微血管减压术后复发三叉神经痛个体化治疗的研究  

Clinical study on individualized treatment for recurrent trigeminal neuralgia after microvascular decompression

作　　者：姜成荣 徐武[1] 王晶[1] 种玉龙 倪红斌[1] 梁维邦[1] JIANG Cheng-rong;XU Wu;WANG Jing(Department of Neurosurgery,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210009,China)

机构地区：[1]南京大学医学院附属鼓楼医院神经外科,南京210009

出　　处：《临床神经外科杂志》2021年第3期326-329,共4页Journal of Clinical Neurosurgery

摘　　要：目的探讨微血管减压(MVD)术后复发三叉神经痛(TN)的个体化治疗方法及疗效。方法回顾分析34例MVD术后复发三叉神经痛患者的临床资料。患者经术前影像学检查评估后,个体化地选择治疗方案;分析患者的术后疗效及并发症。结果本组患者中,15例患者术前MRI示蛛网膜下腔间隙尚宽、存在血管压迫,且无明显手术禁忌证,予以再次行MVD术;术后14例患者疼痛消失,1例患者疼痛明显减轻,3例患者出现面部麻木,无复发患者。19例患者行经皮三叉神经半月节球囊压迫(PBC)术,术后所有患者面部疼痛均消失,但均出现面部麻木,并发咀嚼肌无力11例、角膜炎1例、口唇疱疹2例,1例患者术后10个月疼痛复发。结论MVD术后复发三叉神经痛患者,再次行MVD及PBC术治疗均有良好的疗效;需根据影像学评估和患者状况个体化地选择治疗方式。Objective To investigate the individualized treatment of recurrent trigeminal neuralgia(TN)after microvascular decompression(MVD).Methods The clinical data of 34 patients with recurrent TN after MVD were retrospectively analyzed.The patients were evaluated by preoperative imaging examination and individualized treatment plan was selected.The postoperative efficacy and complications were analyzed.Results In this group,15 patients were performed MVD again because of wide subarachnoid space,vascular compression and no obvious contraindication.The pain disappeared in 14 patients,relieved in 1 patient,and facial numbness occurred in 3 patients without recurrence.19 patients underwent percutaneous trigeminal semilunar ganglion balloon compression(PBC).The facial pain disappeared in all patients,but facial numbness occurred in all patients.There were 11 cases of masticatory muscle weakness,1 case of keratitis and 2 cases of lip herpes.One patient had pain recurrence10 months after operation.Conclusion The recurrence of TN after MVD can be cured by MVD and PBC.Individualized treatment should be selected according to imaging evaluation and patient condition.

关 键 词：三叉神经痛 个体化 微血管减压术 经皮穿刺球囊压迫术 

分 类 号：R744.11[医药卫生—神经病学与精神病学]