目的 探讨并总结原发性三叉神经痛的责任病变,提高手术治疗的针对性和准确性,以便对三叉神经进行充分减压.方法 术前诊断为原发性三叉神经痛的患者91例,86例接受显微血管减压手术治疗,其中85例术中亦诊断为原发性三叉神经痛,根据术中探查所见,判断分析其三叉神经痛的责任病变.结果 85例原发性三叉神经痛患者术中发现单一责任血管者60例(70.6％,包括蛛网膜明显粘连3例),2支及以上责任血管者21例(24.7％),无责任血管者4例(4.7％,其中1例蛛网膜增厚粘连明显).85例患者中,有蛛网膜增厚粘连者共4例(4.7％,其中3例合并动脉压迫、1例未见明显责任血管).结论 原发性三叉神经痛的责任病变除单一责任血管外,还包括2支及多支责任血管、合并蛛网膜明显粘连等,显微血管减压手术治疗中需要明确所有可能的责任病变,以便对三叉神经进行充分减压.%Objective To explore and summarize the offending lesions of primary trigeminal neuralgia,in order to im-prove the pertinence and accuracy of surgery and achieve sufficient decompression of trigeminal nerve. Methods Ninety-one cases were diagnosed as primary trigeminal neuralgia before surgery,and 86 cases received planned microvascular de-compression,of which 85 cases were verified as primary trigeminal neuralgia during surgery. According to surgical find-ings,the offending lesions of primary trigeminal neuralgia were identified and analyzed. Results Of the 85 cases with pri-mary trigeminal neuralgia undergoing surgery,60 cases were found with only 1 offending vessel (70. 6％,including 3 cases with obvious arachnoid membrane adhesion),21 cases with 2 or more offending vessels (24. 7％),and 4 cases were found with no offending vessel (4. 7％,including 1 case with obvious arachnoid membrane adhesion). Of all patients receiving surgery,4 cases (4. 7％)were found with arachnoid membrane adhesion,including 3 cases accompanied with artery com-pression and 1 case with no obvious offending vessel. Conclusions For primary trigeminal neuralgia,besides solely one vessel,the offending lesions include two or more vessels,obvious arachnoid membrane adhesion and others. During the op-eration of microvascular decompression,all possible offending lesions should be identified to achieve sufficient decompres-sion of trigeminal nerve.
展开▼
