原发性三叉神经痛微血管减压术中岩静脉的处理  

Management of petrosal vein in microvascular decompression for primary trigeminal neuralgia

作　　者：何少宇 李玉[1] 李杨[1] 任仲坤[1] 王波[1] 郭朋坤 杨智勇[1] 

机构地区：[1]昆明医科大学第一附属医院神经外科,昆明650032

出　　处：《中国临床神经外科杂志》2016年第12期747-749,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的 探讨原发性三叉神经痛微血管减压术中岩静脉及其分支的处理方法。方法 回顾性分析2012年1月至2015年5月微血管减压术治疗的92例原发性三叉神经痛的临床资料。根据术中表现,将岩静脉和其属支分为四种情况：1岩静脉主干妨碍手术操作;2岩静脉属支妨碍手术操作;3岩静脉为责任血管;4岩静脉未妨碍手术操作。结果 岩静脉主干妨碍手术操作32例,电凝切断10例;岩静脉属支妨碍手术操作40例,电凝切断28例;岩静脉及其属支为责任血管3例,电凝切断1例;岩静脉未妨碍手术操作17例,均未切断。术后疼痛消失82例,好转8例,无效2例;手术有效率为97.8%。术后随访3个月~3年,平均18个月;复发3例。术后死亡1例,为小脑梗死,术中切断岩静主干。结论 原发性三叉神经痛微血管减压术中,岩静脉的处理是术中重要的操作环节,同时也是减少术后严重并发症的重要环节。Objective To explore the management of petrosal vein and its branches during microvascular decompression for primary trigeminal neuralgia. Methods The clinical data of 92 patients with primary trigeminal neuralgia who were treated with microvascular decompression were analyzed retrospectively. The patients were divided into four groups according to the relationship of the trunks and the branches of the petrosal veins with surgical approach （SA）. The experience in treating the petrosal veins was summarized. Results Of 32 patients （34.8%） with the trunks of the superior petrosal veins obstructing SA or operative field, 10 received the cutting of the trunks of petrosal veins and 22 not. Of 40 patients with the branches of superior petrosal veins obstructing SA or the field, 28 received cutting of the branches of the superior petrosal veins and 12 not. Of 3 patients with superior petrosal veins which were responsible for the trigeminal neuralgia, 1 received cutting of the perusal veins and 2 not, All the petrosal veins which did not obstruct SA or the field were not cut off in 17 patients. One patient who had the postoperative eerebellar infarction due to cutting of trunk of the petrosal veins died. Conclusions The treatment of the petrosal vein is a very important step in microvascular decompression for the primary trigeminal neuralgia and also an important step to decrease the complication after operation.

关 键 词：原发性三叉神经痛 微血管减压术 岩静脉 

分 类 号：R745.11[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]