三叉神经微血管减压术岩静脉特点及处理方法探讨  

Anatomy and management of superior petrosal vein in microvascular decompression for trigeminal neuralgia

作　　者：杨玉明[1] 王作伟[1] 崔壮[1] 姜宏志[1] 沙成[1] 袁庆国[1] 谢红雯[1] 王大明[1] 

机构地区：[1]北京医院国家老年医学中心,100730

出　　处：《中华医学杂志》2017年第7期522-524,共3页National Medical Journal of China

摘　　要：目的探讨微血管减压手术中岩静脉的特点及对手术视野的影响，分析处理岩静脉的手术入路、指征及对预后的影响。方法回顾分析2013年1月年至2016年6月北京医院收治的280例三叉神经痛患者临床资料，分析其岩静脉解剖特点、主干属支情况、术中电凝切断状况及术后并发症。结果术中岩静脉完全保留者152例（54.29%），属支切断者103（36.79%），主干切断者25例（8.92%）。岩静脉为责任血管者17例（6.07%）岩静脉主干为1-3支者分别占67例（23.90%）、168例（60%）、45例（16.10%）；静脉属支有1-4支者分别为17例（6.07%）、112例（40%）、136例（48.57%）、15例（5.36%）。主干切断者发生术后小脑梗死1例，经2周保守治疗后未留明显神经功能障碍。无小脑出血及死亡病例。结论微血管减压术是原发性三叉神经痛理想治疗方法，多数情况下不必切断岩静脉，必要时可切断岩静脉属支或主干，主干切断者极少数发生小脑梗死或出血等严重并发症。Objective To investigate the characteristics of superior petrosal vein （SPV） and its influence on the surgical field in microvascular decompression （MVD） for trigeminal neuralgia （ TN）, and to analyze the effect of the surgical treatment of SPV on the surgical approach, indication and prognosis. Methods The clinical data of 280 patients with trigeminal neuralgia between Jan. 2013 and Jun. 2016 were collected, including the trunks and the branches of SPV, intraoperative electrocoagulation status, the surgery outcome and complications. Results The petrosal vein during the operation was fully preserved in 152 cases （54.29%）. The SPV were completely sectioned in 25 cases （8.92%） , while some branches of SPV were sectioned in 103 cases （36. 79% ）. We found that SPV have 1 to 3 trunks, accounted for 67 cases （23.90%）, 168 cases （60%）, and 45 cases （16. 10% ）, while the SPV with 1 to 4 branches accounted for 17 cases （6. 07% ） , 112 cases （40%） , 136 cases （48.57%） , and 15 cases （5.36%）. The SPV was identified as offending vessel in 17 cases （6. 07% ）. One patient with cutoff SPV trunk encountered cerebellar infarction and recovered completely at 2 weeks after MVD by using intravenous medication. Conclusions MVD is the recommended treatment method for PTN, mostly SPV is unnecessary to be sectioned completely and small branches of SPV could be sacrificed. Very few patients may develop cerebellar infarction or hematoma.

关 键 词：三叉神经痛 显微血管减压术 岩静脉 

分 类 号：R651.3[医药卫生—外科学]