微血管减压术治疗原发性三叉神经痛的疗效分析
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摘要
目的:探讨微血管减压术治疗原发性三叉神经痛的临床效果及影响手术疗效的相关因素。
方法:回顾性分析34例2006年4月至2010年8月期间在广西医科大学第一附属医院神经外科接受微血管减压术治疗的原发性三叉神经痛患者的临床资料。分析34例患者的临床特征、术中所见和术后疗效随访结果。随访时间半年至4年,平均41个月。对可能影响手术疗效的年龄、性别、患侧、病程、临床症状、压迫程度和减压程度等因素进行分析。
结果:根据临床特征分为为典型性三又神经痛(23例)和非典型性三叉神经痛(11例)。本组34例病人中术中见单纯动脉压迫28(82.4%)例,包括SCA、AICA、PICA、BA、及SCA+AICA、AICA+PICA等,3例(8.8%)为动脉和静脉血管同时压迫;单纯静脉压迫2例(5.9%),未见明显血管压迫1例(2.9%)。34例患者神经减压程度中,充分减压的27例, 7例部分减压。至随访结束,本组治愈23例(67.6%)、显效8例(23.5%),有效2例(5.9%),无效1例(2.9%),总有效率97.1%。其中23例典型性TN患者中,治愈及显效23例(100%);11例非典型性三叉神经痛患者中,治愈及显效8例(72.7%),有效2例(18。2%),无效1例(9.1%)。两组间疗效比较有统计学意义(P<0.05)。对年龄、性别、患侧、病程、临床症状、神经压迫程度和减压程度进行统计学分提示临床症状、病程、神经压迫程度和减压程度与手术疗效之间有相关性(P<0.05)。
结论:微血管减压术,使三叉神经功能可以得到保护,疗效确切,是首选治疗方法。典型性三叉神经痛患者微血管减压术后疗效优于非典型性三叉神经痛患者。影响微血管减压手术疗效的因素主要有临床症状、病程、神经压迫程度和减压程度。
Objective:To explore the clinical effect and related factors on the treatment of idiopathic trigeminal neuralgia by microvascular decompression.
Methods: The clinical data of 34 patients with idiopathic trigeminal neuralgia treated by microvascular decompression between April 2006 and October 2010 in Guangxi medical univ- ersity first affiliated hospital neurosurgery department were retrospectively analyzed. Analysis of 34 cases of patients with clinical presentation, operative findings and follow -up outcomes. Follow-up time from six months to 6 years, an average of 41 months. Analysed all the factors of influence effect ofoperation prob- ably:the patients’age,gender,affected side,course of disease,clinical presentation,the degree of com- pression and decompression.
Results: According to clinical characteristics,divided into typical trigeminal neuralgia group(23 cases)and atypical trigeminal neuralgia group(11 cases).In 34 patients,simple artery compression 28 cases (82.4%), including SCA, AICA, PICA, BA, and SCA+AICA, AICA+ PICA etc, 3 cases (8.8%) for arteries and veins while oppression; simple vein compression 2 cases (5.9%), no significant vascular compression of 1 cases (2.9%). Degree of 34 patients with neural decompression, full de- com- pression in 27 cases, of 7 patients with partial decompression. To the end of follow-up, cure for 23 cases of this group (67.6%), Excellent in 8 cases (23. 5%), effective 2 cases (5. 9%), invalid 1 cases (2. 9%), the total effective rate 97.1%. In 23 patients with typical TN, cure and exce- llent in 23 cases (100%); in 11 cases with atypical trigeminal neuralgia, cure and ex- cellent 8 cases (72.7%), effective 2 cases (18. 2%), invalid 1 cases (9.1%).The effect between the two groups had signifi- cant differ- ence (P<0. 05). Statistical analysis of the factors such as age,gender,affected side,disease course,clinical presentation,the degree of com- pression and decompression,suggested that clinical presentation,the disease course,the degree of compression and decompression were significantly correlated with the effect of surgery(P<0. 05).
Conclusion: Microvascular decompression is an etiotropic, safe and effective treatment for idiopathic trigeminal neur- algia. It may be the first choice for healing ITN Microvascular decompression had better eff- ect in pain relief for patients with typical trigeminal neuralgia than pati- ents with atypical trigeminal neuralgia.The main factors affecting the effect of microvascular decompression were clinical presentation , dis- ease course,the degree of compression and decompression.
