微血管减压术治疗典型及非典型三叉神经痛的疗效比较

目的比较微血管减压术治疗典型及非典型三叉神经痛的疗效,探讨其机制.方法对比分析62例经微血管减压术治疗的三叉神经痛病人的临床特征、术中所见和手术疗效.其中45例为典型者,17例为不典型者.结果典型病人平均病程3.1年,平均年龄60.3岁;20例（44.4%）疼痛累及三叉神经的单一分支,25例为2～3支痛;术中见39例（86.7%）为动脉压迫,6例为动静脉混合压迫;术后44例（97.8%）疼痛缓解,1例无效.非典型病人平均病程8.7年,平均年龄55.5岁;均为多支疼痛病人;术中见10例（58.8%）为动脉压迫,7例为动静脉混合压迫;术后疼痛缓解5例（29.4%）,减轻10例（58.8%）,无效2例.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者,可能与其病程较短,发病年龄较晚,疼痛多呈单支分布,以动脉压迫为主,且术中能够实现充分减压有关.

Operative outcomes of microvascular decompression for typical and atypical trigeminal neuralgia: contrast study

Objective To evaluate the operative outcomes and probe the mechanisms of microvascular decompression for treating typical and atypical trigeminal neuralgia.Methods Clinical features,operative findings and outcomes of 62 trigeminal neuralgia patients,including 45 typical and 17 atypical cases,treated by microvascular decompression were analyzed comparatively.Results Of 45 patients with typical trigeminal neuralgia,the mean disease course was 3.1 years and the mean age at pain onset 60.3 years.Single trigeminal branch was involved in 20 patients(44.4%),and 2 or 3 branches were involved in the other 25.During operation,arterial compression was found in 39 patients(86.7%),and both arterial and venous compressions were found in 6.Postoperatively,pain was relieved completely in 44 patients(97.8%),and partially in 1.As for 17 patients with atypical trigeminal neuralgia,the mean disease duration and the mean age at pain onset were 8.7 years and 55.5 years respectively.2 or 3 trigeminal branches were involved in all the atypical patients.During operation,it was found that arterial compression occurred in 10 patients(58.8%),and both arterial and venous compressions in 7.Postoperatively,pain was relieved completely in 5 patients(29.4%),partially in 10(58.8%),and 2 showed no response.Conclusion The operative outcomes of microvascular decompression for trigeminal neuralgia were better in typical than in atypical cases,which might relate to shorter disease duration,older age of pain onset,pain distribution,arterial compression and sufficient decompression.