三叉神经痛显微血管减压的远期疗效观察及相关的临床显微解剖学研究  

Long-term Efficacy of Microvascular Decompression for Trigeminal Neuralgia and Microanatomical Study of the Upper Neurovascular Complex

作　　者：张庆华[1] 孙涛[1] 张莉[1] 齐腾伸二郎 田继辉[1] 徐军[1] 

机构地区：[1]宁夏医学院附属医院神经外科,银川750004 [2]日本山形大学医学部脑神经外科

出　　处：《宁夏医学院学报》2005年第5期368-370,共3页Journal of Ningxia Medical College

摘　　要：目的评价三叉神经痛显微血管减压(MVD)术后1年以上患者151例的远期疗效,针对MVD术中问题,对三叉神经痛相关血管神经复合体进行显微解剖学观察.方法随访宁夏医学院附属医院1991～2004年间90例和日本山形大学医学部1982～1992年间61例三叉神经痛患者13～126个月(平均60个月).应用15例经10%甲醛充分固定并灌有乳胶的国人成人头颅湿标本,模拟临床枕下乙状窦后手术入路,在4～25倍手术显微镜下逐层解剖、观察、测量及照相.结果 MVD术后早期治愈率为93.4%,随访患者主观满意率为80%,术后疼痛未缓解率是6.6%,疼痛复发率为15%,术后并发症发生率7.7%.三叉神经和相关的小脑上动脉(SCA)、小脑前下动脉(AICA)、岩静脉等关系密切,小脑上动脉的行程一般比较恒定,向尾侧凸起46.88%的尾袢对三叉神经造成压迫.结论血管压迫是三叉神经痛的重要发病因素.Objective To evaluate the long- term efficacy and subjective satisfaction of microvascular decompression in 151 patients with trigeminal neuralgia who were followed up more than 1 year, and to study the microanatomical relationships of the upper neurovascular complex later. Methods Ninety patients who underwent MVD between 1991 and 2004 in Ningxia Medical College and 61 patients who underwent MVD between 1982 and 1992 in Yamagata University were followed- up from 13 to 126 months（mean 60 months）and then results were studied. Fifteen adult cadaver heads were fixed in 10% formalin and used for this study. Dissections were performed under 4 to 25 magnification. Results The immediate postoperative cure rate was 93.4%. Satisfactary results obtained by follow- up were 80%. Non - remission rate was 6.6%. Recurrence pain rate were 15%. Postoperative hearing and facial sensory dysfunction rate were 7.7%. The trigeminal nerve is very closed to the SCA, AICA, PICA and the petrosal veins. As a result, about 46.88% of SCA has a point of contacting with the trigeminal nerve. Conclusion Microvascular compression is an important factor which could cause trigeminal neuralgia.

关 键 词：三叉神经痛 微血管减压 随访结果 显微解剖 血管神经复合体 

分 类 号：R651[医药卫生—外科学] R322[医药卫生—临床医学]