不同类型原发性三叉神经痛的手术疗效分析
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摘要
目的探讨不同类型的责任血管及压迫特点对原发性三叉神经痛手术疗效的影响。方法回顾性分析2002～2012年微血管减压术治疗的212例原发性三叉神经痛的临床资料。根据术中发现责任血管类型分为动脉压迫(155例)、静脉压迫(24例)和混合压迫(33例),根据术中发现责任血管压迫特点分为接触压迫型(123例)和粘连包裹型(89例)。结果手术总有效率为95.8%,动脉压迫、静脉压迫和混合压迫有效率分别为98.1%、95.8%和84.8%,接触压迫型和粘连包裹型有效率分别为98.4%和92.1%。结论微血管减压术是治疗原发性三叉神经痛的有效方法,动静脉混合压迫以及术中粘连包裹可能是影响手术疗效的因素。
Objective To explore the impact of different types of responsible vessels and patterns of compression on the curative effect of surgery on primary trigeminal neuralgia(PTN). Methods The microvascular decompression was performed in 212 patients with PTN, of whom, 155 had PTN induced by arterial compression(artery group), 24 by venous compression(vein group) and 33 by artery and vein compression(mixed group). Of theses 212 patients with PNT, 123 had contact compression and 89 had adhesion and package compression according to the patterns of compression to the trigeminal nerves. Results The total effective rate was 95.8%. The effective rate of artery group, vein group and mixed group were 98.1%(152/155), 95.8%(23/24) and 84.8%(28/33), respectively. And the effective rate of contact compression group and adhesion and package compression group were 98.4%(121/123) and 92.1%(82/89),respectively. Conclusions Microvascular decompression is an effective method to treat PTN. The mixed vessel compression and adhesion and package compression may be factors affecting the outcomes of surgery in the patients with PNT.
Objective To explore the impact of different types of responsible vessels and patterns of compression on the curative effect of surgery on primary trigeminal neuralgia(PTN). Methods The microvascular decompression was performed in 212 patients with PTN, of whom, 155 had PTN induced by arterial compression(artery group), 24 by venous compression(vein group) and 33 by artery and vein compression(mixed group). Of theses 212 patients with PNT, 123 had contact compression and 89 had adhesion and package compression according to the patterns of compression to the trigeminal nerves. Results The total effective rate was 95.8%. The effective rate of artery group, vein group and mixed group were 98.1%(152/155), 95.8%(23/24) and 84.8%(28/33), respectively. And the effective rate of contact compression group and adhesion and package compression group were 98.4%(121/123) and 92.1%(82/89),respectively. Conclusions Microvascular decompression is an effective method to treat PTN. The mixed vessel compression and adhesion and package compression may be factors affecting the outcomes of surgery in the patients with PNT.
引文
[1]罗波,范润金,张逵,等.全程围套式微血管减压术治疗原发性三叉神经痛的临床分析[J].中国临床神经外科杂志,2017,22(10):687-689,692.
[2]耿亮,王义宝,王占福.微血管减压术治疗原发性三叉神经痛126例[J].中国临床神经外科杂志,2017,22(2):95-96.
[3]郑玺.微血管减压术治疗原发性三叉神经痛65例[J].中国临床神经外科杂志,2018,23(6):429-430.
[4] Theodosopoulos PV, Marco E, Applebury C, et al. Predictive model for pain recurrence after posterior fossa surgery for trigeminal neuralgia[J]. Arch Neurol, 2002, 59(8):1297-1302.
[5] Sampson JH, Grossi PM, Asao K, et al. Microvascular decompression for glossopharyngeal neuralgia:long-term effectiveness and complication avoidance[J]. Neurosurgery,2004, 54(4):884-890.
[6] Theodros D, Rory Goodwin C, Bender MT, et al. Efficacy of primary microvascular decompression versus subsequent microvascular decompression for trigeminal neuralgia[J]. J Neurosurg, 2017, 126(5):1691-1697.
[7] Chen J, Guo ZY, Yang G, et al. Characterization of neurovascular compression in facial neuralgia patients by 3D high-resolution MRI and image fusion technique[J]. Asian Pac J Trop Med, 2012, 5(6):476-479.
[8] Tucer B, Ekici MA, Demirel S, et al. Microvascular decompression for primary trigeminal neuralgia:short-term follow-up results and prognostic factors[J]. J Korean Neurosurg Soc, 2012, 52(1):42-47.
[9]齐猛,孙澎,陆夏,等.术前3D-CISS联合3D-TOF序列MRI判断原发性三叉神经痛责任血管的效果[J].中国临床神经外科杂志,2017,22(10):684-686.
