微血管减压术治疗三叉神经痛的预后影响因素研究

目的　探讨影响微血管减压术治疗三叉神经痛手术疗效的因素。方法　分析 6 2例经微血管减压术治疗的三叉神经痛患者的临床特征、术中所见和术后疗效。血管对神经根的压迫程度分为单纯接触、接触和移位、单纯粘连、粘连和移位、萎缩五种。手术疗效包括术后疼痛立即缓解、延迟缓解、明显减轻和无效。结果　 6 2例患者起病时均表现为典型三叉神经痛 ,但在术前 17例已经转变为不典型。术中发现压迫血管与三叉神经根之间单纯接触 14例、接触和移位 7例、单纯粘连 15例、粘连和移位 18例、萎缩 8例。术后平均随访 14个月 ,疼痛在术后立即缓解 32例 (5 1 6 % ) ,延迟缓解 17例 (2 7 4 % ) ,明显减轻 11例 (17 7% ) ,无效 2例。结论　病程短、症状典型、以动脉压迫为主且能够充分减压的患者 ,术后多能获得好的疗效。相反 ,以静脉压迫为主 ,病程长及症状不典型的患者 ,术后疗效多不理想

Studies on the influence factors of operative outcmes in treating trigeminal neuralgia with microvascular decompression

Objective To evaluate the major influence factors of operative outcomes in treating trigeminal neuralgia with microvascular decompression. Methods 62 patients with trigeminal neuralgia treated by microvascular decompression from 2000 to 2002 were reviewed, including clinical presentation, operative findings and outcomes. Neurovascular conflicts were divided into single contact, contact and indentation, single adhesion, adhesion and indentation, and trigeminal nerve atrophy. Operative outcomes were graded into immediate post operative pain relief, delayed post operative pain relief, significant pain relief and no response to microvascular decompression. Results All patients presented as typical at the time of pain onset, but 17 patients changed to atypical at the time of surgery. During operation, single contact or adhesion was found in 14 and 15 patients respectively, contact or adhesion in combination with indentation was found in 7 and 18 patients respectively, atrophy occurred in 8 patients. After operation, immediate or delayed complete pain alleviation was achieved in 32(51 6%) patients and 17(27 4%) patients respectively, 11(17 7%) patients got significant pain relief, and 2 patients showed no response. Conclusions Better operative outcomes were predicted by shorter duration, typical presentation, artery compression and complete decompression. And worse outcomes were always related to venous compression, longer duration and atypical presentation.