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《中华临床医师杂志(电子版)》2014,(22)
三叉神经痛是临床常见的一种神经痛,具有阵发性、单边性、撕裂样、短暂性疼痛,一般数秒或数分钟后自行缓解的特点,这是由于三叉神经入根区存在血管压迫或三叉神经入根区被增厚的蛛网膜束裹,导致脱髓鞘病变而异常放电,右侧发病率高于左侧。目前针对三叉神经痛的治疗方式有很多,微血管减压术是治疗方法之一,也是国际上公认的治疗三叉神经痛的首选治疗方法,其原理为解除责任血管和增厚的蛛网膜对三叉神经入根区的压迫,具有治疗效果最明显,并发症最少的特点。微血管减压术要求操作精细,在不损伤神经的前提下充分神经减压,术中特别注意保护面、前庭神经和延静脉,以减少并发症和避免再次复发。现从三叉神经微血管减压术的发展、手术要领、并发症等方面进行阐述。 相似文献
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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。 相似文献
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微血管减压治疗三叉神经痛围手术期护理 总被引:3,自引:0,他引:3
本文总结了微血管减压(MVD)治疗三叉神经痛患者围手术期护理,内容包括:术前进行有效的心理疏导和健康教育,术后重视病情观察和并发症的处理,结果疼痛完全消失27例(90%),疼痛缓解3例(10%),因此优质的护理可缓解患者的紧张焦虑情绪,减轻疼痛,有利于患者康复。 相似文献
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目的探讨舌咽神经痛(GPN)的多种有效显微神经外科手术方法的临床疗效。方法选择1991年至2007年入住我院的GPN患者21例,11例行迷走神经根上部1~2根丝切断术(R),6例行显微外科减压术(MVD),4例MVD同时行R术,对所有患者进行平均6.5年的随访观察。结果21例患者术后疼痛全部消失;2例术后出现咽部不适、偶发性干咳,其中1例7 d后逐步缓解,1例出现轻度声嘶、吞咽功能障碍,3 d后未见好转。随访全部病例无复发。结论采取何种术式应根据术中有无责任血管压迫及责任血管压迫的方式而定,经随访观察证明,三种显微外科手术均为舌咽神经痛安全有效的治疗方法,值得进一步推广使用。 相似文献
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目的探讨内窥镜下,桥脑小脑角三叉神经微血管减压及神经梳理手术的围手术期护理干预对病人的影响。方法对1999~2005年34例单侧原发性三叉神经痛患者按入院顺序随机分为两组,1999~2003年的17例为对照组;2004~2005年的17例为干预组,对照组采用常规治疗护理,干预组除常规治疗护理外,还制定了系统的护理干预措施,对病人进行个性化护理。结果两组病人在住院时间和手术并发症等方面差异都有极显著意义(P<0.01)。结论系统的护理干预,对防治病人术后并发症有积极的意义。 相似文献
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目的研究三叉神经痛(TN)患者实施显微外科微血管减压术(MVD)治疗的临床效果。方法选择102例原发性三叉神经痛患者,对其临床特征、术中情况以及术后治疗效果进行总结,同时分析手术的影响因素。结果实施神经减压治疗后,完全减压92例,不完全减压10例。随访后,治愈82例,显效16例,无效4例。结论原发性三叉神经痛患者应用显微外科血管减压术治疗的效果理想,患者预后效果良好。术中应密切配合护理措施,全程医护结合,确保充分减压,提升手术治疗效果。 相似文献
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显微血管减压术治疗112例老年三叉神经痛患者的术后护理 总被引:11,自引:0,他引:11
显微血管减压手术(MVD)是治疗老年人三叉神经痛(TN)的一种新方法。报告了应用MVD治疗112例老年TN患者的术后护理,主要包括术后严密监测生命体征,密切观察有无术后并发症,如颅内出血,周围性面瘫,脑脊液漏,口唇疱疹,眩晕、呕吐;出院前做好出院指导,讲解有关如何预防感染、疼痛、防止TN复发等问题。本组术后发生颅内出血1例、周围性面瘫4例、脑脊液漏2例、口唇疱疹27例。本组术后疼痛消失87例,减轻24例,无变化1例。按照Taha等的评估标准,112例患者中,85例治疗结果优,17例良好,5例中等,3例差,2例失败。手术前后VAS评分分别为8.86和0.48;手术前后McGill疼痛问卷评分为52.50和1.94。 相似文献
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目的 探讨经皮穿刺球囊压迫术(PBC)与微血管减压术(MVD)治疗三叉神经痛的优缺点及近期疗效。方法 选取30例三叉神经痛患者,其中15例行PBC治疗(PBC组), 15例行MVD治疗(MVD组)。比较2组患者基本情况和住院总费用、手术时间、住院总时间以及术后并发症发生率;评估2组术后疼痛程度。结果 PBC组住院总费用低于MVD组,手术时间及住院总时间短于MVD组,差异有统计学意义(P<0.05); PBC组患者平均年龄高于MVD组,差异有统计学意义(P<0.05)。2组术后疼痛缓解率比较,差异无统计学意义(P>0.05)。MVD组术后面部麻木发生率低于PBC组,差异有统计学意义(P<0.05)。结论 MVD和PBC术后近期疗效相似。MVD术后并发症发生率低于PBC, PBC更适用于老年患者。 相似文献
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ObjectiveWe examined the clinical characteristics and outcomes of patients with recurrent trigeminal neuralgia (TN) and assessed the long-term efficacy and safety of microvascular decompression (MVD) to treat typical recurrent TN.MethodsWe identified 3024 patients who underwent MVD for treatment of TN at the China-Japan Friendship Hospital from March 2009 to December 2020. We retrospectively analyzed the data and outcomes of 137 patients who underwent redo-MVD and 74 patients who did not undergo redo-MVD as the control group. These outcomes were evaluated using the Barrow Neurological Institute scoring system.ResultsRecurrence in 68 of the 137 patients was due to incomplete or absent decompression or new responsible vessels. To ensure thorough pain relief, redo-MVD should include decompression of both the trigeminal root entry zone and the peripheral nerve segments, where blood vessels can cause symptoms. Factors associated with reduced effectiveness of redo-MVD were no period of initial pain relief after the first MVD and a longer duration of symptoms before the first MVD.ConclusionsRedo-MVD should not be excluded as a treatment option for patients with refractory TN who develop recurrent pain after a first MVD procedure. 相似文献
