颏神经撕脱与局部粘膜埋藏治疗原发性三叉神经痛

原发性三叉神经痛是以面部阵发性疼痛为主要特点的疾病，病因至今不详，但治疗方法主要是以药物，封闭治疗，经皮穿刺治疗及手术治疗等。自1993年以来，我们采取颏粘膜神经撕脱与局部粘膜埋藏治疗周围病变引起的下颌神经痛，取得满意效果。     

神经导航下翼点锁孔入路鞍区显微解剖量化研究

目的：定量评价翼点锁孔入路对鞍区各解剖间隙的显微暴露。方法：在15例(30侧)经颈内动脉、椎动脉灌注红色乳胶的成人尸头上模拟经翼点锁孔入路,观察鞍区各间隙显微解剖结构,并在神经导航下量化可观察到的Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ间隙面积。结果：各间隙面积Ⅰ（22.23±2.12）mm²、Ⅱ（63.42±7.84）mm²、Ⅲ（64.96±5.43） mm²、Ⅳ（26±5.85） mm²、Ⅴ（16.64±2.97 ）mm²;可观察双侧视神经及视交叉、鞍隔、垂体柄及对侧颈内动脉、眼动脉、垂体上动脉及其分支;所有标本通过间隙Ⅱ、Ⅲ均可很好显露后交通动脉（PcoA）、脉络膜前动脉（AchA）,清楚显示PcoA发出5-7支穿支,经下丘脑和后穿质穿入脑实质,从AchA发出6-7支小分支,分布于视束、钩回、脉络丛并穿入脑实质;大脑前、中动脉及分支,基底动脉分叉及大脑后动脉、小脑上动脉、动眼神经也可以良好暴露;调整显微镜视野还可观察动眼神经外侧间隙及海绵窦。结论：（1）翼点锁孔入路可良好显露鞍区各解剖间隙;（2）经Ⅱ、Ⅲ、Ⅴ间隙观察鞍上、鞍旁解剖结构较好;（3）更好显示后交通动脉、脉络膜前动脉起始和分支。     

神经内镜联合显微镜微血管减压术治疗原发性三叉神经痛的疗效观察

目的 探讨神经内镜联合显微镜行微血管减压术治疗原发性三叉神经痛的临床疗效。方法回顾分析78例行微血管减压术治疗的原发性三叉神经痛患者资料,其中常规显微镜组(A组) 36例,神经内镜联合显微镜微血管减压术(B组)42例,分析比较两组术中责任血管发现率、手术并发症及术后疗效。结果 B组责任血管发现率(95.2%)明显高于A组责任血管发现率(80.6%)、治愈率(97.6%)高于A组(83.3%),两者差异均有统计学意义(P<0.05);术后并发症B组(14.3%)比A组(30.6%)无明显差异(P>0.05)。结论 神经内镜联合显微镜微血管减压术治疗三叉神经痛有助于避免责任血管遗漏,提高责任血管发现率和手术治愈率。     

DSA 下半月神经节射频毁损术治疗原发性三叉神经痛的效果研究

目的观察原发性三叉神经痛行DSA 下半月神经节射频毁损疗法治疗改善机体VAS 评分的效果,评价其临床应用价 值遥方法抽选2012 年9 月~2016 年11 月入院接受治疗的81 例原发性三叉神经痛患者,参照随机标准分A尧B 两组,A 组41 例患者于DSA 下展开半月神经节射频毁损疗法,B组40例患者行保守疗法,对比两组疗效及VAS评分遥结果治疗后,A 组治 疗有效率优于B 组（约0.05）,A 组VAS 评分（4.79依1.25）分也优于B 组（5.58依1.49）分,约0.05遥结论对于患有原发性三叉神经 痛的患者,于DSA 下展开半月神经节射频毁损疗法实践性高,推荐选用遥     

上颌神经的解剖研究及其临床意义

目的　为翼腭窝内上颌神经手术提供解剖依据。 方法　在15个成人头颅部标本中解剖观测上颌神经出圆孔处到鼻腔外侧壁、正中矢状面的距离,观察上颌神经与上颌动脉的关系。 结果　上颌神经出圆孔处到鼻腔外侧壁的距离为（13.78±2.18）mm;距正中矢状面的距离为（17.89±2.67）mm 。上颌神经与上颌动脉的位置关系是：63.3％动脉位于神经的外下方,37.7％在神经下方。 上颌神经与上颌动脉之间的距离为 （7.68±1.35）mm（6.60~11.10 mm）。 结论　本研究可为上颌神经手术提供解剖学参数。     

