三叉神经痛显微血管减压术中非动脉压迫因素的处理策略

目的探讨三叉神经痛显微血管减压术中非动脉性压迫因素的处理对策,以提高手术效果。方法回顾性分析150例三叉神经痛显微血管减压术术中资料。根据不同的原因,单独或联合采取压迫静脉电凝切断、蛛网膜松解以感觉根纵向梳理术等处理方法。结果岩静脉接触或压迫18例,所有病例均将岩静脉电凝、切断,12例同时进行三叉神经感觉根纵向梳理术。岩静脉接触或压迫合并蛛网膜粘连8例,岩静脉电凝、切断同时行三叉神经颅内段全长蛛网膜粘连松解术。单纯蛛网膜肥厚、粘连5例,全部行三叉神经颅内段全长蛛网膜粘连松解术,同时进行三叉神经感觉根纵向梳理术。既无静脉压迫,也无蛛网膜粘连3例,均行三叉神经感觉根纵向梳理术。术后随访6个月至2年,疼痛消失者32例,2例明显缓解;3例出现面部轻度麻木,半年后消失;1例不全面瘫1年后恢复;1例术侧听力减退,1年后无恢复。结论三叉神经痛显微血管减压术中非动脉性致痛因素处理更为复杂,术中针对不同的原因,单独或联合采用压迫静脉电凝切断、蛛网膜松解、感觉根纵向梳理术,可望取得理想的止痛效果。

Processing strategy of microvascular decompression for trigeminal neuralgia with non-arteriosity

Objective To investigate the treatment measures of trigeminal neuralgia with non-arteriosity compression and improve the operation effect.Methods Operation data of 150 trigeminal neuralgia patients were analyzed retrospectively.Based on the different reasons of trigeminal neuralgia,the subjects was performed disjunction of the compression vein,arachnoid mater lysis and carding manipulation of sensory root of trigeminal nerve sensory root,alone or in combination.Results 18 patients with trigeminal neuralgia were caused by vena petrosa compression or contiguity.All the patiens accepted disjunction of vena petrosa and 12 of the patients were performed carding manipulation of sensory root of trigeminal nerve.8 patients with trigeminal neuralgia were caused by vena petrosa and arachnoid adhesion and disjunction of vena petrosa and arachnoid mater lysis were performed.Etiological factor of 5 patients was only arachnoid adhesion and pachynsis.The 5 patients accepted arachnoid mater lysis and carding manipulation of sensory root of trigeminal nerve.3 patients were not found compression reason and carding manipulation of sensory root of trigeminal nerve were performed.All the patients were followed up for 6 months to 2 years.Pain was disappeared in 32 cases,relieved in 2 case.3 cases appeared mild facial numbness and disappeared after six months.One case suffered from incomplete facial palsy and recovered after 1 year.1 patient occurred amblyacousia,without recovery after 1 year.Conclusion Treatment of trigeminal neuralgia with non-arteriosity compression was more complex.In order to achieve the ideal effect of surgery,operative method should be selected disjunction of the compression vein,arachnoid mater lysis,carding manipulation of sensory root of trigeminal nerve and sensory root rhizotomy of trigeminal nerve,alone or in combination,based on the difference reasons.