微血管减压术治疗非典型三叉神经痛的疗效评价

目的探讨微血管减压手术治疗非典型三叉神经痛的手术疗效。方法自2001年3月至2006年3月,35例非典型三叉神经痛患者术前均经MRTA证实颅内段三叉神经根部存在血管压迫,在我科接受微血管减压手术治疗,回顾性分析患者的临床表现、术中所见和临床疗效。结果本组中累及三叉神经单支者3例(占8.6%),两支或三支者32例(占91.4%)。67.0%的非典型三叉神经痛患者存在多支血管压迫,三叉神经根部上内侧血管压迫占52.6%,上外侧占28.3%,下侧占19.1%。35例患者中有52.5%术后疼痛完全缓解,31.4%部分缓解,而有16.1%的非典型三叉神经痛患者术后疼痛无明显缓解或疼痛复发。结论颅内段三叉神经根部全程充分减压是影响微血管减压术治疗非典型三叉神经痛疗效的重要因素;采用磁共振断层血管成像(magnetic resonance tomographicangiography,MRTA)方法进行术前评估有助于提高患者的预后。

Therapeutic effect evaluation of microvascular decompression for the atypical trigeminal neuralgia

Objective To explore the surgical effect of microvascular decompression for achieving pain relief in patients with atypical trigeminal neuralgia.Methods From March 2001 to March 2006,35 patients with vascular compression in intracranial trigeminal nerve root were identified by high definition magnetic resonance tomographic angiography(MRTA) were treated with microvascular decompression.Clinical presentations,surgical findings and clinical outcomes were analyzed retrospectively.Results In this study,single trigeminal division was involved in only three patients(8.6%) while two or three divisions were involved in the other 32 patients(91.4%).In 67.0% of the patients,several conflicting vessels were found in association.Location of the conflicts around the circumference of the trigeminal root was of super-medial to the root in 52.6%,of super-lateral in 28.3% and of inferior in 19.1%.Microvascular decompression treatment for atypical trigeminal neuralgia resulted incomplete pain relief in 52.5% of the patients,partial pain relief in 31.4% and poor pain relief or pain recurrence in 16.1% in 52 patients.Conclusion Complete decompression of the entire intracranial trigeminal nerve root plays an important role in achieving pain relief in patients with atypical trigeminal neuralgia.Preoperative evaluation by using MRTA helps to improve the prognosis of patients with atypical trigeminal neuralgia.