神经根外周浅层电凝治疗三叉神经痛  

Superficial layer coagulation of trigeminal sensory root in treatment of trigeminal neuralgia

作　　者：李明[1] 高兴强[2] 张剑宁[1] 曹奕[1] 马兆鑫[1] 

机构地区：[1]上海中医药大学附属岳阳中西医结合医院耳鼻咽喉科,上海200437 [2]福建医科大学附属厦门第一医院耳鼻咽喉头颈外科,福建厦门361003

出　　处：《中国耳鼻咽喉头颈外科》2007年第8期479-481,共3页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨神经根外周浅层电凝术治疗多血管挤压诱发三叉神经痛的临床应用价值。方法5例三叉神经痛患者,术前均行头颅MRI(B-FFE)序列检查,采用乙状窦后进路术式治疗。左侧三叉神经痛1例,术中见3支动脉骑跨三叉神经,动脉间有较多细小吻合支;右侧三叉神经痛4例,其中3例三叉神经根受粗大动脉压迫、移位,张力较大;1例三叉神经感觉根呈分支状,并有多条动脉血管伴行,压迫神经。由于神经血管关系复杂,本5例患者均不适宜行微血管减压术治疗。术中尽可能暴露三叉神经根后,在三叉神经根距出脑桥处远端约2/3处,用特殊的电凝镊行神经根外周浅层电凝,电凝输出≤3W,手术显微镜下可看到神经由淡黄色变为银白色。结果所有患者术后三叉神经痛症状完全消失,面部痛、温觉存在,无明显后遗症,随访2.4～5年,疼痛均无复发。结论颅内段三叉神经根外周浅层电凝术是治疗多血管挤压诱发三叉神经痛的一种安全有效的术式。OBJECTIVE To study the clinical value of superficial layer coagulation of trigeminal sensory root in the treatment of trigeminal neuralgia. METHODS The clinical data of 5 cases with trigeminal neuralgia were studied. Head MRI （B-FFE） examinations were made before surgery and operations were performed via retrosigmoidal approach. One case with left facial pain showed 3 arteries with offsets crossing and compressing the left trigeminal nerve. Among 4 cases with right facial pain, 3 cases had an artery compressing the right trigeminal and the nerve were distorted and moved from its original site, one case with an artery going with trigeminal nerve sensory root branchlets. All cases were no indications for microvascular decompression and thus were treated with surface coagulation of trigeminal nerve sensory root. RESULTS Pain disappeared instantly after operation and facial sensory were retained. All cases were followed up for 2.4 to 5 years and no recurrences were found. CONCLUSION Superficial layer coagulation of trigeminal sensory root is a safe and effective method for the treatment of trigeminal neuralgia.

关 键 词：三叉神经痛 电凝术 治疗结果 

分 类 号：R745.1[医药卫生—神经病学与精神病学]