经乙状窦后入路三叉神经微血管减压术125例临床分析

目的 总结微血管减压术治疗三叉神经痛的临床经验。方法 术前对125例三叉神经痛患者进行磁共振断层血管成像（MRTA）检查，手术时经乙状窦后锁孔入路，在神经出脑干区寻找责任血管，进行神经、血管的充分游离减压，血管与脑干间置入Teflon棉。结果 术后125例三叉神经痛患者中，121例术后疼痛消失或明显减轻；4例术后症状无明显改善，经射频治疗后疼痛消失。121例随访1～7年，2例两年后复发，总有效率95、2％，其余均无疼痛发作。术后2例出现颅内感染，无永久性并发症出现。结论 头颅MRTA检查有助于术前判断责任血管与神经的关系，手术时在神经出脑干区发现责任血管并进行充分游离减压是手术成功的关键。

Treatment of Trigeminal Neuralgia by Microvascular Decompression through Retrosigmoid Approach (a report of 125 Cases)

Objective To summarize the experience in treating trigeminal neuralgia by microvascular decompression through retrosigmoid approach. Methods Magnetic resonance tomographic angiography (MRTA) were performed before the operation in 125 patients with trigeminal neuralgia who were treated with microvascular decompression through retrotsigmoid approach. The vessels which were responsible for the neuralgia were identified at root exit zone. A piece of shredded Teflon felt was placed between the vessel and the brain stem after the vessel and the nerve were fully dissociated. Results After the operation, the neuralgia disappeared or was significantly relieved in 121 patients and was insignificantly relieved in 4 patients, in whom the neuralgia disappeared after radiofrequency gangliolysis. Following-up of 121 patients, in whom the neuralgia disappeared or was significantly relieved, from 1 to 7 years showed that the trigeminal neuralgia recurred in 2 patients 2 years after the operation and total effective rate was 95.2%. Conclusions MRTA has an important value for determining the vessels which are responsible for the trigeminal neuralgia. Finding out the vessels which are responsible for the neuralgia at root exit zone and full dissociation and decompression of the vessels and the nerves are the key to the successful operation.