方法:回顾性分析34例2006年4月至2010年8月期间在广西医科大学第一附属医院神经外科接受微血管减压术治疗的原发性三叉神经痛患者的临床资料。分析34例患者的临床特征、术中所见和术后疗效随访结果。随访时间半年至4年,平均41个月。对可能影响手术疗效的年龄、性别、患侧、病程、临床症状、压迫程度和减压程度等因素进行分析。
结果:根据临床特征分为为典型性三又神经痛(23例)和非典型性三叉神经痛(11例)。本组34例病人中术中见单纯动脉压迫28(82.4%)例,包括SCA、AICA、PICA、BA、及SCA+AICA、AICA+PICA等,3例(8.8%)为动脉和静脉血管同时压迫;单纯静脉压迫2例(5.9%),未见明显血管压迫1例(2.9%)。34例患者神经减压程度中,充分减压的27例, 7例部分减压。至随访结束,本组治愈23例(67.6%)、显效8例(23.5%),有效2例(5.9%),无效1例(2.9%),总有效率97.1%。其中23例典型性TN患者中,治愈及显效23例(100%);11例非典型性三叉神经痛患者中,治愈及显效8例(72.7%),有效2例(18。2%),无效1例(9.1%)。两组间疗效比较有统计学意义(P<0.05)。对年龄、性别、患侧、病程、临床症状、神经压迫程度和减压程度进行统计学分提示临床症状、病程、神经压迫程度和减压程度与手术疗效之间有相关性(P<0.05)。
结论:微血管减压术,使三叉神经功能可以得到保护,疗效确切,是首选治疗方法。典型性三叉神经痛患者微血管减压术后疗效优于非典型性三叉神经痛患者。影响微血管减压手术疗效的因素主要有临床症状、病程、神经压迫程度和减压程度。
Objective:To explore the clinical effect and related factors on the treatment of idiopathic trigeminal neuralgia by microvascular decompression.
Methods: The clinical data of 34 patients with idiopathic trigeminal neuralgia treated by microvascular decompression between April 2006 and October 2010 in Guangxi medical univ- ersity first affiliated hospital neurosurgery department were retrospectively analyzed. Analysis of 34 cases of patients with clinical presentation, operative findings and follow -up outcomes. Follow-up time from six months to 6 years, an average of 41 months. Analysed all the factors of influence effect ofoperation prob- ably:the patients’age,gender,affected side,course of disease,clinical presentation,the degree of com- pression and decompression.
Results: According to clinical characteristics,divided into typical trigeminal neuralgia group(23 cases)and atypical trigeminal neuralgia group(11 cases).In 34 patients,simple artery compression 28 cases (82.4%), including SCA, AICA, PICA, BA, and SCA+AICA, AICA+ PICA etc, 3 cases (8.8%) for arteries and veins while oppression; simple vein compression 2 cases (5.9%), no significant vascular compression of 1 cases (2.9%). Degree of 34 patients with neural decompression, full de- com- pression in 27 cases, of 7 patients with partial decompression. To the end of follow-up, cure for 23 cases of this group (67.6%), Excellent in 8 cases (23. 5%), effective 2 cases (5. 9%), invalid 1 cases (2. 9%), the total effective rate 97.1%. In 23 patients with typical TN, cure and exce- llent in 23 cases (100%); in 11 cases with atypical trigeminal neuralgia, cure and ex- cellent 8 cases (72.7%), effective 2 cases (18. 2%), invalid 1 cases (9.1%).The effect between the two groups had signifi- cant differ- ence (P<0. 05). Statistical analysis of the factors such as age,gender,affected side,disease course,clinical presentation,the degree of com- pression and decompression,suggested that clinical presentation,the disease course,the degree of compression and decompression were significantly correlated with the effect of surgery(P<0. 05).
Conclusion: Microvascular decompression is an etiotropic, safe and effective treatment for idiopathic trigeminal neur- algia. It may be the first choice for healing ITN Microvascular decompression had better eff- ect in pain relief for patients with typical trigeminal neuralgia than pati- ents with atypical trigeminal neuralgia.The main factors affecting the effect of microvascular decompression were clinical presentation , dis- ease course,the degree of compression and decompression.
引文
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[7]Kilian JM,Fromm GH.Carbamazepine in the treatment of neur- algia.Arch Neurol,1968;19:129.136.
[8]Sindrup SH,Jensen TS.Pharmacotherapy of trigeminal neur- algia.Clin J Pain,2002:18:22.27.
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[12]Tyler-Kabara EC,Kassam AB,Horowitz MH,Urgo L,HadjiPanayis C,Levy EI Chang YF. Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia:comparison of results following microvascular decompression.J Neurosurg 2002:96:527-531.
