例,均经对症处理好转。随访发现5例患者症状复发,复发率为4.46%。结论锁孔微血管减压术是治疗颅神经疾病最有效的方法,熟练的显微外科技术、术中正确识别责任血管以及充分的减压是提高手术疗效、减少症状复发的关键。     

三叉神经痛脑干三叉神经诱发电位波形特征及微血管减压术后变化

目的研究三叉神经痛脑干三叉神经诱发电位(BTEP)波形特征,及微血管减压术(MVD)后波形变化。方法对10例三叉神经V2支疼痛病人行MVD手术,收集MVD前后BTEP电位波形,观察波形分化,记录潜伏期、波形持续时间,并观察病人术后疗效。结果 10例病人中,术前7例W2、W3波形消失,减压术后5例出现波形分化差;2例出现波形分化差,减压术后潜伏期缩短。术后10例病人疼痛症状均缓解。结论三叉神经痛病人BTEP电位异常,MVD术后BTEP电位波形改善。BTEP监测可用来指导MVD。     

探讨微血管减压术治疗桥小脑角区脑神经压迫综合征的疗效

目的探讨微血管减压术(MVD)治疗桥小脑角区颅神经压迫综合征的临床疗效。方法回顾性分析在我院2011-03—2014-10采用颅神经微血管减压术(MVD)治疗的43例桥小脑角区颅神经压迫综合征患者的临床资料,其中左侧三叉神经痛2例,右侧三叉神经痛1例,面肌痉挛40例。结果术后症状完全消失35例(81.40%)(左侧三叉神经痛1例,面肌痉挛34例),症状明显减轻5例(11.63%)(右侧三叉神经痛1例,面肌痉挛4例),无明显缓解3例(6.98%)(左侧三叉神经痛1例,面肌痉挛2例),有效治愈率93.02%;1例左侧三叉神经痛术后出现面部麻木及嘴角疱疹,面肌痉挛术后听力下降或轻度面瘫2例,无死亡病例,给予临床治疗后可自行痊愈;术后复发2例(面肌痉挛)。结论微血管减压术(MVD)是治疗桥小脑角区颅神经压迫综合征的有效安全方法,并发症少,值得临床大力推广。     

显微血管减压术治疗三叉神经痛长期疗效研究

目的研究显微血管减压术（microvascular decompression,MVD）治疗三叉神经痛的长期效果。方法回顾性分析482例三叉神经痛病人的临床资料,均接受MVD治疗,随访时间5年以上,电话或门诊随访。结果术后疼痛消失419例,术后即刻疼痛消失率86．9％,部分病人有短暂可逆性并发症,包括疱疹病毒感染、面部麻木、周围性面瘫、耳鸣和听力下降。随访时间5—12年,失访24例;出院时疼痛消失的病人在随访期间复发38例,其中5年内复发24例,5年以上复发14例,复发率9．5％。结论MVD是目前惟一针对三叉神经痛病因进行治疗的手术方式,手术后三叉神经的运动和感觉功能完好保留,其长期疗效良好。     

显微血管减压术治疗原发性三叉神经痛21例临床分析

目的探讨显微血管减压术治疗原发性三叉神经痛的临床疗效。方法选取我院神经外科2012-10—2013-12收治的21例原发性三叉神经痛患者,给予全麻下显微血管减压术治疗。结果经电话及预约随访2~16个月,21例患者中术后疼痛立即消失17例,术后2周内疼痛缓解2例,疼痛明显减轻2例,能够耐受疼痛,总缓解率90.5%,总有效率100%。结论显微血管减压术治疗原发性三叉神经痛安全、有效,值得推广。     

微血管减压术治疗原发性三叉神经痛的临床分析

目的探讨微血管减压术治疗原发性三叉神经痛的疗效。方法对32例应用微血管减压术治疗原发性三叉神经痛患者的临床资料进行回顾性分析。结果术后症状立即消失26例,缓解6例,有效率100%。术后随访6个月无复发。结论微血管减压术是治疗原发性三叉神经痛的有效方法,创伤小,治疗效果好。     

悬吊法微血管减压术治疗三叉神经痛（附54例临床分析）

目的探讨悬吊法在微血管减压术中治疗三叉神经痛的疗效评价。方法54例原发性三叉神经痛患者在微血管减压术中应用悬吊法进行治疗。结果54例原发性三叉神经痛患者术后50例(92.59%)疼痛消失,3例(5.56%)明显缓解,有效率98.15%,术后1例疼痛未见缓解,二次手术,未见微血管压迫,所有病例随访6个月～2年,未见复发病例。结论悬吊法的应用是对传统的微血管减压治疗三叉神经痛的改进,可以减少术后复发的机率。     

