老年人三叉神经痛的病因和微血管减压手术治疗

目的 探讨老年人三叉神经痛微血管减压手术的安全性和疗效。方法 回顾性分析82例经保守治疗无效的65岁以上老年三叉神经痛患者全麻下行手术治疗的临床资料。结果 77例患者经磁共振断层血管成像(MRTA)检查,显示责任血管压迫三叉神经63例(81．8％),肿瘤压迫神经5例(6．1％)。术后70例(85．4％)疼痛消失,8例(9．7％)症状明显减轻,手术有效率95．1％。治疗有效中的66例获随访2～106个月,平均31个月。术后3年内复发5例,复发率7．6％。结论 本组未出现与年龄相关的术后并发症,预后较好,只要操作熟练和围手术期的处理规范,手术的安全性和有效性是有保障的。继发性病因在老年三叉神经痛患者中并非少见。特殊序列的磁共振检查不仅有助于发现继发性病因,而且能够显示压迫责任血管,对指导手术和患者筛选都有重要价值。

Etiology of trigeminal neuralgia in elderly patients and its management with microvascular decompression

Objective To explore the etiology of trigeminal neuralgia in patients over 65 years of age and the effectiveness and safety of microvascular decompression operation(MDO). Methods Eighty-two patients with ages ranging from 65~94(average 72.8 years) were included in this study. A high-resolution magnetic resonance imaging was incorporated into preoperative algorithm to select successful candidates for microvassular MDO. Results Five cases of secondary causes were found including 2 cases of meningioma, 2 cholesteatoma and one acoustic neuroma . In 77 cases of so-called "primary" trigeminal neuralgia, however, offending vessels were discerned on MRTA by 81.8%. Operations were uneventful with no major complications. The effective rate was 95.1%, with 85.4% immediate complete cure and 9.7% little residual pain with no further medication. Four point nine percent patients were not benefited from operation. Follow-up was made in 66 successful cases for an average of 31 months. 5 cases recurred within 3 years after operation. Conclusions There is no serious morbidity or mortality that could be ascribed to old age and the operative result is favorably compared with the outcome in a younger age group. Intensive perioperative care and matured microsurgical technique are the musts in carrying out such kind of delicate functional operation. Intracranial tumor as a cause of trigeminal neuralgia is not rare in elderly patients. A thorough MRI check-up is mandatory in order not to miss the secondary cause and find offending vessel definitely.