神经内镜辅助显微血管减压术治疗MRTA阴性原发性三叉神经痛的疗效

目的 探讨神经内镜辅助显微血管减压术（MVD）治疗磁共振断层血管成像（MRTA）阴性原发性三叉神经痛的疗效。方法 回顾性分析2017年1月至2020年5月运用神经内镜辅助MVD治疗的27例MRTA阴性原发性三叉神经痛的临床资料。结果 27例中，术中显微镜下可确认责任血管19例，神经内镜确认责任血管6例，全程探查三叉神经脑池段后未见明确责任血管2例。25例可明确责任血管中，9例责任血管为动脉，15例责任血管为静脉，1例为动静脉同时压迫。显微镜难以观察责任动脉时，神经内镜可以清楚显示三叉神经根部解剖情况，明确责任动脉。术后疼痛完全缓解23例，明显缓解3例，部分缓解1例。随访4~43个月，27例症状无加重或复发。3例术后出现面部麻木，经营养神经等治疗后缓解。结论 神经内镜可提供更多的观察角度，辅助MVD治疗MRTA阴性原发性三叉神经痛的效果良好。

Neuroendoscopy assisted microvascular decompression for patients with MRTA negative primary trigeminal neuralgia

Objective To analyze the clinical efficacy of neuroendoscopy assisted microvascular decompression (MVD) for the patients with magnetic resonance tomographic angiography (MRTA) negative primary trigeminal neuralgia (PTN). Methods A retrospective analysis was performed on the clinical data of 27 patients with MRTA negative PTN who underwent neuroendoscopy assisted MVD from January 2017 to May 2020. Results Responsible vessels were confirmed by intraoperative microscope in 19 patients and by neuroendoscopy in 6, and did not find in 2 after the whole exploration of the cisternal segment of the trigeminal nerve. Responsible vessels were arterial vessels in 9 patients, veins in 15, and arterial vessel and vein in 1. When the microscope was difficult to find the responsible arteries, neuroendoscopy clearly showed the anatomy of the trigeminal nerve root and confirmed the responsible arteries. Pain was completely relieved in 23 patients, significantly improved in 3, and partially relieved in 1. The outcome of follow-up (4~43 months) showed no aggravation or recurrence in all the patients. Facial numbness occurred in 3 patients after the surgery, and were relieved after drug treatment. Conclusions Neuroendoscopy can provide more angles for observation. Neuroendoscopy assisted MVD is an effective method for the treatment of MRTA negative PTN.