神经内镜结合神经导航与显微手术治疗高血压脑出血患者的应用效果对比

目的神经内镜结合神经导航与显微手术治疗高血压脑出血(HICH)患者的临床应用效果对比分析。方法选择2016年6月～2019年5月于我院手术治疗的74例HICH患者作为研究对象,按照随机数字法将其分为A、B两组,每组37例。A组患者进行经神经内镜结合神经导航手术治疗,B组患者进行显微手术治疗。对比两组患者手术时间、住院时长、术中出血量及血肿清除率以及半年预后情况。结果 A组患者手术时长、住院时长、术中出血量及血肿清除率均显著优于B组(P0.05);术后半年A组患者总预后良好率为91.89%,显著高于B组72.97%(P0.05)。结论高血压脑出血患者采用神经内镜结合神经导航手术治疗,患者手术时间、住院时间均明显缩短,术中出血量少,血肿清除率高,预后佳,值得临床推广。     

射频热凝治疗三叉神经痛的临床分析

探讨射频热凝治疗三叉神经痛的临床诊治,我院资料完整的患者130例.螺旋CT定位下行射频热凝治疗.优良120例,良好10例.总有效率100%.三叉神经痛的温控射频疗法的机制和特点.     

微血管减压治疗老年原发性三叉神经痛的护理

随着人口的老龄化,原发性三叉神经痛(triginal neuralgia,TN)的患者正在逐年增加。微血管减压术(microvascular decompression,MVD)治疗TN目前已经得到广泛应用,但老年TN患者多由于基础疾病多,导致手术风险增大,影响疗效和预后[1],而采取有效的护理措施则能够起到显著的积极作用。现     

三联法治疗原发性三叉神经痛40例

目的观察针药结合治疗原发性三叉神经痛的临床疗效。方法选择原发性三叉神经痛患者80例,随机分为2组,治疗组采用电针火针配合中药内服,对照组口服卡马西平、维生素B1,观察疼痛消失缓解的情况,评定疗效。结果疗程结束后,治疗组临床治愈11例,显效21例,有效5例,无效3例,总有效率为92.50%。结论针药结合治疗原发性三叉神经痛疗效显著。     

射频热凝治疗三叉神经痛56例临床分析

目的 探讨射频热凝法治疗三叉神经痛的临床效果.方法 对2010年4月至2011年4月期间在我院就诊的三叉神经痛56例患者临床资料进行总结、分析.结果 经采取射频热凝治疗,56例三叉神经痛患者中,治疗效果为优良的有45例,占80.36%;好转的有9例,占16.07%,总有效率达96.43%.结论 三叉神经痛发病时疼痛难忍,反复发作,严重影响患者的生活质量.射频热凝法是目前三叉神经痛较理想的治疗方法,具有操作简便、安全、高效、严重并发症少、住院时间短、费用低、可重复治疗等优点,尤其适合对药物有不良反应以及不耐手术的老年人,随着先进的医疗仪器设备的不断开发,射频热凝法治疗三叉神经痛必将在临床得到广泛的应用.     

三叉神经根慢性压迫损伤对三叉神经节细胞髓鞘碱性蛋白及P75表达的影响

目的 探讨三叉神经节中卫星胶质细胞与神经元相互作用对三叉神经痛（TN）的影响。 方法 在SD大鼠假手术组（n=24）和三叉神经根慢性压迫诱导的TN大鼠模型组（n=24）中,运用免疫荧光和Western blotting方法,研究髓鞘碱性蛋白（MBP）、胶质纤维酸性蛋白（GFAP）及P75神经营养因子受体（P75NTR）在三叉神经节中的表达情况。 结果 TN模型组P75NTR 表达较假手术组增高,术后第7天和第14 天的表达增高有统计学意义（P<0.01）;MBP在TN模型组的表达较假手术组均降低,特别在第7和14天的表达降低有统计学意义（P<0.05）;卫星胶质细胞标志物GFAP在TN模型组术后第7、14和21天表达增高（P<0.01）。 结论 大鼠三叉神经根区慢性压迫损伤引起三叉神经节神经元MBP和P75NTR 表达改变和卫星胶质细胞的活化,可能影响神经元-卫星胶质细胞的相互作用,参与TN大鼠口面部周围伤害性信息向中枢的传递。     

Collateral projections of trigeminal ganglion neurons to both the principal sensory trigeminal and the spinal trigeminal nuclei in the rat

