手术和伽玛刀治疗三叉神经痛的个体化选择  

Individualized options for surgery and gamma knife treatment of trigeminal neuralgia

作　　者：李肖越 刘翠翠 赵冬冬 卢冰 陈靓 潘海鹏 冯文 何永生[2] Li Xiaoyue;Liu Cuicui;Zhao Dongdong;Lu Bing;Chen Liang;Pan Haipeng;Feng Wen;He Yongsheng(Department of Neurosurgery,363 Hospital,Chengdu,Sichuan 610041,China;Department of Neurosurgery,Sichuan Provincial People's Hospital,Affiliated Hospital of University of Electronic Science and Technology of China,Chengdu,Sichuan 610072,China)

机构地区：[1]三六三医院神经外科,四川成都610041 [2]电子科技大学附属医院四川省人民医院神经外科,四川成都610072

出　　处：《中国微侵袭神经外科杂志》2024年第1期11-15,共5页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的评价微血管减压术(microvascular decompression,MVD)、微血管减压术联合部分三叉神经感觉根切断术(partial sensory rhizotomy,PSR)和伽玛刀(gamma knife surgery,GKS)治疗原发性三叉神经痛(primary trigeminal neuralgia,PTN)的疗效与安全性,探讨个体化外科治疗。方法回顾性分析187例PTN病例资料。根据治疗方法不同,分为MVD组、MVD+PSR组和GKS组。随访时间均大于1年。比较三组间疼痛缓解率与并发症发生情况。结果末次随访时疼痛缓解有效率:MVD组为93.33%,MVD+PSR组为95.45%和GKS组为90.00%,无显著性差异。完全无痛率:MVD组为73.33%,MVD+PSR组为86.36%和GKS组为43.33%,MVD组、MVD+PSR组显著高于GKS组(P<0.0167)。MVD+PSR组并发症发生率显著高于GKS组、MVD组(P<0.0167)。结论①手术和GKS都是治疗PTN的有效手段,疼痛缓解有效率相当。②MVD和GKS治疗后并发症发生率低。虽然MVD+PSR组止痛效果满意,但其并发症发生率极高,满意度低,不推荐首选。③术前影像有明确神经血管压迫,首选MVD。④GKS安全性高,无明确神经血管压迫,老年、不能耐受手术、拒绝手术或选择伽玛刀治疗者,推荐伽玛刀治疗。Objective To evaluate the efficacy and safety of microvascular decompression(MVD),MVD combined with partial sensory rhizotomy(PSR)and Gamma knife surgery(GKS)in the treatment of primary trigeminal neuralgia(PTN)and to explore the individualized surgical treatment of PTN.Methods The clinical data of 187 PTN patients were analyzed retrospectively.They were divided into MVD group,MVD+PSR group and GKS group according to the treatment.The follow-up time was greater than 1 year.The pain relief rate and the occurrence of complications were compared between the three groups.Results At the last follow-up,the rate of effective pain relief was 93.33%in MVD group,95.45%in MVD+PSR group and 90.00%in GKS group respectively,with no significant difference.The total pain-free rates were 73.33%in the MVD group,86.36%in the MVD+PSR group and 43.33%in the GKS group respectively,which was significantly higher in the MVD group and MVD+PSR group than in the GKS group(P<0.0167).The complication rate was significantly higher in the MVD+PSR group than in the GKS group and MVD group(P<0.0167).Conclusions①Surgery and GKS are both effective treatments for PTN,and the pain relief efficiency is similar.②The complication rate after MVD and GKS treatment is low.Although the analgesic effect of MVD+PSR group is satisfactory,its complication rate is extremely high and satisfaction is low,so it is not recommended to be preferred.③MVD is preferred when there is clear neurovascular compression on preoperative imaging.④GKS is safety,can be recommended in the patients who have no definite neurovascular compression,are the aged,cannot tolerate surgery or refuse surgery.

关 键 词：三叉神经痛 微血管减压术 放射外科手术 部分感觉根切断术 

分 类 号：R745.11[医药卫生—神经病学与精神病学]