三叉神经痛微血管减压术后疼痛不缓解的治疗体会

目的 探讨三叉神经微血管减压(MVD)术后患者疼痛不缓解的治疗方法 . 方法 对北京大学人民医院神经外科自2005年1月至2009年6月收治的50例原发性三叉神经痛患者行MVD术后手术效果进行回顾性分析.对术后疼痛不缓解的患者应用经皮卵圆孔三叉神经池甘油封闭术治疗. 结果 50例患者MVD术后有3例疼痛不缓解.3例患者中对责任血管实施减压者2例,无责任血管仅行梳理者1例;3例患者均有蛛网膜粘连增厚.应用经皮卵圆孔三叉神经池甘油封闭术治疗后疼痛消失. 结论 尽管实施有效的MVD术仍不能保证所有患者术后疼痛缓解,特别是无责任血管者,术后持续疼痛可能性更大.荧屏监视下经皮卵圆孔穿刺半月节甘油封闭术为MVD术后疼痛不缓解者提供了一种避免再次开颅、简便易行、安全有效的方法 .

Treatment of non -remission of trigeminal neuralgia after microvascular decompression

Objective To explore the treatment of non-remission of trigeminal neuralgia after microvascular decompression (MVD). Methods The data of 50 patients with trigeminal neuralgia from 2005 to 2009 were reviewed and analyzed; those with non-remission of trigeminal neuralgia after MVD were performed percutaneous shutdown of trigeminal cistern with glycerol via foramen ovale. The operative efficacy was compared. Results Three (6%) patients were noted with non-remission outcomes: 2 with blood vessel compression were performed MVD and 1 without blood vessels compression did not receive MVD procedure; all these 3 patients had thicken adhesion of the arachnoid.The pain was remitted after the showdown operation. Conclusion Percutaneous shutdown oftrigeminal cistern with glycerol is a safe and effective surgical method for patients with non-remission oftrigeminal neuralgia after MVD.