多根颅神经异常兴奋综合征临床特点及治疗（附44例报告）

发布时间：2018-04-13 17:33

本文选题：多根颅神经异常兴奋综合征 + 危险因素　；参考：《山东大学》2017年硕士论文

【摘要】：研究目的:通常将血管压迫颅神经入脑干区而引起的病理过程称之为颅神经异常兴奋综合征(Hyperactive dysfunction syndrome,HDS),包括原发性三叉神经痛(Trigeminal neuralgia,TN)、特发性偏侧面肌痉挛(Hemifacial spasm,HFS)、舌咽神经痛(Glossopharyngeal neuralgia,GPN)。而多根颅神经异常兴奋综合征(Combined HDS)则为两根或两根以上的颅神经入脑干区受血管压迫造成的多发性颅神经病变,其既可发生在单侧,亦可发生在双侧。既可同时起病,亦可先后起病。本文旨在对齐鲁医院神经外科行微血管减压术治疗的44例多根颅神经异常兴奋综合征进行回顾性研究,以深化对该综合征相关临床特点及治疗的进一步认识。研究背景:临床上,多根颅神经异常兴奋综合征比较少见,目前对该综合征的临床特点缺乏系统性的研究及足够的了解,通过深化对多根颅神经异常兴奋综合征的研究,可进一步加强对该综合征的认识,并指导相关临床诊断与治疗。研究方法:收集山东大学齐鲁医院脑外科2006年11月至2016年9月行微血管减压术后的颅神经异常兴奋综合征1450例,包括单纯原发性三叉神经痛1030例,单纯特发性面肌痉挛310例,单纯舌咽神经痛66例,两根或两根以上的颅神经疾患44例。收集所有病历中的相关临床及影像学资料,包括病史,临床表现,既往史,术前磁共振(MRI),术中观察,术后表现及术后并发症等,进行整理分析,总结多根颅神经异常兴奋综合征的临床特点。并通过对多根组与单根组患者在年龄、性别、血压水平、血脂水平、血糖水平、术后并发症的发生情况等方面的比较,得出两组间是否存在差异。研究结果:在本研究中的所有行微血管减压手术治疗的1450例颅神经异常兴奋综合征患者中,多根颅神经异常兴奋综合征共44例,占总数的3.03%,包括单侧 TN-HFS 14 例,单侧 TN-GPN 26 例,双侧 TN 2 例,单侧 TN-HFS-GPN 2 例。多根颅神经异常兴奋综合征组中,女性39例,男性5例,相对于单根颅神经异常兴奋综合征,更好发于女性,且有统计学差异[88.6%(39/44)vs.66.9%(940/1406),p=0.002]。多根颅神经异常兴奋综合征组平均年龄60.9岁,单根颅神经异常兴奋综合征组平均年龄53.5岁,p=0.035,具有统计学差异。多根颅神经异常兴奋综合征组中,高血压发病率明显高于单根颅神经异常兴奋综合征组[40.9%(18/44)vs.23.8%(335/1406),p=0.009]。多根颅神经异常兴奋综合征组中,三叉神经、面神经、舌咽神经的最常见责任血管分别是小脑上动脉(21/44)、小脑前下动脉(7/16)、小脑后下动脉(12/28)。且相关颅神经责任血管的发生率较之单根颅神经异常兴奋综合征组的差异无统计学意义(p0.05)。44例多根颅神经异常兴奋综合征患者全部行经乙状窦后开颅微血管减压术,总治愈率97.7%(43/44)。随访时间6～80个月,平均40.3个月。共有3例三叉神经痛复发,复发率3.33%。多根颅神经异常兴奋综合征组术后某些并发症的发生率明显高于单根颅神经异常兴奋综合征组,包括心功能不全[6.81%(3/44)vs.1.78%(25/1406),p=0.050],呼吸系统感染[6.81%(3/44)vs.1.35%(19/1406),p=0.027],下肢深静脉血栓形成[4.55%(2/44)vs.0.57%(8/1406),p=0.035],术后谵妄[27.2%(12/44)vs.14.9%(209/1406),p=0.024]。结论:临床上多根颅神经异常兴奋综合征相对少见,好发于老年女性。其中,原发性三叉神经痛合并舌咽神经痛是该综合征较为常见的类型。鉴于该综合征好发于老年患者,术后心功能障碍、肺部感染、下肢静脉血栓、一过性认知功能障碍等并发症相对多见,应该引起足够的关注。显微血管减压术是目前应首选的有效治疗方法。
[Abstract]:Objective: To study the vascular compression of cranial nerve usually into the brainstem and pathological process caused by the called cranial nerve excited syndrome (Hyperactive dysfunction, syndrome, HDS), including primary trigeminal neuralgia (Trigeminal neuralgia, TN), idiopathic hemifacial spasm (Hemifacial spasm, HFS), glossopharyngeus neuralgia (Glossopharyngeal neuralgia, GPN). The multiple cranial nerve excited syndrome (Combined HDS) for two or more cranial nerve into the brainstem vascular compression caused by multiple cranial neuropathy, which may occur in both unilateral and bilateral. It also occurs in both disease at the same time, also has this paper aims at the onset. 44 cases of cranial nerves in the Department of Neurosurgery of Qilu Hospital underwent microvascular decompression for the treatment of excited syndrome were retrospectively studied, so as to deepen the further understanding of the syndrome related to the clinical characteristics and treatment General background: clinically, multiple cranial nerve excited syndrome is rare, the clinical features of the syndrome is lack of systematic study and sufficient understanding, through the study of deepening excited for multiple cranial nerve syndrome, can further enhance the understanding of the syndrome, and related clinical guidance the diagnosis and treatment. Methods: collected the cranial nerve Department of cerebral surgery of Qilu Hospital of Shandong University from November 2006 to September 2016 after undergoing microvascular decompression of the excited syndrome in 1450 cases, including simple primary trigeminal neuralgia in 1030 cases with idiopathic hemifacial spasm in 310 cases, simple