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目的探讨3.0 T MRI 3D-TOF序列联合3D-FIESTA序列结合多平面重建在三叉神经微血管减压术术前评估中的应用价值。材料与方法回顾性分析187例湘雅医院原发性三叉神经痛行三叉神经微血管减压术(MVD)的病例资料,将术前3D-TOF序列联合3D-FIESTA序列检查情况与术中探查结果进行对比研究。结果 187例患者术前3D-TOF序列联合3D-FIESTA序列显示:症状侧三叉神经血管压迫(neurovascular compression,NVC)阳性173例,阳性率达92.3%,MVD术发现血管神经压迫179例,阳性率达95.6%。其中小脑上动脉73例(40.8%)、小脑前下动脉28例(15.4%)、基底动脉17例(9.8%)、小脑后下动脉5例(3.2%)、复合压迫35例(20.2%)、静脉11例(6.2%)。3D-TOF序列联合3D-FIESTA序列显示无血管压迫14例,阴性率7.7%,而术中发现无责任血管10例,阴性符合率58.8%。症状对侧血管压迫阳性20例,假阳性率10.7%,两侧阳性率差异有统计学意义(P0.05)。结论 3D-TOF序列联合3D-FIESTA序列,结合3D后处理重建能相对清晰显示三叉神经与周围血管的空间关系,是三叉神经微血管减压术术前评估的有效方法之一。 相似文献
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We present a case report of a patient with the typical sensory features of idiopathic trigeminal neuralgia (ITN). The pain was elicited by innocuous stimuli, summated with repeated stimulation, radiated outside the stimulus zone, referred to a distant site, persisted beyond the period of stimulation, and exhibited a variable refractory period. Unusual sensory features included multiple trigger zones that changed over time and involved all 3 trigeminal divisions. Our sensory evaluation indicated that the pain was evoked by repetitive activation of rapidly adapting, A beta, low-threshold mechanoreceptive afferents. However, activation of such mechanoreceptive afferents alone never produces pain in normal situations and often leads to a suppression of pain responsivity. The findings support the idea that the mechanism of pain in ITN involves pathophysiological mechanisms in the central nervous system. Our hypothesis is that structural and functional changes in the trigeminal system result in an alteration in the receptive field organization of wide-dynamic-range (WDR) neurons. There appears to be an alteration in the surround inhibition mechanism of these neurons leading to an expansion of their touch receptive fields. This results in touch stimuli producing activity in WDR neurons that mimics the activity produced under normal conditions by noxious stimuli. Since WDR neurons participate in the encoding of the perceived intensity of noxious stimuli, a series of punctate tactile stimuli are now perceived as localized, pin-prick or electric shock-like sensations. Similar pathophysiological mechanisms may explain, in part, the pain of peripheral neuropathies associated with postherpetic neuralgia, diabetes and causalgia. 相似文献
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目的:探讨三叉神经痛型桥小脑角胆脂瘤的发生机制、临床表现和治疗原则。方法:回顾性总结21例以原发典型三叉神经痛为主要表现的胆脂瘤患者的临床表现、肿瘤生长部位与大小、手术入路与技巧、结果和术后并发症等资料。结果:肿瘤全切16例,次全切5例。所有患者均表现为同侧三叉神经痛。术中发现10例肿瘤将三叉神经包绕在瘤内。术后三叉神经痛均消失,面部感觉减退2例,听力减退1例;1例疑似无菌性脑膜炎。结论:桥小脑角区胆脂瘤与三叉神经痛的关系复杂,应采取手术治疗,术中根据肿瘤和周围结构的关系以确定是否全切,术后注意无菌性脑膜炎等并发症。 相似文献
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Mario Meglio Beatrice Cioni Gianpiero Tamburrini Luigi Pentimalli Yi Ma 《The journal of headache and pain》2000,1(3):187-195
A patient with trigeminal neuralgia may need different forms of treatment during his or her lifetime. Physicians should be aware of the different available surgical treatments, and know their effectiveness, side effects and complications. Microvascular decompression is considered by many to be the most effective treatment. The goal of the procedure is to remove the cause of pain, obtained by decompressing the nerve at its entry point into the pons. Percutaneous procedures are more easily performed but the recurrence rate of pain is higher. It is difficult to compare the results of surgical procedures reported by different authors. Therefore, we compare the efficacy of 155 microvascular decompressions with 113 radiofrequency thermocoagulations and 215 percutaneous microcompressions performed by the same surgical team. Our study confirms microvascular decompression as the most effective surgical treatment, although percutaneous procedures play an important role in the treatment protocol and have to be offered to patients as a therapeutic option. Received: 22 August 2000 / Accepted in revised form: 22 January 2001 相似文献