本文選題：原發(fā)性三叉神經(jīng)痛 + 無(wú)責(zé)任血管壓迫��； 參考：《中國(guó)老年學(xué)雜志》2017年05期

【摘要】：目的探討原發(fā)性三叉神經(jīng)痛術(shù)中無(wú)責(zé)任血管壓迫時(shí)的手術(shù)方法。方法回顧性分析21例經(jīng)微血管減壓術(shù)治療三叉神經(jīng)痛患者的臨床資料,術(shù)前均行三維時(shí)間飛越法核磁共振血管造影(3D-TOF-MRA)檢查,了解三叉神經(jīng)是否存在責(zé)任血管及其壓迫位置,采用枕下乙狀竇后入路顯露三叉神經(jīng)全程,仔細(xì)辨識(shí),判斷致痛原因,如有壓迫則在壓迫點(diǎn)放置Teflon減壓墊棉,未見責(zé)任血管壓迫則將三叉神經(jīng)完全松解游離;結(jié)果此21例病例術(shù)中均未發(fā)現(xiàn)血管直接壓迫三叉神經(jīng),其中17例三叉神經(jīng)與小腦幕之間蛛網(wǎng)膜粘連增厚,使得三叉神經(jīng)走行成角、扭曲,17例中有5例術(shù)中剪開蛛網(wǎng)膜后發(fā)現(xiàn)走行成角的三叉神經(jīng)通過(guò)蛛網(wǎng)膜與血管粘連,全程松解游離三叉神經(jīng)使得三叉神經(jīng)恢復(fù)正常形態(tài)后無(wú)需Tefflon墊棉;3例麥克氏腔入口下緣處蛛網(wǎng)膜外硬腦膜上有不知名的竇性靜脈壓迫三叉神經(jīng),將三叉神經(jīng)和不知名的竇性靜脈用Tefflon墊棉墊開;1例內(nèi)聽道上結(jié)節(jié)肥大,導(dǎo)致橋前池空間狹小,骨性結(jié)構(gòu)直接壓迫三叉神經(jīng),術(shù)中磨除肥大的結(jié)節(jié),完全解除骨質(zhì)對(duì)三叉神經(jīng)的壓迫,無(wú)需Tefflon墊棉;本組病例隨訪時(shí)間3~24個(gè)月,隨訪期間暫沒(méi)有復(fù)發(fā)病例。結(jié)論血管壓迫三叉神經(jīng)是三叉神經(jīng)痛的主要原因,但術(shù)中在沒(méi)有發(fā)現(xiàn)任何壓迫血管的情況下將三叉神經(jīng)腦池段全程完全松解游離,并恢復(fù)三叉神經(jīng)正常走行形態(tài),可以有效治療三叉神經(jīng)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.
【作者單位】： 首都醫(yī)科大學(xué)北京宣武醫(yī)院神經(jīng)外科;吉林省腫瘤醫(yī)院神經(jīng)外科;
【分類號(hào)】：R651.3

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