微血管减压术治疗老年性三叉神经痛的临床分析

目的 探讨微血管减压术(MVD)治疗老年性三叉神经痛的效果和安全性.方法 收集大连大学附属中山医院神经外科自2005年1月至2008年6月收治的84例三叉神经痛患者的临床资料,回顾性分析其中29例65岁以上老年患者(老年组)行MVD的疗效及其并发症,并与同期65岁以下患者(对照组)比较.结果 老年组与对照组术后效果均良好,老年组术后疼痛缓解率为93.10%,对照组为96.36%;老年组存在一定的解剖学和身体特征,如有脑萎缩的倾向、责任血管部分动脉硬化明显(老年组约1/4,对照组约1/10)、既往伴有其它全身疾病增多(老年组占71.69%,对照组占41.81%)、术后并发症风险增大的表现(老年组1例术后出现脑十梗死,2例术后出现下肢深血栓栓塞症).结论 结合现代化有效的围手术期处理,用MVD可治愈或缓解老年性三又神经痛.     

原发性三叉神经痛微血管减压治疗体会

目的探讨微血管减压术在原发性三叉神经痛治疗中的效果。方法回顾性分析经微血管减压术治疗的36例原发性三叉神经痛患者的临床资料。结果 35例患者术后1周内疼痛明显缓解,1例疼痛轻度改善。术后分别电话或门诊随访3月至2年,32例疼痛完全消失;3例疼痛明显改善,但需结合小剂量药物控制;1例术后一个月左右复发。除1例怀疑有短暂性脑脊液鼻漏外无其它手术相关并发症。结论微血管减压术是原发性三叉神经痛的理想治疗手段,手术病例严格选择(有典型症状,且术前MRI颅底薄层增强扫描提示痛侧三叉神经根部有血管紧密接触),术中判定责任血管、解除压迫、充分且适当减压三叉神经是保证疗效的关键。     

枕下乙状窦后入路手术治疗三叉神经痛的术式选择

目的探讨枕下乙状窦入路手术治疗三叉神经痛术中手术方式的选择。方法对39例原发性三叉神经痛患者的临床资料进行回顾性分析。其中31例患者术中有明确的血管压迫,仅行微血管减压术(MVD)手术;6例患者血管压迫不明显,行MVD+三叉神经梳理术(TNC);3例患者行三叉神经感觉根部分离断术(PSR),1例患者行二次手术。对患者术后的疗效及并发症进行分析。结果 31例行MVD手术患者,术后疼痛立即完全缓解26例,延迟缓解2例,无效3例,总有效率90.6%。6例行MVD+TNC的患者和3例行PSR手术的患者术后疼痛均立即缓解。结论为提高手术治疗三叉神经痛的治愈率,应根据术中不同情况决定不同的手术方式。对于老年人及不能耐受第二次手术的患者,更应积极行PSR手术。     

Comparison of percutaneous trigeminal ganglion compression and microvascular decompression for the management of trigeminal neuralgia

This investigation evaluates the results of percutaneous trigeminal ganglion compression (PTGC) and compares them those for microvascular decompression (MVD) in treating trigeminal neuralgia. The authors report 127 cases of trigeminal neuralgia treated by PTGC and comparing the results with those of 114 patients whom underwent MVD from 1985 to 2000. The following parameters were compared: technical success, pain relief and recurrence, complications, perioperative morbidity, and perioperative mortality. PTGC and MVD initially had similar initial success rates. However, MVD had a higher rate of pain recurrence at the first 2 years follow-up, as well as higher rates of major complications and perioperative morbidity. Meanwhile, PTGC had higher rates of facial numbness, dysesthesia and minor complications.     

