摘要
目的总结采用经皮热凝上颚神经以辅助标准的经皮热凝三叉神经节根治疗三叉神经痛的经验。方法第一组:13例有三叉神经第二支与第三支疼痛的典型三叉神经痛病人,接受标准神经节根热凝术,同时辅助以经皮热凝眶下上颚神经。第二组:12例过去接受热凝神经节根治疗的病人,复发疼痛于V2,但V3未复发。采用经皮热凝眶下神经做为权宜的缓解疗法,而不必再施行神经节根热凝术。结果第一组病人经合并两法治疗后,获得满意的疗效,在V2区获得无痛,而V3 区仅轻度麻木,且几乎没有咀嚼功能障碍,疗效维持3年,未见复发。第二组病人,仅施行简单的神经热凝术,不需重做神经节根的热凝术,即可获得满意的缓解复发疼痛,疗效可维持1年。结论针对某些病例,热凝三叉神经节根辅助以经皮热凝上颚神经,比起只做三叉神经节根热凝术的结果优越, 可避免脸部过度麻木与咀嚼功能的障碍,不会产生痛性麻木。对于仅限于V2复发疼痛的病人,采用权宜简单的经皮热凝眶下神经,可有效解除其复发,而不需重做神经节根的热凝治疗,避免恶化其副作用。
Objective To evaluate the advantage of percutaneous thermoneurotomy as an adjunct to percutaneous thermorhizotomy for trigeminal neuralgia （TN）. Methods First group： 13 patients with typical TN had pain involving V2 and V3 regions. They received standard thermorhizotomy combined with a simultaneous thermoneurotomy of the infraorbital maxillary nerve. Second group： 12 patients had recurrence of pain on V2. region but not on V3 region after previous thermorhizotomy. They were treated with percutaneous thermoneurotomy of the infraorbital nerve as a stop-gap treatment instead of redoing thermorhizotomy. Results First group patients obtained satisfactory relief of facial pain with sufficient analgesia on V2 region and mild hypoesthesia on V3 region and negligible mastication dysfunction without recurence in three years. Second group patients achieved satisfactory relief of recurrent pain on V2 region without the necessity of redoing thermorhizotomy and obtained pain free for one year. Conclusions In some selective cases of TN, thermorhizotomy adjunct with thermoneurotomy is superior to thermorhizotomy alone. With such combination, it can eliminate the untoward side effects of dense facial numbness and mastication dysfunction, particularly, it can avoid the development of anesthesia dolorosa. For those patients with recurrent pain only at V2 region, thermoneurotomy is simple and effective as a stop-gap treatment to spare the redoing of thermorhizotomy and avoid the aggravation of its side effects on retreatment.
出处
《中华神经外科杂志》
CSCD
北大核心
2006年第4期223-225,共3页
Chinese Journal of Neurosurgery
