显微血管减压术后复发三叉神经痛的手术治疗

目的探讨显微血管减压术后复发三叉神经痛的手术治疗方法。方法1998年1月至2005年12月采用显微神经外科手术治疗37例显微血管减压术后复发三叉神经痛患者，30例患者行三叉神经感觉根部分切断术，单纯三叉神经显微血管减压术3例，显微血管减压术加行感觉根部分切断术4例。结果95％患者术中发现有CPA局部蛛网膜明显增厚粘连。全部患者获平均38．2个月的随访。随访期间总有效率97％。并发症：行三叉神经感觉根部分切断术者术后均有面部麻木，随访期间均见不同程度好转；术后发生听力障碍合并轻度面瘫1例，复视1例，随访期间好转；术后发生化脓性脑膜炎1例，出院时治愈；1例高龄患者术后发生小脑半球出血，量约5ml，经保守治疗后好转出院。结论CPA局部蛛网膜严重粘连是导致显微血管减压术后疼痛复发的最重要原因，二次手术时的术式选择应以三叉神经感觉根部分切断术为主。

The microsurgical management of patients with recurrent trigeminal neuralgia after microvascular decompression

Objective To study the microsurgical management of patients with recurrent trigeminal neuralgia after microvascular decompression. Methods 37 cases of patients with recurrent trigeminal neuralgia alter microvascular decompression were treated by microsurgical operations from 1998 to 2005. 30 cases were treated by partial rhizotomy(PR) of the sensory root of trigeminal nerve, 3 eases were treated by microvascular decompression (MVD) , MVD and PR were performed simultaneously in 4 cases. Results Severe adhesion of local arachnoid membrane was found in 95% cases. All cases were followed up for about 38.2 months (mean duration). The total effective rate during the follow-up period was 97%. The complications included: Facial numbness was found in all cases of PR; 1 case had hearing dysfunction and facial paralysis; I diplopia, 1 bacterial meningitis and 1 cerebellar hematoma. Conclusion Severe adhesion of local arachnoid membrane was the main cause of recurrence of postoperative trigeminal neuralgia. The partial rhizotorny of sensory root of trigeminal nerve should be the choice of the second microsurgical procedure.