Employing a combination of fluorescent retro grade double labelling and immunofluorescence histo chemistry for substance P (SP) and calcitonin gene-relat ed peptide (CGRP), we examined collateral projections from single neurons in the trigeminal ganglion (TG) of the rat to both the principal sensory trigeminal nucleus (Vp) and the oral, interpolar or caudal subnuclei of the spinal trigeminal nucleus (Vo, Vi or Vc). In the rats that were unilaterally injected with fast blue (FB) into the Vp and with diamidino yellow (DY) into the Vo, Vi or Vc, neurons labelled with FB and/or DY were observed in the TG ipsilateral to the injections. Of the labelled TG neurons, about 2% were double labelled with both trac ers in the rats that were injected with FB into the Vp and with DY into the Vo or Vi, and about 10% were double labelled in the rats that were injected with FB into the Vp and with DY into the Vc. The results indicate that TG neurons sending their axons to the Vp project, by way of axon collaterals, to the Vc more frequently than to the Vo or Vi.Some of the TG neurons double labelled with FB and DY exhibited SP-or CGRP-like immunoreactivity (LI): Of the TG neurons that were double labelled with FB injected into the Vp and with DY injected into the Vo, Vi or Vc, about 38%, 49% and 42%, respectively, displayed SP-LI, and about 54%, 58% and 59%, respectively, showed CGRP-LI. Some of the SP-or CGRP-LI TG neurons that were double labelled with FB and DY were assumed to mediate pain signals to both the Vp and the spinal trigeminal nucleus (Vo, Vi and/or Vc) by way of axon collaterals.Yun-Qing Li is on leave from the Department of Anatomy, The Fourth Military Medical University, Xian, People's Republic of China     

脑干薄层3D-TOF磁共振扫描在原发性三叉神经痛的诊断价值

目的 三叉神经根部与周围血管关系的临床意义.方法 观察脑干薄层3D-TOF扫描的病例150例,MR 检查采用SIMENS3.0T磁共振机,使用头部8 通道线圈平扫,采用3DTOF 扫描程序,扫描参数:TR 23 ms,TE 3.6 ms,翻转角15°,FOV 165×220,层厚1 mm.统计分析了三叉神经痛组69例及...     

A qualitative and quantitative study of substance P immuno-cytochemistry of the trigeminal ganglion in the monkey

The immunoreactivity of substance P(SP) in the monkey trigeminal ganglion was examined and the distribution of immunoreactive cells determined. The monkey trigeminal ganglion is composed of clusters of sensory cells arranged in cords parallel to the long axis of the nerve fibres. The cells have prominent nuclei and are surrounded by satellite cells. Abundant organelles are randomly distributed throughout the cytoplasm. A striking feature of the ganglion was the presence of some axon-like prolifes containing mainly dense-cored vesicles and some agranular vesicles. Between 16 and 32% of the ganglion cells displayed SP-immunoreactivity. Most of the SP-IR cells were unipolar, small to medium-sized ganglion cells and they had no specific pattern of distribution. The staining of the SP-IR cells varied considerably, ranging from weak or moderate to heavy staining, although the majority of them were moderately stained. Immuno-electron microscopy showed that the SP-IR products were distributed throughout the soma of ganglion cells and not associated with any particular organelles or inclusions. The reaction products were also found in both myelinated and unmyelinated fibres between the ganglion cells. Another remarkable feature of the trigeminal ganglion was the occurrence of some SP-IR nerve fibres forming a rich glomerular network of pericellular arborizations around some of the SP-negative cells. Ultrastructural study showed the presence of some SP-IR nerve terminals in close approximation to some SP-negative cells, but there were no synaptic contacts. The relative frequency of the SP-IR pericellular arborizations paralleled the frequency of all the SP-IR cells. The results may imply that the pericellular arborizations function as a medium of communication between SP-positive and SP-negative sensory cells within the ganglion. It was suggested that the fibres forming the pericellular arborizations may originate from the intrinsic ganglion cells that are SP-positive.     

Fine structural features of light and dark cells in the trigeminal ganglion of the rat

Summary Prolonged fixation times and handling procedures designed to minimize the introduction of post mortem artifact were used in preparation of rat trigeminal ganglia for fine structural study. Larger, more numerous, light neurons and smaller, less numerous, dark neurons were observed. Major fine structural differences included a more discrete clumping of Nissl substance and more neurofilaments in the light compared with the dark cell. The results suggest that these differences are not artifacts of preparation.     

Typical and atypical neurovascular relations of the trigeminal nerve in the cerebellopontine angle: an anatomical study

