显微血管减压术治疗椎-基底动脉延长扩张症致三叉神经痛患者的效果分析  

Effect analysis of microvascular decompression for patients with trigeminal neuralgia caused by vertebrobasilar dolichectasia

作　　者：刘小伟 周川 江建东 李罡 赵强 梁建涛[2] Liu Xiaowei;Zhou Chuan;Jiang Jiandong;Li Gang;Zhao Qiang;Liang Jiantao(Department of Neurosurgery,Xiamen Humanity Hospital,Xiamen 361009,China)

机构地区：[1]厦门弘爱医院神经外科,361009 [2]首都医科大学宣武医院神经外科

出　　处：《中国脑血管病杂志》2019年第4期197-203,共7页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨显微血管减压术治疗椎-基底动脉延长扩张症(VBD)所致三叉神经痛的安全性和效果。方法回顾性连续纳入2013年4月至2016年8月解放军第一七四医院神经外科(2例)及首都医科大学宣武医院神经外科(11例)采用显微血管减压术治疗VBD致三叉神经痛13例患者的临床资料,其中男9例,女4例;年龄37～72岁,平均(59±10)岁;病程4～240个月,病程中位数36. 0(9. 5,54. 0)个月;术前合并脑梗死1例,短暂性脑缺血发作1例;合并高血压病9例,糖尿病2例,冠心病1例; 10例术前均使用卡马西平治疗,2例术前行射频治疗;疼痛分布以三叉神经第2、3支分布区为主。术前及术后采用巴罗神经研究所(BNI)疼痛分级进行评分;术前行头部MRI检查(包括三维时间飞跃法序列)明确诊断。采用枕下乙状窦后入路行显微血管减压术。术后采用门诊及电话进行临床随访。结果 (1) 13例患者术前BNI疼痛分级:Ⅳ级4例,V级9例;经MRI及术中所见均符合VBD特征,三叉神经受压移位明显;责任血管分布为基底动脉6例,基底动脉+小脑上动脉3例,椎动脉4例; 12例单纯行显微血管减压术,1例患者在显微血管减压术基础上行选择性三叉神经感觉根切断术(SPPR)。(2) 13例患者均完成临床随访,随访时间24～64个月,平均(48±13)个月。13例患者术后即刻均有效(BNI分级I级),其中1例术后出现同侧听力下降;1例术后1年复发(BNI分级Ⅲ级),1例术后3年复发(BNI分级Ⅲ级),11例患者均为随访有效(BNI分级I级)。结论显微血管减压术对VBD所致的三叉神经痛短期疗效较确切,安全性较好,但因样本量少,且VBD属慢性进展性疾病,其长期疗效有待进一步观察。Objective To investigate the safety and efficacy of microvascular decompression for patients with trigeminal neuralgia caused by vertebrobasilar dolichectasia (VBD).Methods From April 2013 to August 2016,the clinical data of 13 consecutive patients with trigeminal neuralgia caused by VBD and treated with microvascular decompression at the Department of Neurosurgery,the 174th Hospital of PLA ( n =2) and the Department of Neurosurgery,Xiamen Humanity Hospital ( n =11) were enrolled retrospectively.Among them,4 were females and 9 were males,aged from 37 to 72 (mean 59±10) years;the duration of the disease was 3 - 12 months,with a median of 36.0 (9.5,54.0) months;1 patient was complicated with cerebral infarction before operation,1 had transient ischemic attack;9 patients were complicated with hypertension,2 had diabetes,and 1 had coronary heart disease;10 were treated with carbamazepine before operation,and 2 were treated with radiofrequency before operation;pain was mainly distributed in the second and third branches of trigeminal nerve.Preoperative and postoperative scores were assessed using the Baro Nervous Institute (BNI) pain grading;preoperative head MRI was performed (including three-dimensional time of flight sequence) in order to confirm the diagnosis.Clinical follow-up was performed by outpatient and telephone after operation.Results (1) Preoperative BNI pain grading in 13 patients:grade Ⅳ in 4 cases and grade V in 9 cases.Both MRI and intraoperative findings were consistent with VBD characteristics,and the trigeminal nerve was significantly displaced by pressure.The distribution of guilty vessels was 6 cases in basilar artery,3 in basilar artery + superior cerebellar artery,and 4 in vertebral artery.Twelve patients were treated with microvascular decompression alone,and 1 was treated with microvascular decompression + selective partial posterior rhizotomy (SPPR).(2) All 13 patients completed clinical follow-up.The follow- up period ranged from 24 to 64 months,mean 48± 13 months .All 13 patients were

关 键 词：三叉神经痛 椎基底动脉延长扩张症 颅神经 显微血管减压术 

分 类 号：R651.12[医药卫生—外科学]