微血管减压术后复发性三叉神经痛的原因分析及再手术对策  

Research of the causes and Repeat operations for recurrent trigeminal neuralgia after microvascular decompression

作　　者：姜晓峰[1] 牛朝诗[1] 计颖[1] 费小瑞[1] 丁宛海[1] 傅先明[1] 汪业汉[1] 

机构地区：[1]安徽医科大学附属省立医院神经外科安徽省脑立体定向神经外科研究所,合肥230001

出　　处：《立体定向和功能性神经外科杂志》2011年第6期321-325,共5页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的对微血管减压术后复发性三叉神经痛进行再次手术,术中探查复发的致病原因。方法对6例复发性三叉神经痛的患者进行再手术探查,1例进行了微血管再减压术,5例进行了感觉根部分切断术。结果 1例患者为垫棉位置不理想,重新减压手术,5例血管减压充分,但明显有蛛网膜增厚、垫棉与神经根粘连、包裹,锐性分离困难,只能行感觉根部分切断。术后均疼痛消失,切断患者遗留有面部麻木。结论垫棉粘连可能是导致复痛的主要原因,感觉根部分切断术是该种情况下的首选。Objective The purpose was to determine what factors are associated with recurrent trigeminal neuralgia after microvascular decompression（MVD）, the retreatment were performed in patients with partial sensory rhizotomy（PSR）. Methods Repeat operations were performed in 6 patients with recurrent trigeminal neuralgia after MVD. 1 case was treated by MVD again and 5 cases were treated by PSR. Results At the second operation, 1 case was found that the Teflon felt sliped and reoperated by MVD,the adhesion of local arachnoid membrane and the interposed Teflon felt was found in the other cases. The teflon felt adhering between the offending artery and the pons and/or nerves was difficult dissected, then re-operation was treated by PSR. The neuralgia disappeared in all cases, postoperative facial numbness was found in all cases of PSR. Conclusion The adhesion of the interposed teflon felt in all cases was the main cause of recurrence of postoperative trigeminal neuralgia. The PSR should be the chief choice of the retreated procedure.

关 键 词：三叉神经痛 微血管减压术 复发 感觉根部分切断术 

分 类 号：R745.11[医药卫生—神经病学与精神病学]