[13] Seif C, Junemann KP, Braun PM. Deafferentation of the urinary bladder and implanatation of asacral anterior root stimulator (SARS) for the treatment of neurogenic bladder in paraplegic patients[J]. Biomed Tech (Berl), 2004, 49 (4):88-92.
[14]Sharma HS. Post-traumatic application of brain-derived neurotrophic factor and glia-derived neurotrophic factor on the rat spinal cord enhances neuroprotection and imp- roves motor function[J].Acta Neurochir,2006,96 (Suppl): 329-334.
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[21]King WA, Wackym PA, Sen C, et al. Adjunctive use of endoscopy during posterior fossa surgery to treat cranial neuropathies [J].Neurosurgery, 2001, 49 (1) : 108 - 116.
[22]Matsushima T,Huynh-Le P,Miyazono M.Trigeminal neumlgia caused by Venous compression[J]Neurosurgery,2004,55(2):334.337.
[23]Broggi G, Ferroli P, Franzini A, et al. Operative findings and outcomes of microvascular decompression for trigeminal neuralgia in 35 patients affected by multiple sclerosis. Neurosurgery, 2004, 55:830-838.
[24]种衍军,朱广庭,段德义等.微血管减压术治疗三叉神经痛2643例临床分析[期刊论文]-中华外科杂志,2005,43(21):1407-1409.
[25]Merskey H,Bogduk N.Classification of chronic pain.Descri- ption of Chronic Pain.Syndromes and Definitions of Pain Terms.Seattle:IASP Press,1994:59-71.
[26]Anonymous.Classification and diagnostic eriteria for headache disorders,crania neuralgias and facial pain. Headaehe Classification Committee of the International Headache Society.Cephalalgia 1 988;8(Suppl 7):1-96.
[27]Korogi Y,Nagahiro S,DuCetal.Evaluation of vascularcompression in tngeminal neuralgia by 3D·time offlight MRA.compute Assist Tomogr,1995;19(6):879-884.
[28]李又成,黎金林等.血管压迫性三叉神经痛的MR成像序列选择.中国临床医学影像杂志,2009,20(2):1 19.122.
[29]Yoshino N,DDS.,Aklmoto H,MD.,Yamadal,MD.,etal.Trige- minal Neuralgia:Evaluation of Neuralgic Manifestation and Site of Neurovascular Compression With 3D CISS MR Imaging and MR AngiograPhy.Radiology,2003,228:539-545.
[30] Miller J,M.D.,Aear F,M.D.,Hamilton B,M.D. et al. Preo- perative visualization of neurovascular anatomy in tri- geminal neuralgia.JNeurosurg,2008,108:477-482
[31]吕福林,陈援朝,郑鲁等.治疗典型和非典型的三叉神经痛微血管减压术后结果对照分析.中华临床医药,2003;4(24): 20-24.
[32]李世亭,潘庆刚,海舰等.微血管减压术治疗典型及非典型三叉神经痛的疗效比较.中国微侵袭神经外科杂志, 2005,10(11): 483-484.
[33]陈国强,李锐,郭京.三叉神经痛微血管减压术导致患者死亡的手术并发症[J].立体定向和功能神经外科杂志, 2004.17: 44～45.
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[2]Spatz AL,Zaktzewska JM.Kay EJ.Decision analysis of medical and surgical treatments for trigeminal neural6a:how patient evaluations of benefits and risks affect the utility of treatment decisions[J].Pain,2007,131(3):302-310.
[3]Manzoni GC,Torelli P.Epidemiology of typical and atypical craniofacial neuralgia.NeurolSci,2005,26(Suppl 2):65-67.
[4]王忠诚主编.王忠诚神经外科学.武汉:湖北科学技术出版社,2002:1025.1027.
[5]Rye H,Yamamoto S,Sugiyama K,et a1.Neurovascular decom- pression for trigeminal neuralgia in elderly patients.Ne- urolo Med Chk(Tokyo),1999;39:226-230.
[6] Love S,Hilton,DA,CoakhamHB.Central demyelination of the Vth nerve root in trigeminal neuralgia assoeiated with vascular compression. Brain Pathol,1998,8:1212.
[7]Kilian JM,Fromm GH.Carbamazepine in the treatment of neur- algia.Arch Neurol,1968;19:129.136.
[8]Sindrup SH,Jensen TS.Pharmacotherapy of trigeminal neur- algia.Clin J Pain,2002:18:22.27.
[9]Camepell FG,Graham JG,Zilkha KJ.Clinical trial of car- bamazepine(Tegret01)in trigeminal reuralgia.Neurol Neur- osurg Psychiatry,1966;29:265-267.
