微血管减压术治疗面肌痉挛合并三叉神经痛的疗效观察

目的：对微血管减压术（MVD）治疗面肌痉挛合并三叉神经痛的疗效进行观察。方法：选取2013年1月-2013年12月在本院以MVD进行治疗的面肌痉挛合并三叉神经痛患者12例,对患者术前采用三维时间飞跃序列技术经磁共振成像判断患者脑病变严重程度,并对手术过程、手术结果进行探讨。结果：术前磁共振成像图显示粗大扭曲椎动脉（VA）偏向于患侧,严重患者对侧的粗大扭曲椎动脉有向患处偏移的趋势。术中有5例患者椎动脉对面神经和三叉神经进行直接压迫,4例患者小脑前下动脉（AICA）和小脑后下动脉（PICA）对面神经和三叉神经间接进行压迫,3例患者小脑后下动脉对面神经进行压迫、小脑上动脉对三叉神经进行压迫。术后,8例患者疼痛症状消失彻底迅速,2例患者1个月后疼痛症状完全消失;2例患者术后7 d疼痛得到缓解,除此以外,还对患者的预后进行随访总结。结论：导致面肌痉挛合并三叉神经痛的主要原因为血管对面神经造成压迫,其直接或间接的责任血管为粗大移位的VA。MVD效果显著的关键在于该法是从后组颅神经开始,逐渐将VA向下移位,进行解剖,从根本上解决面神经受压迫问题,而并非简单地在神经与血管之间塞进垫片。微血管减压手术可有效治疗面肌痉挛合并三叉神经痛,且预后较好。同时本院提倡患者早诊断、找治疗,缩短病程,帮助尽早恢复。此法效果显著,值得在临床上广泛推广,帮助更多患者受益。

Clinical Observation of Microvascular Decompression （MVD） on the Treatment of Hemifacial Spasm Combined with Trigeminal Neuralgia

Objective： To observe microvascular decompression （MVD） on the treatment of hemifacial spasm combined with trigeminal neuralgia.Method： 12 patients with treatment of hemifacial spasm combined with trigeminal neuralgia by using MVD in our hospital from Jan. 2013 to Dec. 2013 were selected. Before operation, estimate the severity of patients＇ encephalopathy through magnetic resonance imaging with the help of three-dimensional time leap sequence technology. Besides,on the procedures and results of the operation were discussed.Result： Preoperative magnetic resonance imaging reveals that big and twisted vertebral artery （VA） leans to the affected side. Contralateral big and twisted vertebral artery of severe patient had the tendency of skewing to the affected area. During operation, there were 5 cases in which patients＇ vertebral arteries had direct pressure on facial nerves and trigeminal nerves; there were 4 cases in which patients＇ anterior inferior cerebellar artery（AICA ） and posterior inferior cerebellar artery （PICA） had indirect pressure on facial nerves and trigeminal nerves; there were 3 cases in which patients＇ posterior inferior cerebellar artery （PICA） had pressure on facial nerves as well as the superior cerebellar artery had pressure on trigeminal nerves. After operation, the pain of 8 patients had been released in a short time, and 2 patients had been free from pain completely after one month. In addition, we also made follow-up summaries for each patient after recovery.Conclusion： The Main cause of hemifacial spasm combined with trigeminal neuralgia is the pressure from blood vessels on facial nerves. Its direct or indirect offending vessel is big and dislocated VA. The key to the significant effect of MVD is that the operation starts from posterior cranial nerves and displaces the VA downwards gradually, which solves the problem of facial nerve oppression fundamentally rather than simply stuff the pad between nerves and blood vessels. Microvascular decompression is