显微血管减压术治疗原发性三叉神经痛

目的：探讨原发性三叉神经痛显微外科手术方法和效果。方法：应用三叉神经根显微血管减压术治疗原发性三叉神经痛36例,探讨手术技巧及效果。结果：三叉神经根显微血管减压术治疗原发性三叉神经痛创伤小,手术疗效满意。结论：三叉神经根显微血管减压术是治疗原发性三叉神经痛的较好手术方案。     

原发性三叉神经痛的微血管减压术治疗

目的评价微血管减压术治疗原发性二叉神经痛的效果。方法运用三叉神经微血管减压术探查三叉神经并分离责任血管，在微血管与三叉神经间垫人Teflon涤纶绵。结果20例患者术后疼痛完全缓解19例，仅1例仍有轻微疼痛，无永久性并发症。结论三叉神经微血管减压术是三叉神经痛的一种病因性治疗，疗效确切，三叉神经功能可以得到保护，是首选治疗方法。     

神经内镜辅助下三叉神经微血管减压术的手术配合

三叉神经痛是一种顽固性疼痛，传统的外科治疗方法存在缓解率不高，有较高的复发率和并发症。由于微血管减压术能明显克服这些弊端，近来倍受推广。我院自1996年10月-2007年10月采用三叉神经微血管减压术治疗三叉神经痛408例，取得了较好的疗效，手术后疼痛缓解率达97．2％，其中特别是近3年来我们将神经内镜应用于该手术，目前利用内镜辅助手术已经开展了68例，手术后疼痛缓解达到100％，现将手术配合总结如下。[第一段]     

采用显微血管减压术治疗三叉神经痛

目的：总结近年采用显微血管减压手术治疗三叉神经痛的方法和结果，以期进一步提高手术治愈率。方法：回顾分析从1994年1月至2003年12月进行后颅窝手术探查的21例原发性三叉神经痛患者。19例行显微血管减压术。有1例术中采用脑室镜协助观察。结果：在头颅磁共振扫描上，有11例可见疼痛一侧的桥脑旁有异常血管影。术中发现三叉神经出脑干处有血管压迫者19例(动脉血管压迫16例，静脉血管压迫3例)。19例中，术后早期疼痛完全缓解17例。结论：显微血管减压术是治疗原发性三叉神经痛的安全和有效的方法。     

三叉神经痛显微血管减压术20例临床分析

三叉神经痛显微血管减压术是原发性三叉神经痛首选的手术方法,疗效可靠,可保留三叉神经功能,是目前治疗原发性三叉神经痛的最好方法。现将1998年2月～1999年12月20例三叉神经痛显微血管减压术的临床资料分析如下。     

乙状窦后进路三叉神经微血管减压术的手术配合和体会

原发性三叉神经痛是临床常见的神经科病症,由于其剧烈的颜面部疼痛而严重影响患者的生活质量.随着显微外科技术的发展,治疗上取得很大进步.微血管减压手术治疗三叉神经痛的治愈率为86%～98%[1].本院2007年1月～2010年3月运用三叉神经微血管减压术治疗原发性三叉神经痛18例,取得满意疗效,现将手术配合及体会报道如下.     

显微外科手术治疗原发性三叉神经痛

目的:探讨运用乙状窦后入路三叉神经根显微血管减压手术治疗原发性三叉神经痛的疗效评估。方法:对38例原发性三叉神经痛患者实施显微神经血管减压手术,通过手术前后症状改善情况评定其临床疗效。结果:38例患者症状完全缓解33例,4例仍有轻微疼痛,1例症状改善不明显。结论:显微外科手术治疗原发性三叉神经痛为目前一种针对患者发病机制治疗的有效、首选方法。     

