显微血管减压联合三叉神经感觉根部分切断治疗特殊类型三叉神经痛1例  

Treatment of a special type of trigeminal neuralgia with microvascular decompression combined with partial sensory rhizotomy:a case report

作　　者：杨帆 刘树轩 刘云阳 冯学泉[1] YANG Fan;LIU Shuxuan;LIU Yunyang;FENG Xuequan(Department of Neurosurgery,Tianjin First Central Hospital,No.24 Fukang Road,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院神经外科,天津300192

出　　处：《中国神经精神疾病杂志》2022年第5期303-305,共3页Chinese Journal of Nervous and Mental Diseases

摘　　要：动脉穿过三叉神经感觉根并导致三叉神经痛发生,这类病例非常罕见,少有报告。本文报告1例57岁女性患者,右侧颜面部疼痛半年余。术前三叉神经高分辨核磁提示:右侧小脑上动脉与右侧三叉神经关联紧密。诊断为右侧原发性三叉神经痛。术中发现,右侧小脑上动脉呈垂直关系穿过右侧三叉神经感觉根,与其密切接触并有较明显压迫,因无法分离动脉和神经,且小脑上动脉上方的三叉神经纤维束较薄,镜下观察有些萎缩,故将小脑上动脉上方的三叉神经感觉根进行切断,充分分离血管和神经后,将Teflon垫片置入动脉和位于动脉下方的三叉神经感觉根之间。术后患者疼痛消失。该病例的发病机制较为特殊,丰富了三叉神经痛的形成原因,而且治疗方式上,采用显微血管减压术联合三叉神经感觉根部分切断术进行治疗,效果显著,值得同行关注与讨论。Cases of trigeminal neuralgia caused by an artery transfixing the trigeminal nerve sensory root are rarely documented.This report described a 57-year-old woman suffered severe pain on the right face for more than half a year.Pre-operative magnetic resonance imaging showed right superior cerebellar artery was closely related with trigeminal nerve,and the patient was diagnosed with primary trigeminal neuralgia.Intraoperative found the compressing right superior cerebellar artery,which vertically transfixed trigeminal nerve sensory root and closely related.As a result,it was impossible to separate the offending artery from the nerve.In addition,nerve fibers above the superior cerebellar artery were thinning and looked atrophic under the microscope.We therefore transected the thin and atrophic nerve fiber,releasing the artery from the trigeminal nerve,and the superior artery was kept apart from the underlying nerve fibers by a Teflon gasket.Pain was completely disappeared after surgery.The etiological mechanism of this case was extremely rare,which enrich the knowledge of etiology of trigeminal neuralgia.In this report,microvascular decompression combined with partial trigeminal sensory root amputation is considered an effective surgery method to treat trigeminal neuralgia,which needs further attention and discussion.

关 键 词：原发性三叉神经痛 显微血管减压术 三叉神经感觉根部分切断术 小脑上动脉 三叉神经 

分 类 号：R745[医药卫生—神经病学与精神病学]