脑干三叉神经诱发电位对三叉神经痛微血管减压术的应用研究

目的 评价三叉神经痛微血管减压术前、后三叉神经的传导功能变化，探讨脑干三叉神经诱发电位对三叉神经痛微血管减压术的指导及其对手术预后的评估，探讨微血管减压术的可能机制。方法 14例经术前核磁共振斜矢状位成像证实有神经血管压迫的三叉神经痛的病人，在微血管减压过程中，通过术前、中、后记录早期头皮诱发电位监测三叉神经传导功能。结果 所有病例的术前头皮诱发电位均呈潜伏期延长与波幅降低的改变，显示三叉神经根部的传导功能损害。脑干三叉神经诱发电位证实微血管减压术后，14例病人三叉神经传导功能迅速恢复，术后疼痛均缓解。结论 微血管减压术后三叉神经痛的改善，常与神经生理学数值恢复正常有关，提示神经传导功能的恢复。微血管减压术后电生理参数值的迅速恢复及疼痛缓解，证明这两种现象与髓鞘再生无关。脑干三叉神经诱发电位预测微血管减压术的效果是可靠的。

Application of brain-stem trigeminal evoked potentials in microvascular decompression for trigeminal neuralgia

Objective To evaluate changes of trigeminal nerve conduction pre-microvascular decompression and post-vascular decompression and to explore value of guidance in MVD and prognosis of operation with brain-stem trigeminal evoked potentials,thus explore possible mechanism of microvascular decompression.Methods 14 patients with trigeminal neuralgia confirmed by MRTA pre-microvascular decompression was monitored trigeminal nerve conduction successively pre-microvascular decompression,intravascular decompression and post-microvascular decompression by recording trigeminal evoked potentials.Results Trigeminal evoked potentials pre-microvascular decompression of all cases showed latent period delaying and amplitude depressing that indicated impaired conduction of the trigeminal root.Trigeminal evoked potentials validated that trigeminal nerve conduction of all 14 cases recovered immediately postoperatively.All 14 patients were pain free postoperatively.Conclusions Improvement in trigeminal neuralgia following microvascular decompression is often associated with normalization of neurophysiologic data,suggesting recovery of nerve conduction and painrelief following microvascular decompression argue that neither microvascular phenomenon is linked to remyelination.It is possible that the trigeminal evoked potentials might predict microvascualr decompression effective or ineffective.