微血管减压术治疗典型和非典型三叉神经痛结果对照分析  

Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia:comparison of results following microvascular decompression

作　　者：吕学明[1] 袁绍纪[1] 张荣伟[1] 孙希炎[1] 卢培刚[1] 刘子生[1] 陈援朝[1] 吕福林[1] 

机构地区：[1]济南军区总医院神经外科全军神经外科专科中心,山东省疼痛研究会三叉神经痛诊疗中心,济南250031

出　　处：《立体定向和功能性神经外科杂志》2010年第5期257-261,共5页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的本文对微血管减压术治疗典型和非典型三叉神经痛术后结果对比分析。方法 134例患者,经过156次手术。其中,典型89例和非典型三叉神经痛45例。术后直接止痛,典型86例,非典型39例。5年随访结果显示:术后止痛比较,典型72例,非典型21例。结果典型术后止痛率占96.6%,而非典型为86.7%。5年随访典型的止痛73%,部分止痛7.9%,共计80.9%;非典型的止痛35.6%,部分止痛11.1%,共计46.7%。术前患者"首次典型疼痛发作"和"有或无板机点"是典型与非典型三叉神经痛两者术后疗效不同的关键因素,术前面部感觉损害的非典型三叉神经痛患者,术后止痛效果差。结论微血管减压术是治疗典型三叉神经痛的主要方法,对于非典型三叉神经痛患者选择微血管减压术仍需严格筛选适应证。Objective The authors compare the results of MVD performed for typical and atypical TN at their institution.Methods The results of 156 MVDs in 134 patients were reviewed using information obtained from the department database.The authors examined immediate postoperative relief in 89 patients with typical and 45 with atypical TN,and long-term follow-up results in patients for whom more than 5 years of follow-up data were available（72 with typical and 21 with atypical TN）.Results In this study,MVD for typical TN resulted in complete postoperative pain relief in 96.6% of patients,compared with 86.7% complete relief in these with atypical TN.When patients were followed by more than 5 years,the long-term pain relief after MVD for those with typical TN was excellent in 73% and good in an additiona7.9%,for an overall significant pain relief in 80.9% of patients.In contrast,following MVD for atypical TN,the long-term results were excellent in only 35.6% of cases and good in an addition 11.1%,for overall significant pain relief in only 46.7%.Memorable onset and trigger points were predictive of better postoperative pain relief in both atypical and typical TN.Preoperative sensory loss might be a negative predictor for good long-term results following MVD for atypical TN.Conclusion Microvascular decompression（MVD） has become one of the primary treatments for typical trigeminal neuralgia（TN）.Not all patients with facial pain,however,suffer from the typical form of this disease;many patients who present for surgical intervention actually have atypical TN.

关 键 词：典型三叉神经痛 非典型三叉神经痛 微血管减压术 

分 类 号：R745.11[医药卫生—神经病学与精神病学]