显微手术治疗中青年三叉神经痛的临床疗效

【目的】探讨显微手术治疗中青年三叉神经痛病人的疗效和手术方式。【方法】回顾分析63例中青年三叉神经痛患者的临床资料,其中21例可见明显责任血管压迫,并且有压痕;36例可见责任血管与神经相贴,无明显压痕;6例未见明显责任血管压迫。31例行三叉神经微血管减压术,32例行蛛网膜松解术。【结果】本组63例无手术死亡,治疗后全部有效,随访49例,5例复发。【结论】三叉神经微血管减压术,蛛网膜黏连松解术是治疗中青年三叉神经痛患者的有效方法。     

继发性三叉神经痛诊疗策略

目的探讨继发性三叉神经痛的诊断及治疗策略。 方法回顾使分析北京大学人民医院神经外科2017年1月至2022年3月临床收治的继发性三叉神经痛患者，共34例，并参考相关文献。 结果34例继发性三叉神经痛病例均由占位性病变引起，所有患者均接受手术治疗，31例肿瘤完全切除，3例部分切除，其中10例术中发现血管压迫三叉神经，行三叉神经微血管减压术。术后33例患者的疼痛症状消失，1例患者明显减轻。 结论相应CPA区占位性病变是继发性三叉神经痛的首要病因，原发性因素可同时存在，头颅CT及MRI检查必不可少，手术是治疗继发性三叉神经痛的首选治疗手段。术中切除肿瘤后，应注意是否存在血管压迫神经情况，做到三叉神经充分减压。     

Jannetta微血管减压术治疗三叉神经痛

目的 探讨三叉神经痛的显微外科手术疗效。方法 回顾分析30例使用显微镜行Jannetta微血管减压术治疗的三叉神经痛患者(均为内科治疗无效患者)的临床资料。结果 全部患者术后疼痛消失，无一例永久性并发症出现，2年复发率为20％。结论 Jannetta微血管减压术治疗三叉神经痛可获得良好的治疗效果。     

Studies on the operative outcomes and mechanisms of microvascular decompression in treating typical and atypical trigeminal neuralgia

OBJECTIVE: To evaluate the operative outcomes and mechanisms of microvascular decompression in treating typical and atypical trigeminal neuralgia. METHODS: A group of 45 patients with typical trigeminal neuralgia and 17 patients with atypical trigeminal neuralgia treated by micro-vascular decompression from 2000 to 2002 were reviewed, including their clinical presentations, operative findings, and outcomes. RESULTS: Of 45 patients with typical trigeminal neuralgia, the mean duration was 3.1 years, and the mean age of pain onset was 60.3 years. Single trigeminal division was involved in 20 patients (44.4%), and 2 or 3 divisions were involved in the other 25 patients (55.6%). During the operation, artery compression was found in 39 patients (86.7%), and the combined artery and venous compression was found in 6 patients (13.3%). Postoperatively, complete pain relief was achieved in 44 patients (97.8%), and significant pain relief was achieved in 1 patient (2.2%). As for 17 patients with atypical trigeminal neuralgia, the mean duration and the mean age of pain onset was 8.7 years and 55.5 years, respectively. Two or 3 trigeminal divisions were involved in all of these patients. During operation, artery compression occurred in 10 patients (58.8%), and the combined artery and venous compression was found in 7 patients (41.2%). Postoperatively, complete pain relief was achieved in 5 patients (29.4%), and partial pain relief was achieved in 10 patients (58.8%), and 2 patients showed no response to microvascular decompression. CONCLUSIONS: The operative outcome of microvascular decompression in patients with typical trigeminal neuralgia was better than that of patients with atypical trigeminal neuralgia, which perhaps related to short duration, late onset of pain, limited distribution, artery compression, and complete operative decompression.     