[10]Ahn KS,Lee MK,Hwang SH,Lee JE,Cho CW, Kim DJ.Percutaneous Balloon Compression of Trigeminal Ganglion for the treatment of idiopathic Trigeminal Neuralgia.Korean Neurosurg Soc,2004;36:213-217.
[11]Shapiro S, Borgens R, Pascuzzi R, et al. Oscillating field stimulation for complete spinal cord injury in humans: A phase 1 trial[J]. J Neurosurg Spine,2005, 2(1):3–10.
[12]Tyler-Kabara EC,Kassam AB,Horowitz MH,Urgo L,HadjiPanayis C,Levy EI Chang YF. Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia:comparison of results following microvascular decompression.J Neurosurg 2002:96:527-531.
[13] Seif C, Junemann KP, Braun PM. Deafferentation of the urinary bladder and implanatation of asacral anterior root stimulator (SARS) for the treatment of neurogenic bladder in paraplegic patients[J]. Biomed Tech (Berl), 2004, 49 (4):88-92.
[14]Sharma HS. Post-traumatic application of brain-derived neurotrophic factor and glia-derived neurotrophic factor on the rat spinal cord enhances neuroprotection and imp- roves motor function[J].Acta Neurochir,2006,96 (Suppl): 329-334.
[15]Sindou M,Howeidy T,Acevedo G Anatomical observations during microvascular decompression for idiopathic trige- minal neuralgia.Prospective study in a series of 579 patients.Acta Neurochir,2002;144:l-13.
[16]Brisman R. Gamma knife radiosurgery for primary management for trigeminal neuralgia [J]. J Neurosurg, 2000; 93(Suppl 3): 159-161.
[17]Headache Classifiication Subcommittee of the Interna- tional Headache Society.The international classification of headache disorders[J].Cephalalgia, 2004,24(Suppl 1): 9-160.
[18] Nagaseki Y,HorikoshiT,OmataT,et al.Oblique sagittal magnetic resonance imaging visualizing vascular compre- ssion of the trigeminal or facial nerve.J Neurosurg,1992,77:379-386.
[19]李世亭,潘庆刚等.微血管减压术治疗三叉神经痛的预后影响因素研究.中国神经精神疾病杂志,2004;30(3):169.172.
[20]王任直主译.神经外科手术学[M].北京:人民卫生出版社, 2003:1453-1466.
[21]King WA, Wackym PA, Sen C, et al. Adjunctive use of endoscopy during posterior fossa surgery to treat cranial neuropathies [J].Neurosurgery, 2001, 49 (1) : 108 - 116.
[22]Matsushima T,Huynh-Le P,Miyazono M.Trigeminal neumlgia caused by Venous compression[J]Neurosurgery,2004,55(2):334.337.
[23]Broggi G, Ferroli P, Franzini A, et al. Operative findings and outcomes of microvascular decompression for trigeminal neuralgia in 35 patients affected by multiple sclerosis. Neurosurgery, 2004, 55:830-838.
[24]种衍军,朱广庭,段德义等.微血管减压术治疗三叉神经痛2643例临床分析[期刊论文]-中华外科杂志,2005,43(21):1407-1409.
[25]Merskey H,Bogduk N.Classification of chronic pain.Descri- ption of Chronic Pain.Syndromes and Definitions of Pain Terms.Seattle:IASP Press,1994:59-71.
[26]Anonymous.Classification and diagnostic eriteria for headache disorders,crania neuralgias and facial pain. Headaehe Classification Committee of the International Headache Society.Cephalalgia 1 988;8(Suppl 7):1-96.
[27]Korogi Y,Nagahiro S,DuCetal.Evaluation of vascularcompression in tngeminal neuralgia by 3D·time offlight MRA.compute Assist Tomogr,1995;19(6):879-884.
[28]李又成,黎金林等.血管压迫性三叉神经痛的MR成像序列选择.中国临床医学影像杂志,2009,20(2):1 19.122.
[29]Yoshino N,DDS.,Aklmoto H,MD.,Yamadal,MD.,etal.Trige- minal Neuralgia:Evaluation of Neuralgic Manifestation and Site of Neurovascular Compression With 3D CISS MR Imaging and MR AngiograPhy.Radiology,2003,228:539-545.
[30] Miller J,M.D.,Aear F,M.D.,Hamilton B,M.D. et al. Preo- perative visualization of neurovascular anatomy in tri- geminal neuralgia.JNeurosurg,2008,108:477-482
[31]吕福林,陈援朝,郑鲁等.治疗典型和非典型的三叉神经痛微血管减压术后结果对照分析.中华临床医药,2003;4(24): 20-24.
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