原发性典型与不典型三叉神经痛微血管减压术的疗效分析

目的 评价微血管减压术(MVD)对原发性典型三叉神经痛(CTN)和不典型三叉神经痛 (ATN)的治疗效果,并从病因学角度探讨产生不同术后效果的原因.方法 本文采用Barrow神经科学研究所面部疼痛评分标准,将168例原发性三叉神经痛病例疼痛水平分为Ⅰ～Ⅴ级.结果 MVD后早期,92.7%的CTN达Barrow I级;97.6%达Barrow ≥Ⅱ级;86.4%的ATN达Barrow Ⅰ级;95.5%达Barrow ≥Ⅱ级.平均随访5.2年,88.6%的CTN达Barrow ≥Ⅱ级;55.3%的ATN达Barrow ≥Ⅱ级.结论 术后早期二者治疗效果无明显差异(P=0.202).ATN可能存在血管压迫以外的起病因素或因神经轴突受损严重,造成ATN术后远期效果差,疼痛复发率高(P<0.05).     

Surgical Management of Medically Refractory Trigeminal Neuralgia

The role of surgery for patients with medically refractory trigeminal neuralgia (TN) is well established. High-quality magnetic resonance imaging, including gadolinium-enhanced and volume acquisition sequences, should be performed to exclude intracranial tumors or demyelinating disease as the cause of the pain, as well as to clearly demonstrate the trigeminal nerve and adjacent blood vessels. For physiologically healthy patients with Type 1 TN, a microvascular decompression (MVD) is the preferred surgical approach because of its high rate of complete pain relief, the durability of the pain relief, and the fact that trigeminal injury is not required for pain relief. Patients with recurrent TN after a failed MVD, patients with significant medical comorbidities, and patients with multiple sclerosis–related TN are generally recommended to undergo less invasive, destructive surgical techniques aimed at providing pain relief by damaging the trigeminal nerve.     

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.     

微血管减压术治疗原发性三叉神经痛(附75例报告)

目的 评价微血管减压术治疗原发性三叉神经痛的临床疗效。方法 1998年至2003年采用微血管减压术治疗75例原发性三叉神经痛，对其疗效、并发症及不良反应进行分析。结果 73例有效(总有效率97．3％)，其中疗效优者70例(93．3％)，疗效良者3例(4％)，无效者2例(2．7％)；并发症有脑脊液漏1例、轻度面瘫2例、面部麻木6例、术后口唇嘴角处疱疹11例。不良反应包括头痛、头晕、恶心、呕吐等。结论 微血管减压术是一种病因性治疗，具有治愈率高保持三叉神经功能的特点，是原发性三叉神经痛外科治疗的首选方法。     

微血管减压术治疗复发三叉神经痛与再手术分析

目的评价微血管减压术治疗三叉神经痛术后无效及复发病例再手术的疗效及随访结果。方法对微血管减压术后无效10例和复发25例三叉神经痛病人再次手术探查,据术中不同情况具体处理,并进行4个月至8年的随访。结果25例见有血管压迫神经根,涤纶片过大致神经轴弯曲者5例,另5例未探及明显原因。分别行微血管减压术(MVD)、MVD 三叉神经感觉根部分切除术(PSR)、PSR、调整涤纶片或神经根松解术。术后效果良好,并发症少且轻微。随访满意,仅3例轻度复发。结论对MVD术后无效及复发的病人,再次手术探查均应首选,并尽可能行MVD或神经根松解术,但PSR仍是一种有效的可选择的治疗方法。     

Trigeminal neuralgia in an elderly patient associated with a variant of persistent primitive trigeminal artery

An 86-year-old woman presented with a 10-year history of right paroxysmal facial pain. The trigger zone was the right maxilla. Magnetic resonance (MR) angiography and MR cisternography sourse images showed an aberrant artery originating from the right internal carotid artery anastomosed to the anterior inferior cerebellar artery territory (AICA) of the cerebellum, and it was closed at the root entry zone of trigeminal nerve. The patient underwent microvascular decompression (MVD), and her pain resolved after the operation. Most of the offending vessels that cause trigeminal neuralgia are the superior cerebellar artery (75-80%) and AICA. Although persistent primitive trigeminal artery (PTA) is the most common type of persistent carotid-basilar anastomosis, trigeminal neuralgia associated with PTA or a PTA variant is very rare, and particularly, a PTA variant is an uncommon, anomalous, intracranial vessel. It is necessary to inspect MR imaging scans carefully prior to MVD surgery because they are frequently associated with intracranial aneurysms. During surgery, we must be careful not to injure the perforating arteries from the PTA variant. MVD for trigeminal neuralgia in elderly patients is effective if the patients can have a tolerate general anesthesia. However, when we plan surgery for elderly patients, we must take care that it does not to lead to unexpected complications.