178例原发性三叉神经痛微血管减压手术体会

目的：探讨原发性三叉神经痛微血管减压的手术技巧和总结手术体会。方法：采用乙状窦后锁孔入路对178例原发性三叉神经痛行显微血管减压术治疗，选择Teflon棉为减压垫，根据术中所见压迫血管的类型，分别采用Teflon棉隔离、血管悬吊、血管隔离加感觉根部分切断及神经松解加部分感觉根烧灼等手术方式。其中发现明确血管压迫，尤其压迫处神经变形者单纯行Teflon棉隔离减压；部分责任血管仅与神经接触者，行血管隔离加感觉根部分切断；责任血管为长袢状者行血管悬吊；而未见明确责任血管者行神经松解加部分感觉根烧灼。随访观察其疗效。结果：术中发现三叉神经入脑干区有血管压迫者154例，血管与神经接触密切者19例．未见责任血管但明显蛛网膜增厚者5例。其中动脉责任血管145例，动静脉联合责任血管22例，单纯静脉责任血管6例。单纯行Teflon棉隔离减压155例，减压加部分感觉根切断11例，责任血管悬吊7例，蛛网膜松解加感觉根部分烧灼s侧。术后疼痛立邵消失169例，显著减轻者6例，1周内明显减轻者2例。所有患者术后获3个月～3年随访（平均1．5年），疼痛消失175例（98．3％），服用卡马西平片控制满意者2例．疼痛复发如术前1例。结论：微血管减压术是原发性三叉神经痛有效的治疗方法，根据责任血管类型采取适当减压方法是提高三叉神经痛手术有效率及减少复发的关键措施。

Operative experience of microvascular decompression for 178 cases with idiopathic trigeminal neuralgia

Objective:To study the operative technique of microvascular decompression(MVD)on idiopathic trigeminal neuralgia(TN)and its operative experience.Method:178 cases with idiopathic TN were treated by MVD with Teflon through keyhole retrosigmoid approach.Several operation methods were used according to different types of offending vascular during operation:patients with evident neurovascular compression underwent microvascular decompression with Teflon alone;those with neuro-vascular contact,were treated by mic...