[10]何少宇,李玉,李杨,等.原发性三叉神经痛微血管减压术中岩静脉的处理[J].中国临床神经外科杂志,2016,21(12):747-749.
[11] Matsushima T, Huynh-Le P, Miyazono W. Trigeminal neuralgia caused by venous compression[J]. Neurosurgery,2004, 55(2):334-337.
[12] Sindou M, Howeidy T, Acevedo G. Anatomical observations during microvascular decompression for idiopathic trigeminal neuralgia(with correlations between topography of pain and site of the neurovascular conflict):prospective study in a series of 579 patients[J]. Acta Neurochir(Wien), 2002,144(1):1-13.
[13]漆松涛,朱蔚林,张喜安,等.静脉压迫性三叉神经痛的手术治疗[J].中华神经医学杂志,2008,7(4):388-392.
[14]闫薇.三叉神经微血管减压术与部分切断术治疗三叉神经痛的疗效比较[J].吉林医学,2013,34(27):5563.
[15] Leal PR, Hermier M, Souza MA, et al. Visualization of vascular compression of the trigeminal nerve with high resolution 3T MRI:a prospective study comparing preoperative imaging analysis to surgical findings in 40 consecutive patients who underwent microvascular decompressionfor trigeminal neuralgia[J]. Neurosurgery, 2011, 69(1):15-25.
[16] Patrick BS. Unusual nerve-artery relationship in microvas cular exploration for tic douloureux[J]. Neurosurgery, 2005,56(4):E873.
[2]耿亮,王义宝,王占福.微血管减压术治疗原发性三叉神经痛126例[J].中国临床神经外科杂志,2017,22(2):95-96.
[3]郑玺.微血管减压术治疗原发性三叉神经痛65例[J].中国临床神经外科杂志,2018,23(6):429-430.
[4] Theodosopoulos PV, Marco E, Applebury C, et al. Predictive model for pain recurrence after posterior fossa surgery for trigeminal neuralgia[J]. Arch Neurol, 2002, 59(8):1297-1302.
[5] Sampson JH, Grossi PM, Asao K, et al. Microvascular decompression for glossopharyngeal neuralgia:long-term effectiveness and complication avoidance[J]. Neurosurgery,2004, 54(4):884-890.
[6] Theodros D, Rory Goodwin C, Bender MT, et al. Efficacy of primary microvascular decompression versus subsequent microvascular decompression for trigeminal neuralgia[J]. J Neurosurg, 2017, 126(5):1691-1697.
[7] Chen J, Guo ZY, Yang G, et al. Characterization of neurovascular compression in facial neuralgia patients by 3D high-resolution MRI and image fusion technique[J]. Asian Pac J Trop Med, 2012, 5(6):476-479.
[8] Tucer B, Ekici MA, Demirel S, et al. Microvascular decompression for primary trigeminal neuralgia:short-term follow-up results and prognostic factors[J]. J Korean Neurosurg Soc, 2012, 52(1):42-47.
[9]齐猛,孙澎,陆夏,等.术前3D-CISS联合3D-TOF序列MRI判断原发性三叉神经痛责任血管的效果[J].中国临床神经外科杂志,2017,22(10):684-686.
[10]何少宇,李玉,李杨,等.原发性三叉神经痛微血管减压术中岩静脉的处理[J].中国临床神经外科杂志,2016,21(12):747-749.
[11] Matsushima T, Huynh-Le P, Miyazono W. Trigeminal neuralgia caused by venous compression[J]. Neurosurgery,2004, 55(2):334-337.
[12] Sindou M, Howeidy T, Acevedo G. Anatomical observations during microvascular decompression for idiopathic trigeminal neuralgia(with correlations between topography of pain and site of the neurovascular conflict):prospective study in a series of 579 patients[J]. Acta Neurochir(Wien), 2002,144(1):1-13.
[13]漆松涛,朱蔚林,张喜安,等.静脉压迫性三叉神经痛的手术治疗[J].中华神经医学杂志,2008,7(4):388-392.
[14]闫薇.三叉神经微血管减压术与部分切断术治疗三叉神经痛的疗效比较[J].吉林医学,2013,34(27):5563.
[15] Leal PR, Hermier M, Souza MA, et al. Visualization of vascular compression of the trigeminal nerve with high resolution 3T MRI:a prospective study comparing preoperative imaging analysis to surgical findings in 40 consecutive patients who underwent microvascular decompressionfor trigeminal neuralgia[J]. Neurosurgery, 2011, 69(1):15-25.
[16] Patrick BS. Unusual nerve-artery relationship in microvas cular exploration for tic douloureux[J]. Neurosurgery, 2005,56(4):E873.