枕下乙状窦后入路手术治疗三叉神经痛的术式选择  

Option of surgical treatment of trigeminal neuralgia with suboccipital retrosigmoid approach

作　　者：宋昭[1] 刘如恩[2] 夏小雨 李荣刚[4] SONG Zhao LIU Ru-en XIA Xiao-yu et al(Department of Neurosurgery, Shenzhen Hospital of Southern Medical University, Shenzhen 518000, China)

机构地区：[1]南方医科大学深圳医院,518000 [2]北京中日友好医院 [3]北京陆军总医院附属八一脑科医院神经外科 [4]复旦大学附属金山医院

出　　处：《临床神经外科杂志》2016年第6期459-463,共5页Journal of Clinical Neurosurgery

摘　　要：目的探讨枕下乙状窦入路手术治疗三叉神经痛术中手术方式的选择。方法对39例原发性三叉神经痛患者的临床资料进行回顾性分析。其中31例患者术中有明确的血管压迫,仅行微血管减压术(MVD)手术;6例患者血管压迫不明显,行MVD+三叉神经梳理术(TNC);3例患者行三叉神经感觉根部分离断术(PSR),1例患者行二次手术。对患者术后的疗效及并发症进行分析。结果 31例行MVD手术患者,术后疼痛立即完全缓解26例,延迟缓解2例,无效3例,总有效率90.6%。6例行MVD+TNC的患者和3例行PSR手术的患者术后疼痛均立即缓解。结论为提高手术治疗三叉神经痛的治愈率,应根据术中不同情况决定不同的手术方式。对于老年人及不能耐受第二次手术的患者,更应积极行PSR手术。Objective To explore the choice of operative method in the treatment of trigeminal neuralgia（ TN）with suboccipital retrosigmoid approach. Methods 39 cases of primary trigeminal neuralgia were analyzed retrospectively,including 31 cases of intraoperative vascular compression,undewent microvascular decompression（ MVD） operation only,the effective rate was 90. 6%. 6 cases of vascular compression was not obvious and underwent MVD ＋ trigeminal nerve combing（ TNC） surgery. 3 cases underwent partial sensory rhizotomy（ PSR） surgery only,including 1 case of secondary surgery. All patients＇ postoperative efficacy and postoperative complications were analyzed. Results Of 31 cases underwent MVD surgery,26 postoperative pain immediately completely remission,2 of delayed relief,3 were ineffective. Of 6 cases underwent MVD ＋ TNC,postoperative pain were complete response immediately. 3 underwent PSR routine surgery,postoperative pain were immediate relief. Conclusions To improve the cure rate of surgical treatment of TN,different ways of operation shall be decided according to different situation. Those elderly patients can＇t tolerate a second surgery,PSR surgery should be more active.

关 键 词：三叉神经痛 枕下乙状窦后入路 外科手术 

分 类 号：R745.1[医药卫生—神经病学与精神病学]