摘要
目的探讨三叉神经痛微血管减压术的疗效与责任血管的解剖特点。方法通过对136例三叉神经痛患者行微血管减压手术治疗,术中观察和判定责任血管的来源、压迫三叉神经根部的位置,探讨责任血管的解剖特点及疗效。结果责任血管以小脑上动脉的外侧支的分支压迫三叉神经的上表面最常见,共80侧(58.8%);小脑前下动脉的分支压迫三叉神经的下表面较少,共20侧(14.7%);两支血管分别压迫三叉神经的上、下表面的有18侧(13.2%);单纯静脉压迫三叉神经根部的有12侧(8.8%);附近无任何血管压迫但术中发现三叉神经覆盖的蛛网膜明显增厚者6侧(4.4%)。136例病人中,术后疼痛消失134例,治愈率为98.5%,无效2例。术后随访112例,平均4.3年.102例疼痛完全消失,4例部分缓解,6例复发或无效。结论邻近血管的压迫是三叉神经痛的主要病因,微血管减压术是治疗三叉神经痛最有效的方法,其疗效取决于熟练的显微解剖知识和显微操作技巧。仔细寻找所有的责任血管并隔离确实,保护好邻近区域的神经和血管,是增加疗效、减少术后并发症的关键。
Objective To explore the efficacy of microvascular decompression （MVD） for trigeminal neuralgia and the anatomical characteristics of the responsible blood vessels. Methods In a study of using MVD for the treatment of 136 cases with trigeminal neuralgia, the origins of the responsible blood vessels and sites of compression at the trigeminal root were observed and determined, and the anatomical characteristics of the responsible blood vessels and their efficacy correlation were analyzed. Results The number of the responsible blood vessels of superior cerebellar artery （SCA） lateral branches compressing the upper surface of the trigeminal nerve was 80 sides （58.8%）, which was mostly frequently observed, the number of anterior inferior cerebellar artery （AICA） branches compressing the lower surface of the trigeminal nerve was 20 sides （14.7%）, which was not so frequently observed; the number of two arteries respectively compressing the upper and lower surfaces of the trigeminal nerve was 18 sides （13.2%）; the number of sole veins compressing the trigeminal root was 12 sides （8.8%）; and, the number with no vascular compression but evident increase in the thickness of the trigeminal-coated arachnoid mater was 6 sides （4.4%）. In the 136 cases, neuralgia of 134 cases disappeared after decompression, namely, the curative rate was 98.5% and MVD failed in two cases. The follow-up study for the 112 cases, with the average of 4.3 year, found that neuralgia of 102 cases disappeared completely, of 4 cases, was partially alleviated and of the other 6 cases, recurred or made no progress at all. Conclusion Compression of the adjacent blood vessels is one of the primary etiological factors for trigeminal neuralgia and microvascular compression is by far the most effective therapy for the treatment of this disease, the efficacy of which depending on the mastery of professional microsurgical anatomy knowledge and microsurgical techniques. The key to enhancing the efficacy and reducing postoperative complications is carefully searching and assuredly isolating all the responsible blood vessels, and protecting the nerves and blood vessels in adjacent areas.
出处
《中华神经医学杂志》
CAS
CSCD
2007年第9期961-963,966,共4页
Chinese Journal of Neuromedicine
关键词
三叉神经痛
责任血管
Trigeminal neuralgia
Responsible blood vessel
