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目的探讨颅内肿瘤继发三叉神经痛的临床特点、发病机制、治疗方案及手术要点。方法回顾性分析我院2000年9月至2010年4月间收治的36例继发性三叉神经痛病人的临床资料及手术治疗效果。结果 21例肿瘤全切除,11例肿瘤及1例蛛网膜囊肿次全切除,3例肿瘤部分切除。5例患者还行三叉神经感觉根部分切断术,1例行三叉神经微血管减压术。术后35例病人面部疼痛消失,1例疼痛明显减轻。术后新增并发症包括面部麻木8例,暂时性面瘫6例,听力下降3例,口唇疱疹3例,眼球轻度外展受限2例,无菌性脑膜炎1例。术后平均随访33个月,无疼痛复发病例。结论桥小脑角区肿瘤是继发性三叉神经痛的最常见原因,发病机制可能为三叉神经传导通路受压及脱髓鞘改变。显微手术切除病灶是继发性三叉神经痛的首选治疗方案。手术原则是保护颅神经功能的前提下争取病灶全切以及三叉神经的充分减压。
Objective To investigate the clinical features, pathogenesis, treatment options and operative points of intracranial tumors secondary to trigeminal neuralgia. Methods The clinical data and surgical treatment of 36 patients with secondary trigeminal neuralgia admitted in our hospital from September 2000 to April 2010 were retrospectively analyzed. Results Totally resected 21 cases of tumor, 11 cases of tumor and 1 case of arachnoid cyst subtotal resection, 3 cases of tumor resection. Five patients underwent partial trigeminal sensory root resection and one underwent trigeminal microvascular decompression. 35 cases of patients after facial pain disappeared, 1 case of pain was significantly reduced. Postoperative complications include facial numbness in 8 cases, temporary facial paralysis in 6 cases, 3 cases of hearing loss, 3 cases of oral herpes labialis, eye outreach in 2 cases limited, 1 case of aseptic meningitis. After an average follow-up of 33 months, no recurrence of pain. Conclusions The cerebellopontine angle tumor is the most common cause of secondary trigeminal neuralgia. The pathogenesis may be the compression and demyelination of the trigeminal nerve conduction pathway. Microsurgical removal of the lesion is the treatment of choice for secondary trigeminal neuralgia. The principle of surgery is to protect the cranial nerves under the premise of full lesions as well as trigeminal nerve decompression.