原发性三叉神经痛罕见病因分析及手术方法

发布时间：2018-05-09 18:55

本文选题：原发性三叉神经痛 + 无责任血管压迫　；参考：《中国老年学杂志》2017年05期

【摘要】：目的探讨原发性三叉神经痛术中无责任血管压迫时的手术方法。方法回顾性分析21例经微血管减压术治疗三叉神经痛患者的临床资料,术前均行三维时间飞越法核磁共振血管造影(3D-TOF-MRA)检查,了解三叉神经是否存在责任血管及其压迫位置,采用枕下乙状窦后入路显露三叉神经全程,仔细辨识,判断致痛原因,如有压迫则在压迫点放置Teflon减压垫棉,未见责任血管压迫则将三叉神经完全松解游离;结果此21例病例术中均未发现血管直接压迫三叉神经,其中17例三叉神经与小脑幕之间蛛网膜粘连增厚,使得三叉神经走行成角、扭曲,17例中有5例术中剪开蛛网膜后发现走行成角的三叉神经通过蛛网膜与血管粘连,全程松解游离三叉神经使得三叉神经恢复正常形态后无需Tefflon垫棉;3例麦克氏腔入口下缘处蛛网膜外硬脑膜上有不知名的窦性静脉压迫三叉神经,将三叉神经和不知名的窦性静脉用Tefflon垫棉垫开;1例内听道上结节肥大,导致桥前池空间狭小,骨性结构直接压迫三叉神经,术中磨除肥大的结节,完全解除骨质对三叉神经的压迫,无需Tefflon垫棉;本组病例随访时间3~24个月,随访期间暂没有复发病例。结论血管压迫三叉神经是三叉神经痛的主要原因,但术中在没有发现任何压迫血管的情况下将三叉神经脑池段全程完全松解游离,并恢复三叉神经正常走行形态,可以有效治疗三叉神经痛。
[Abstract]:Objective to investigate the operative methods of primary trigeminal neuralgia without responsible vascular compression. Methods the clinical data of 21 patients with trigeminal neuralgia treated by microvascular decompression were retrospectively analyzed. Before operation, 3D-TOF-MRA-3D-TOF-MRA-3D-TOF-MRA-3D-TOF-MRA-3D-TOF-MRA-3D-TOF-MRA-3D-TOF-MRA-3D-TOF-MRA. The trigeminal nerve was exposed through the retrosigmoid approach of the suboccipital sinus. The causes of the pain were identified carefully. If there was compression, the Teflon decompression pad was placed at the compression point, and the trigeminal nerve was completely released and dissociated without the responsible vascular compression. Results there was no direct compression of the trigeminal nerve by blood vessels in all of the 21 cases. In 17 cases, the arachnoid adhesion between the trigeminal nerve and the tentorium of the cerebellum was thickened and the trigeminal nerve was angled. In the 17 cases, 5 cases were cut off arachnoid and found that the trigeminal nerve was conglutinated by arachnoid and blood vessel. Three cases of trigeminal nerve were compressed by sinus vein on the lower edge of the entrance of the McClain cavity without Tefflon pad after the free trigeminal nerve was released to normal shape. The trigeminal nerve and the unknown sinus vein were cushioned with Tefflon pad cotton in 1 case, which resulted in the narrow space of the anterior cistern of the bridge, the compression of the bone structure directly into the trigeminal nerve, and the removal of the hypertrophic nodule during the operation. The bone compression on trigeminal nerve was completely relieved without Tefflon pad cotton. The follow-up time was 3 ~ 24 months and there was no recurrence during the follow-up period. Conclusion the trigeminal nerve compression is the main cause of trigeminal neuralgia, but the trigeminal cisternal segment is completely dissociated during the operation without any compression of the blood vessel, and the normal pattern of trigeminal nerve is restored. Can effectively treat trigeminal neuralgia.
【作者单位】：首都医科大学北京宣武医院神经外科;吉林省肿瘤医院神经外科;
【分类号】：R651.3

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