微血管减压术治疗典型及非典型三叉神经痛的疗效对比研究

目的探讨微血管减压术治疗典型及非典型三叉神经痛的不同疗效及其可能机制。方法寸比分析2003～2004年间经微血管减压术治疗的45例典型三又神经痛患者及17例非典型三叉神经痛患者的临床特征、术中所见年口手术疗效。结果45例典型三叉神经痛患者中，平均痛程3．1年，平均发病年龄60．3岁。其中20例（44．4％）患者中疼痛累及三又神经的单一分支，其余25例（55．6％）疼痛均累及2或3个分支。术中见39例（86．7％）为动脉压迫，6例（13．3％）为动脉和静脉混合压迫。术后疼痛完全缓解44例（97．8％），明显减轻1例（2．2）。而在17例非典型三叉神经痛患者中，平均病程8．7年，平均发病年龄55.5岁，疼痛均累及三叉神经的2或3个分支。术中见10例（58．8％）为动脉压迫，7例（41．2％）为动脉年口静脉混合压迫。术后疼痛完全缓解5倒（29.4％），明显减轻10例（58．8％），无效2例（11．8％）。结论微血管减压术治疗典型三叉神经痛的疗效明显优于非典型患者，这可能与典型三叉神经痛患者的病程较短、发病年龄较晚、疼痛多呈单支分布、且以动脉压迫为主以及术中能够实现充分减压有关。

Study on the Effect of Microvascular Decompression in Treating Typical and Atypical Trigeminal Neuralgia

Objective To evaluate the therapeutic effect and mechanisms of microvascular decompression in treating typical and atypical trigeminal neuralgia.Methods From 2003 to 2004,45 patients with typical trigeminal neuralgia and 17 patients with atypical trigeminal neuralgia treated with microvascular decompression were reviewed,including clinical feature,findings in operation and clinical therapeutic effect.Results Of 45 patients with typical trigeminal neuralgia,the mean course of disease is 3.1 years and the mean age of pain onset is 60.3 years.Single trigeminal branch was involved in 20 patients(44.4%),and 2 or 3 branches were involved in the other 25 patients(55.6%).During 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 achieved in 44 patients(97.8%),and significant partial pain relief achieved in 1 patients(2.2%).As for 17 patients with atypical trigeminal neuralgia,the mean duration and the mean age of pain onset is 8.7 years and 55.5 years respectively.2 or 3 trigeminal branches were involved in all of atypical patients.During operation,artery compression occurred in 10 patients(58.8%),and the combined artery and venous compression were found in 7 patients(41.2%).Postoperatively,complete pain relief achieved in 5 patients(29.4%),significant partial pain relief achieved in 10 patients(58.8%),and 2 patients showed no response to microvascular decompression.Conclusions The effect of microvascular decompression in treating typical trigeminal neuralgia were better than in atypical trigeminal neuralgia, which might relate to shorter duration,older age of pain onset,limited distribution,artery compression and complete operative decompression.