三叉神经痛的疼痛范围与神经血管压迫位置的关系研究  

Correlation between painful range of trigeminal neuralgia and location of neurovascular compression

作　　者：李强[1] 于炎冰[1] 张黎[1] Li Qiang;Yu Yanbing;Zhang Li(Department of Neurosurgery,China-Japan Friendship Hospital,National Health Care Commission,Beijing 100029,China)

机构地区：[1]国家卫健委中日友好医院神经外科,北京100029

出　　处：《中华神经医学杂志》2020年第11期1098-1103,共6页Chinese Journal of Neuromedicine

摘　　要：目的探讨三叉神经痛的疼痛范围与神经血管压迫位置的关系。方法对国家卫健委中日友好医院神经外科自2017年3月至2019年6月采用经乙状窦后入路桥小脑角(CPA)区显微手术治疗、术中发现有明确血管压迫、临床资料完整的165例单支三叉神经痛患者(第Ⅰ支支配区域疼痛22例,第Ⅱ支支配区域疼痛84例,第Ⅲ支支配区域疼痛59例),统计其神经血管压迫位置[位于三叉神经感觉根脑池段(CPA区池段)者分为头、尾、腹、背4侧,位于三叉神经感觉根入脑干区(REZ)者分为头腹、头背、尾腹、尾背4个象限]。结果(1)第Ⅰ支支配区域疼痛患者中,8例的神经血管压迫位置位于CPA区池段,其中头侧5例、腹侧2例、背侧1例;责任血管主要为小脑上动脉(7例),且主要从头侧压迫;14例的神经血管压迫位置位于REZ区,其中头腹象限11例、头背象限2例、尾腹象限1例;责任血管主要为小脑上动脉(11例),其中经头腹象限压迫8例。(2)第Ⅱ支支配区域疼痛患者中,29例的神经血管压迫位置位于CPA区池段,其中腹侧16例、背侧10例、头侧2例、尾侧1例;责任血管主要为小脑上动脉(22例),主要从腹侧或背侧压迫;55例的神经血管压迫位置位于REZ区,其中头背象限26例、头腹象限20例、尾背象限6例、尾腹象限3例;责任血管主要为小脑上动脉(41例),其中经头背象限压迫23例、头腹象限压迫17例。(3)第Ⅲ支支配区域疼痛患者中,26例的神经血管压迫位置位于CPA区池段,其中背侧16例、尾侧10例;责任血管主要为小脑上动脉(7例),且主要从背侧压迫;33例的神经血管压迫位置位于REZ区,其中头背象限25例、尾背象限6例、尾腹象限2例;责任血管主要为小脑上动脉(22例),均经头背象限压迫。结论三叉神经第Ⅰ支支配区域疼痛患者的神经血管压迫位置在CPA池段以头侧为主,在REZ区以头腹象限为主;第Ⅱ支支配区域疼痛患者的神经血管压�Objective To discuss the correlation between painful range of trigeminal neuralgia(TN)and location of neurovascular compression(NVC).Methods A total of 165 patients with single branch TN enjoying complete clinical data and having definite offending vessels were enrolled into this study;these patients underwent microsurgical treatment in cerebellopontine angle(CPA)area via suboccipital retrosigmoid approach in our hospital from March 2017 and June 2019;22 patients had branch I TN,84 patients had branch II TN,and 59 patients had branch III TN.The cistern part of trigeminal sensory root(CPA cistern part)was divided into four directions:cephalic,caudal,ventral and dorsal sides.The root entry zone(REZ)of trigeminal nerves was divided into four quadrants:cephalic-ventral,cephalic-dorsal,caudal-ventral and caudal-dorsal quadrants.Results(1)In patients with branch I TN,8 patients had location of NVC in the cistern part of CPA,including 5 in the cephalic side,two in the ventral side and one in the dorsal side;main offending vessels were superior cerebellar artery(SCA,n=7),mainly with cephalic compression.Another 14 patients had location of NVC in the REZ,including 11 in the cephalic-ventral quadrant,2 in the cephalic-dorsal quadrant and one in the caudal-ventral quadrant;main offending vessels were SCA(n=11),mainly with cephalic-ventral compression(n=8).(2)In patients with branch II TN,29 patients had location of NVC in the cistern part of CPA,including 16 in the ventral side,10 in the dorsal side,2 in the cephalic side and one in the caudal side;main offending vessels were SCA(n=22),mainly with ventral and dorsal compression.Another 55 patients had location of NVC in REZ,including 26 patients in the cephalic-dorsal quadrant,20 in the cephalic-ventral quadrant,6 in caudal-dorsal quadrant and 3 in the caudal-ventral quadrant;main offending vessels were SCA(n=41),mainly with cephalic-dorsal compression(n=23)and cephalic-ventral compression(n=17).(3)In patients with branch III TN,26 patients had location of NVC in the cister

关 键 词：三叉神经痛 疼痛范围 神经血管压迫 位置 责任血管 

分 类 号：R745.11[医药卫生—神经病学与精神病学]