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三叉神经痛颅内段手术前后面部浅感觉功能的改变及其影响因素分析
引用本文:张剑宁,曹奕,李明,马兆鑫. 三叉神经痛颅内段手术前后面部浅感觉功能的改变及其影响因素分析[J]. 临床耳鼻咽喉头颈外科杂志, 2008, 22(22): 1032-1035
作者姓名:张剑宁  曹奕  李明  马兆鑫
作者单位:上海市中医药大学附属岳阳医院耳鼻咽喉科,上海,200437;上海市中医药大学附属岳阳医院耳鼻咽喉科,上海,200437;上海市中医药大学附属岳阳医院耳鼻咽喉科,上海,200437;上海市中医药大学附属岳阳医院耳鼻咽喉科,上海,200437
摘    要:目的:探讨经乙状窦后径路的三叉神经痛颅内段手术前后面部浅感觉功能的改变及相关影响因素。方法:收集2006年3月~2008年1月间因原发性三叉神经痛住院手术的患者56例,所有病例均经乙状窦后径路行三叉神经血管减压术联合电凝梳理术或电凝梳理术,记录术前及术后1周面部触觉、痛觉及温度觉评分,结合神经根受血管压迫情况,了解手术对面部浅感觉功能的影响并分析相关原因。结果:术后面部感觉正常19例(占33.9%),感觉减退37例(占66.1%)。术后1周各分支浅感觉评分较术前显著降低(P<0.05);第Ⅰ支支配区域的触觉及温度觉评分手术前后无显著差异(P>0.05),痛觉评分存在显著差异(P<0.01);第Ⅱ、Ⅲ支手术前后各类浅感觉评分均存在显著差异(P<0.01);第Ⅲ支外侧痛觉和温度觉评分的下降值显著低于内侧(P<0.05),触觉无显著差异。56例患者中,有责任血管者45例,其中术后感觉减退26例;无责任血管者11例,术后感觉均减退。术后感觉减退组,责任血管出现在神经根远端、中段和近端的比例分别为42.3%、26.9%和30.8%;感觉正常组的责任血管63.2%(12例)出现在近端,仅5.3%(1例)出现在远端。结论:三叉神经痛颅内段手术对面部不同部位的浅感觉功能均有不同程度的影响。除手术直接损伤外,感觉根特别是三叉神经入脑桥区受机械性牵拉可能是造成术后感觉障碍的重要原因。

关 键 词:三叉神经痛  手术  感觉减退

Study on changes of face superficial sensory function and its relating factors after intracranial surgery of trigeminal nerve
ZHANG Jianning,CAO Yi,LI Ming,MA Zhaoxin. Study on changes of face superficial sensory function and its relating factors after intracranial surgery of trigeminal nerve[J]. Journal of clinical otorhinolaryngology, head, and neck surgery, 2008, 22(22): 1032-1035
Authors:ZHANG Jianning  CAO Yi  LI Ming  MA Zhaoxin
Abstract:Objective:To explore changes of facial sensory function after intracranial surgery in the treatment of idiopathic trigeminal neuralgia(TN) and their possible reasons.Method:Fifty-six patients of TN receiving trigeminal microvascular decompression(MVD) or nerve combing or coagulation surgery by post-sigmoid approach from 2006 to 2008 were observed.Their sensory score of pain,temperature and tactile were recorded before and 1 week after surgery.These scores as well as status of neurovascular conflict in trigeminal sensory root were analyzed and potential reasons were discussed.Result:Nineteen(33.9%) cases had normal facial sense after surgery and 37(66.1%) cases had a decreased sensation.Sensory scores of each divisions 1 week after surgery were significantly lower than those before surgery(P<0.05).The tactile and temperature sensory score of the first division had not significant difference before and after surgery(P>0.05 respectively),while the pain sensory had obvious difference(P<0.01).In the third division the descend score of pain and temperature in the lateral portion was lower than that of the medial portion(P<0.05),but tactile score had not differences.In all 56 patients,45 had neurovascular conflict and 26 of them had a decreased facial sense.While in 11 cases without responsible vessel,their facial sense were all abnormal.In the abnormal sensory group,the ratio of conflict vessel presenting at caudal,middle and rostral end of sensory root is 42.3%,26.9% and 30.8% respectively.In normal sensory group,63.2% cases had rostral conflict vessel and only 5.3% had caudal conflict vessel.Conclusion:Intracranial surgery of trigeminal nerve results different changes of superficial sensation on the different portion of the face.In addition to direct injury,stretching of the sensory root(especially at root entry zoon) is an important possible responsibility of postoperative sensory hypesthesia.
Keywords:Trigeminal neuralgia  Surgery  Hypesthesia
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