glossopharyngeal neuralgia 66 cases, two or more than two cranial nerve diseases 44. Collect all medical records of the clinical and imaging data, including medical history, clinical symptoms, medical history, preoperative magnetic resonance (MRI), intraoperative, postoperative appearance and postoperative complications, By analyzing the clinical features of multiple cranial nerve excited syndrome. According to a plurality of groups and single groups in age, gender, level of blood pressure, blood lipids, blood glucose levels, and other aspects of the occurrence of postoperative complications between the two groups that whether there exist differences. Results: 1450 patients all cases of cranial nerve in the study of the microvascular decompression surgery excited syndrome, multiple cranial nerve excited syndrome 44 cases, accounting for 3.03% of the total, including 14 patients with unilateral TN-HFS, unilateral TN-GPN in 26 cases, 2 cases of double side TN, 2 cases of unilateral TN-HFS-GPN. Multiple cranial nerve abnormalities excited syndrome group, 39 cases were female, 5 male patients, compared with the single cranial nerve excited syndrome is more common in women, and there were significant differences in [88.6% (39/44) vs.66.9% (940/1406) p=0.002]., a plurality of cranial nerve excited synthesis Patients with an average age of 60.9 years, a single cranial nerve excited syndrome group, the average age of 53.5 years, p=0.035, with statistical difference. A plurality of cranial nerve excited syndrome group, the incidence of hypertension was significantly higher than that of single cranial nerve excited syndrome group [40.9% (18/44) vs.23.8% (335/1406), p=0.009]. of cranial nerve very excited syndrome group, trigeminal nerve, facial nerve, the most common blood vessel of the glossopharyngeal nerve were the superior cerebellar artery (21/44), anterior inferior cerebellar artery (7/16), posterior inferior cerebellar artery (12/28). And the incidence of cranial nerve vascular than single cranial nerve excited syndrome between groups no statistical significance (P0.05).44 cases of multiple cranial nerve excited syndrome patients underwent retrosigmoid craniotomy microvascular decompression, the total cure rate was 97.7% (43/44). The follow-up time was 6~80 months, with an average of 40.3 months. A total of 3 cases The recurrence rate of recurrent trigeminal neuralgia, 3.33%. cranial nerves excited syndrome group after some complication rate was significantly higher than that of single cranial nerve excited syndrome group, including heart failure [6.81% (3/44) vs.1.78% (25/1406), p=0.050], [6.81% infection of the respiratory system (3/44), p=0.027] vs.1.35% (19/1406). Deep venous thrombosis of lower extremity [4.55% (2/44) vs.0.57% (8/1406, p=0.035]), postoperative delirium (12/44) [27.2% vs.14.9% (209/1406) p=0.024].. Conclusion: the clinical syndrome of cranial nerves excited relatively rare, occurs in older women. Among them, the primary trigeminal neuralgia and glossopharyngeal neuralgia is the the most common types of syndrome. The syndrome occurs in elderly patients with cardiac dysfunction, postoperative pulmonary infection, venous thrombosis, transient cognitive dysfunction and other complications are more common, should arouse enough attention.. Microvascular decompression is the first choice for effective treatment.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.3

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