三叉神经微血管减压手术探讨

目的探讨三叉神经痛的外科治疗方法。方法于全身麻醉下对96例三叉神经痛患者施行微血管减压术,取垂肩侧俯卧位,耳后切口长4cm,骨窗直径2cm,硬脑膜"K"字形切开,借助显微镜和内镜仔细探查三叉神经全程,分离压迫神经的血管使三叉神经得到充分松解,止血后缝合硬脑膜修补颅骨缺损,肌肉分层缝合。73例患者随访3个月～6年(平均31个月),采用Giovanni Broggi标准进行手术结果评价。结果压迫三叉神经的血管包括小脑上动脉(81例)、小脑上动脉及小脑前下动脉(6例)、小脑前下动脉(5例)、小脑上动脉及岩静脉(1例)、小脑上动脉及大脑后动脉(1例)、基底动脉(1例)、无名血管(1例)。手术效果达优者94例(97.92%),良好者2例。手术后出现不同程度眩晕者31例,出现单纯疱疹者29例,伤口发生炎症反应者2例,手术后新增面部麻木病例7例。无死亡和严重并发症病例,随访无复发病例。结论微血管减压手术安全、微创、有效,可作为三叉神经痛的首选治疗方法。

The exploration of microvascular decompression for trigeminal neuralgia

Objective To explore the surgical treatment method of trigeminal neuralgia (TN). Methods We performed microvascular decompression (MVD) operation on 96 patients with TN in the period of June 2000 to May 2006. The operation was performed under general anesthesia, patients were placed in the park bench position, the length of retroauricular incision was 4 cm, the diameter of bone window was 2 cm, and dura was opened as K shape. The operation procedure was closely examined with microscope and endoscope, compressing arteries were mobilized away from the nerve, and the compressing veins were coagulated and divided. A small piece of Teflon was interpositioned between the nerve and the artery to prevent recontact. After hemostasis, the dura was closed and bony defect was repaired before musculofascial closure in layers. The mean follow-up duration was 31 months (3 months-6 years) in 73 cases. The outcomes were evaluated by Giovanni Broggi's criteria. Results Arteries compressing the trigeminal nerve were superior cerebellar artery (81 cases), superior cerebellar artery and anterior inferior cerebellar artery (6 cases), anterior inferior cerebellar artery (5 cases), superior cerebellar artery and petrosal vein (1 case), superior cerebellar artery and posterior cerebral artery (1 case), basilar artery (1 case), and vascular without name (1 case). The outcome after operation was excellent in 94 cases (97.92%), and the result was good in 2 cases. After operation, vertigo with various degree occurred in 31 cases, herpes simplex occurred in 29 cases, incision infection occurred in 2 cases, and postoperative facial numbness occurred in 7 cases. There were no operative mortality or morbidity, and no recurrent cases. Conclusion MVD is a safe, microinvasive and the most effective surgical modality for TN. We propose that any patients with TN who are fit for general anesthesia should choose MVD first.