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目的探讨微血管减压术治疗三叉神经痛的疗效及桥脑旁区血管与三叉神经“敏感区”的关系。方法回顾性分析微血管减压术治疗的96例三叉神经痛病人的临床资料。术中探查发现“敏感区”责任血管92例(95.83%),其中小脑上动脉20例(21.74%),小脑前下动脉13例(14.13%),椎动脉及基底动脉11例(11.96%),其他多根血管压迫7例(7.61%),起源不清楚的动脉19例(20.65%),岩静脉21例(22.83%),脑血管畸形1例(1.09%),未见责任血管为动脉瘤者。按文献报道的标准将这些血管与三叉神经的关系进行分型:无接触型4例,接触型32例,压迫型27例,粘连包绕型32例,贯穿型1例。根据不同分型,采取不同方法对血管进行处理。结果手术总有效率98.96%(95例)。主要并发症包括听力下降及消失4例,轻-中度面肌障碍8例,轻度后组颅神经症状1例,小脑症状3例,脑脊夜漏1例,术后切口枕大神经痛1例,伤口延迟愈合2例,无死亡与致残病例。术后随访3个月~4年,平均2.7年,未见疼痛复发患者。结论微血管减压术是目前外科治疗三叉神经痛的有效方法,术中正确识别桥脑旁区三叉神经“敏感区”的责任血管并充分减压,是确保微血管减压术成功的关键。
Objective To investigate the curative effect of microvascular decompression in the treatment of trigeminal neuralgia and the relationship between pontine vessels and trigeminal nerve “sensitive area ”. Methods The clinical data of 96 patients with trigeminal neuralgia treated by microvascular decompression were retrospectively analyzed. During operation, 92 patients (95.83%) had responsibility vessel, including 20 cases of superior cerebellar artery (21.74%), 13 cases of inferior cerebellar anterior artery (13.13%), 11 cases of vertebral artery and basilar artery (11.96%), %). Other multi-vessel vascular compression occurred in 7 cases (7.61%), in 19 cases (20.65%) in unclear origin, in 21 cases (22.83%) in petrous vein and in 1 case (1.09%) in cerebrovascular malformation. For aneurysms. According to the standard reported in the literature, the relationship between these vessels and the trigeminal nerve was classified. There were 4 cases of non-contact type, 32 cases of contact type, 27 cases of compression type, 32 cases of adhesions and 1 case of penetrating type. According to different types, take different ways to deal with the blood vessels. Results The total effective rate was 98.96% (95 cases). The main complications included 4 cases of hearing loss and disappearance, 8 cases of mild to moderate facial dysfunction, 1 case of cranial neuropathy in mild posterior group, 3 cases of cerebellar symptoms, 1 case of cerebrocephalic nocturnal leakage, 1 case, delayed wound healing in 2 cases, no death and disability cases. Postoperative follow-up 3 months to 4 years, an average of 2.7 years, no recurrence of pain patients. Conclusions Microvascular decompression is an effective method for the surgical treatment of trigeminal neuralgia. Correctly identifying the responsible vessels in the pontine trigeminal nerve and the “sensitive zone” during intraoperative decompression is the key to successful microvascular decompression.