微血管减压术治疗三叉神经痛的临床分析

目的探讨微血管减压术治疗三叉神经痛的疗效及桥脑旁区血管与三叉神经“敏感区”的关系。方法回顾性分析微血管减压术治疗的96例三叉神经痛病人的临床资料。术中探查发现“敏感区”责任血管92例（95．83％），其中小脑上动脉20例（21．74％），小脑前下动脉13例（14．13％），椎动脉及基底动脉11例（11．96％），其他多根血管压迫7例（7．61％），起源不清楚的动脉19例（20．65％），岩静脉21例（22．83％），脑血管畸形1例（1．09％），未见责任血管为动脉瘤者。按文献报道的标准将这些血管与三叉神经的关系进行分型：无接触型4例，接触型32例，压迫型27例，粘连包绕型32例，贯穿型1例。根据不同分型，采取不同方法对血管进行处理。结果手术总有效率98．96％（95例）。主要并发症包括听力下降及消失4例，轻-中度面肌障碍8例，轻度后组颅神经症状1例，小脑症状3例，脑脊夜漏1例，术后切口枕大神经痛1例，伤口延迟愈合2例，无死亡与致残病例。术后随访3个月。4年，平均2．7年，未见疼痛复发患者。结论微血管减压术是目前外科治疗三叉神经痛的有效方法，术中正确识别桥脑旁区三叉神经“敏感区”的责任血管并充分减压，是确保微血管减压术成功的关键。

Microvascular Decompression for Trigeminal Neuralgia(a Report of 96 Cases)

Objectives To explore the curative effect of microvascular decompression （MVD） on trigeminal neuralgia and the relationship between sensitive areas of the trigeminal nerve and blood vessels in the parapontine region. Method The clinical data of 96 patients with trigeminal neuralgia who underwent MVD in the parapontine region were analyzed retrospectively. Results The effective rate was 98.96% （95/96）. The trigeminal neuralgia did not recur in all the patients during following-up from 3 months to 4 years （mean, 2.7 years）. Major complications included the loss of hearing in 4 patients, light or moderate disturbance of facial muscles function in 8, appearance of symptoms of mildly injured lower cranial nerves in 1, and cerebellar symptoms in 3, cerebrospinal leak in 1, greater occipital neuralgia in 1 and delayed healing of wounds in 2. No patients were disabled and died. The causative blood vessels were found in 92 patients with trigeminal neuralgia, which was produced by superior eerebellar artery compression in 20 cases （21.74%）, anterior inferior cerebellar artery in 13 cases （14.13%）, vertebral artery and hasilar artery in 11 cases （11.96%）, one than more vessels in 7 （7.61%）, the artery of the unknown origin in 19 cases （20.65%）, petrosal vein in 21 case （22.83%）, and arteriovenous malformation in 1 case （1.09%）. Conclusions The MVD in the parapontine region is an effective method to treat trigeminal neuralgia. Intraoperative correct identification of the causative blood vessels producing trigeminal neuralgia and the full decompression are the key to ensuring the success of MVD.