The aim of the present study was to anatomically evaluate in adults the neurovascular trigeminal relations in the cerebellopontine angle (CPA), from a morphological and topographical perspective and thus to improve, detail and debate the pre-existing information, with educational and surgical implications. For the present anatomical study we performed bilateral dissections on 20 human adult skull bases, in formalin-fixed cadavers, at the level of the cerebellopontine angle, using the anatomical superior approach; we also studied 20 additional drawn specimens—cerebellum and brainstems, from autopsied cadavers, in order to better document the vasculature at the trigeminal root entry zone (REZ). The most constant but not exclusive neurovascular relations of the trigeminal nerves were those with the superior cerebellar artery (SCA) and the superior petrosal vein (the petrosal vein of Dandy). The regular possibility for the SCA to appear divided into a medial and a lateral branch and these to represent individual trigeminal relations at the level of the pontine cistern or REZ must not be neglected. The petrosal vein tributaries can also represent superior, inferior, or interradicular trigeminal relations. Arterioles emerging from the SCA or the anterior inferior cerebellar artery (AICA) represented trigeminal relations either at the REZ or were coursing between the trigeminal roots. A dissected specimen presented a radicular trigeminal artery emerging from the basilar artery and entering the trigeminal cavum inferior to the nerve. Another specimen presented two bony lamellae superior to the trigeminal nerve at the entrance in the trigeminal cavum—these lamellae were embedded within the lateral border of tentorium cerebelli and the posterior petroclinoid ligament. So we bring here an evidence-based support extremely useful not only for specialists dealing with this area but also for educational purposes. It appears important not only to consider the typical anatomy at this level but also to take into account the atypical and hardly predictable morphologies that may alter the diagnoses and the specific surgical procedures.     

The development of myelinated nociceptors is dependent upon trks in the trigeminal ganglion

Cell size of primary sensory neurons and distribution patterns of neurons that are immunopositive (ip) for VRL-1, a newly cloned capsaicin-receptor homologue, were examined in trigeminal ganglia (TGs) of knockout mice for trkA, trkB or trkC to determine the developmental dependency of myelinated nociceptors on expression of the genes. The number of TG neurons was strongly decreased in the knockout mice as compared to wildtype and heterozygous mice (82%, 39%, and 48% reduction for trkA, trkB and trkC, respectively). The absence of trkA and trkC reduced the number of TG neurons in all cell-size ranges. The number of medium-sized and large TG neurons was decreased in trkB-knockout mice, whereas that of small TG neurons was barely affected by trkB deficiency. TG contained abundant VRL-1-ip neurons in wildtype and heterozygous mice; 9% of TG neurons exhibited immunopositivity. In trkA-knockout mice, VRL-1-ip neurons almost disappeared (1% of TG neurons were VRL-1-ip). However, 13% and 9% of TG neurons in trkB- and trkC-knockout mice, respectively, were immunostained for the ion channel protein. In trkC-knockout mice, the proportion of large VRL-1-ip neurons decreased whereas that of small and medium-sized VRL-1-ip neurons increased. In addition, immunohistochemistry of the protein gene product 9.5 (PGP 9.5) demonstrated that trkA deficiency caused a marked reduction of varicose endings in the epithelium of the palatal mucosa. Loss of trkC diminished the number of PGP 9.5-ip varicose fibers in the deep layer of mucosal connective tissue of the palate. In tooth pulp, PGP 9.5-ip nerve fibers were absent in trkA-knockout mice but abundant in trkB- and trkC-knockout mice. The present study suggests that the development of myelinated nociceptors is dependent on trkA and trkC but not on trkB.     

TSEP和BAEP监测在三叉神经痛微血管减压术中的应用价值

目的：探讨三叉神经痛微血管减压术（MVD）中联合应用三叉神经诱发电位（TSEP）、脑干听觉诱发电位（BAEP）监测的价值。方法：2007年2月至2009年11月我院采用MVD治疗58例三叉神经痛病人,以术中使用电生理监测的30例患者为试验组,未使用这两种电生理监测的28例患者为对照组,对比分析两组有效率（三叉神经痛症状缓解或消失）及眩晕、听力下降等并发症的发生率。结果：试验组术后有效率为93％（28例）,发生眩晕1例（3％）和听力下降1例（3％）;对照组术后有效率为68％（19例）,发生眩晕8例（29％）和听力下降9例（32％）。两组MVD治疗疗效差异及并发症发生率比较差异均有统计学意义（P〈0．05）。结论：三叉神经痛MVD中,联合应用TSEP和BAEP作术中监测能较好地控制并发症的发生及提高三叉神经MVD的治疗效果。     

导航联合内镜辅助远外侧入路的解剖学研究

目的　探讨导航联合内镜辅助远外侧入路的可行性及对颅颈交界区腹侧解剖学特点的观察。 方法　对6例（12侧）尸头标本模拟远外侧入路,分别用显微镜、0度和30度内镜观察,随后磨除后内侧1/3枕髁和颈静脉结节,再次用显微镜观察（其中内镜下观察和磨除颅底骨性结构均在导航引导下完成）,比较这四种方式对颅颈交界区腹侧显露的差异。 结果　导航联合内镜能够通过面听神经、后组颅神经组成的上、中、下3个间隙近距离观察颅底结构,还能观察被颈静脉结节和枕髁遮挡的神经血管,与远外侧经髁入路显露范围相似。 结论　在内镜和神经导航辅助下,远外侧入路能够良好的观察颅颈交界区腹侧的神经血管结构,避免磨除颈静脉结节和枕髁,减少手术创伤。