微血管减压术治疗三叉神经痛的疗效及其并发症的预防与处理

目的探讨微血管减压术治疗三叉神经痛的疗效及其并发症的预防与处理策略。方法采用微血管减压术治疗93例三叉神经痛患者,对其临床疗效及术后并发症等临床资料进行回顾性分析。结果 93例中89例术后疼痛症状消失,有效率为95.70%。术后并发症的发生情况：皮下积液4例,脑脊液漏1例,听力下降3例,耳鸣3例,面神经功能障碍4例,手术无效4例,死亡1例。结论微血管减压术治疗三叉神经痛是一种十分成熟的技术,规范手术的各种操作和积极应用监测技术能够尽量避免各种并发症的发生,显著提高手术的安全性。     

感觉根入髓区血管压迫是三叉神经痛的主要病因

目的:研究显微血管减压手术(microvascular decompression, MVD)治疗三叉神经痛(trigeminal neuralgia, TN)的适应症、术中所见、术后疗效和安全性.探讨TN的主要病因及发病机制.方法:2000年12月到2003年10月间,169例TN患者接受了显微外科手术,手术前后进行了直观模拟量表(Visual Analogue Scales, VAS)评分.结果:术后1周疼痛消失131例,疼痛减轻35例,疼痛无变化3例.手术前后VAS评分分别为8.86±1.08和0.48±0.12,统计结果表明手术前后疼痛改变有显著性差异.术后无死亡病例,手术并发症多为暂时性并发症.随访期间有4例复发.结论:MVD手术的有效性证明了三叉神经感觉根入髓区血管压迫是TN的主要病因.     

Diagnosis and treatment of trigeminal neuralgia

Trigeminal neuralgia is a disease affecting older individuals. The clinical hallmark of trigeminal neuralgia is a sudden, excruciating paroxysm of pain in the area of the trigeminal nerve. Drug therapy is considered the first line of treatment for trigeminal neuralgia. Anticonvulsant carbamazepine has been used. If relevant pharmacotherapy has been tried without any effect, other procedures are selected. These procedures are microvascular decompression(a radical technique), glycerol trigeminal rhizotomy, percutaneous trigeminal nerve decompression and nerve block. Nerve block with neurolytic solutions and radiofrequency thermocoagulation is a simple, less invasive therapy. In order to avoid hypesthesia and dysesthesia, nerve block using a high concentration of local anesthetics is recommended. In recent years, stereotactic radiosurgery for trigeminal neuralgia has emerged as a new therapeutic modality.     

Ergebnisse der mikrochirurgischen vaskulären Dekompression bei der Trigeminusneuralgie

INTRODUCTION: From 1 August 1983 to 6 June 1992, 284 patients underwent decompression of the trigeminal root in the rear part of the skull as treatment for tic douloureux. According to preoperative diagnosis and intraoperative inspection, a space-occupying process was the cause of the typical neuralgia in 13 cases (4 meningiomas, 3 epidermoid tumours, 3 acoustic neuromas and 2 trigeminal neuromas). In 271 cases (95.4%) microsurgical vascular decompression according to Jannetta was carried out. METHODS: The majority of patients were between 45 and 75 years of age. The follow-up period ranged from 10 months to 9.3 years (average 59.45 months). The results of the long-term investigations are based on standardized questionnaires completed by 202 patients. Of the total of 271 patients operated upon by Jannetta's technique, 261 (96.3%) were free of pain immediately after the operation. The main causes of failure were misdiagnosis (myoarthropathy, cluster headache) and incorrect indications (encephalomyelitis disseminata, trigeminal neuropathy following peripheral lesion). In 3 cases vascular displacement and complete decompression of the trigeminal root were impossible because the basilaris was exceptionally long. RESULTS: In the long term, 87.6% of the patients operated on remained free of pain or improved sufficiently to require no further carbamazepine medication. Relapses developed in 7.4% of cases, and except for operative revision and rhizolysis of the trigeminal root in a case of relapsed trigeminal neuralgia, thermo-controlled high-frequency lesion of the gasserian ganglion was carried out in a second operation. The complications of the Jannetta operation were hypoacusis and anacusis (4%), hyposmia (1%), dizziness (3.5%) and chronic subdural haematoma (1 case). Neither postoperative bacterial meningitis nor any lethality was recorded. In 94.5% of cases the patients expressed positive opinions of the operation and its results, while 4% regretted having the operation and 1.5% were undecided. The question as to whether the operation had significantly improved the quality of life was answered in the affirmative by 88.4% of the patients. DISCUSSION: In summary, the long-term results confirm that microsurgical vascular decompression can be offered as the method of choice for treatment of trigeminal neuralgia in younger patients, and in older patients when cardiopulmonary risk factors and cerebrovascular processes can be eliminated. Alternative methods are high-frequency lesionsing of the gasserian ganglion according to Sweet and chemorhizolysis of the gasserian ganglion, but these must be restricted exclusively to the treatment of typical trigeminal neuralgia with tic douloureux. Persistent neuropathic pain caused by atraumatic or drug-induced lesion to the trigeminal nerve cannot be positively influenced either by surgical decompression or by destructive operations on the gasserian ganglion.     

Neurosurgical therapy of facial neuralgias

INTRODUCTION: Neuralgias of the face, especially trigeminal neuralgia and glossopharyngeal neuralgia are indications for surgical interventions after failed medical therapy. In contrast to other forms of headache or atypical facial pain, where surgical measures are considered to be contraindicated, percutaneous procedures or microvascular decompression are able to produce immediate and longstanding pain relief. Careful preoperative evaluation is essential to confirm the clinical diagnosis and to rule out other causes as multiple sclerosis or tumors afflicting the cranial nerves. The following study will summarize the common surgical techniques and their role considering a mechanism-based therapy as well as document long-term results of these measures. METHODS: Between 1977 and 1997 316 thermo-controlled radiofrequency trigeminal rhizotomies (TK) and 379 microvascular decompressions (MVD) were performed in our hospital to treat trigeminal neuralgia; additional 6 MVDs for glossopharyngeal neuralgia and one MVD of the intermediate facial nerve were carried out. Questionnaires were sent out to all patients still living in 1981, 1982, 1992 and 1998. For all other patients, interviews with relatives or the general practitioners were conducted. A retrospective analysis of postoperative pain relief was performed using Kaplan-Meier curves at the latest follow-up. Additionally 80 patients underwent careful quantitative sensory testing with Von-Frey-hairs. RESULTS: 225 patients who underwent microvascular decompression and 206 with radiofrequency trigeminal rhizotomies were further analyzed. There was a 50% risk for pain recurrence two years after radiofrequency rhizotomy. On the other hand 64% of patients who underwent microvascular decompression remained painfree 20 years postoperatively. Patients with microvascular decompression without sensory deficit were painfree significantly longer than patients with postoperative hypesthesia. DISCUSSION: Etiology and pathogenesis of facial neuralgias are far from understood despite several hypotheses. Based on current models there is no explanation for the immediate pain relief especially after microvascular decompression. Some authors even discuss surgical trauma as the only cause for postoperative pain relief.     

Percutaneous controlled thermocoagulation in the treatment of trigeminal neuralgia

This study reviews the results and complications of 162 percutaneous thermocoagulations of the gasserian ganglion in 124 patients with typical idiopathic trigeminal neuralgia. The mean duration of follow-up observation was 3.7 years (range, 1-6 years). One hundred eighteen of 124 patients continued to show complete pain relief 1 month after the operation, and at the end of follow-up observation, 83 of 124 patients (67%) continued to enjoy complete pain relief (recurrence rate, 28.2%). Anesthesia dolorosa occurred in 3% of cases, dysesthesia in 3%, and paresthesia in 17%; neuroparalytic keratitis with permanent reduction of visual acuity was observed in 2% of cases, permanent diplopia in 1%, permanent hearing deficit in 3%, and permanent impairment of mastication in 3%. We compare thermocoagulation with other surgical procedures (microvascular decompression, glycerol injection, and percutaneous decompression) used in the treatment of trigeminal neuralgia.