首页|三叉神经痛个体化微血管减压手术策略分析

三叉神经痛个体化微血管减压手术策略分析

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目的 探讨个体化微血管减压术（MVD）治疗三叉神经痛（TN）的临床疗效，以期为患者提供个体化治疗策略及新的治疗思路。 方法 回顾性分析2021年1月至2023年9月安徽医科大学第一附属医院神经外科收治的46例TN患者的临床资料，男19例，女27例；发病年龄为（58。3 ± 9。0）岁。根据巴罗神经学研究所(BNI)提出的疼痛分级评估患者术前疼痛分级及手术疗效。其中术前BNI Ⅳ级27例，Ⅴ级19例。46例患者手术均采用经乙状窦后入路，结合术中血管情况采取显微镜手术完成10例，内镜完成手术12例，内镜和显微镜双镜联合24例。探明责任血管后，予以涤纶垫棉减压。术后通过电话或者门诊跟踪随访患者。 结果 46例TN MVD患者，43例（93。5%）术后疼痛即刻完全缓解（BNI分级Ⅰ级），3例（6。5%）术后疼痛部分缓解（BNI分级Ⅱ级）。4例患者术后出现面部麻木、感觉减退，2例出现面瘫（House-Brackmann分级Ⅱ级1例、Ⅲ级1例），8例出现颅内积气，4例出现术后发热，2例皮下积液。经过治疗，颅内积气、发热均治愈，皮下积液1例消失，1例持续存在。46例患者随访中位时间为16。2（1~33）个月，3例术后BNI Ⅱ级患者2例完全缓解（BNI分级Ⅰ级），1例复发加重（BNI分级Ⅳ级）。 结论 责任血管的复杂程度是制定TN MVD策略的重要考量因素之一，结合术中具体血管情况制定个体化的手术方案，是TN治疗值得借鉴的手术策略。 Objective To investigate the clinical efficacy of individualised microvascular decompression (MVD) for trigeminal neuralgia (TN)， so as to provide individualised treatment strategies and new thoughts for treatment。 Methods Clinical data of 46 patients who had TN and treated in the Department of Neurosurgery at the First Affiliated Hospital of Anhui Medical University from January 2021 to September 2023 were retrospectively studied。 The study consisted of 19 males and 27 females， with an average age of morbidity at (58。3 ± 9。0) years old。 Preoperative pain ratings and surgical outcomes were evaluated using the Barrow Neurological Institute (BNI) pain rating scale， and of which 27 patients were rated at BNI grade IV and 19 at grade V before surgery。 A posterior trans-sigmoid sinus approach was applied in surgery on all patients， which could be performed in various ways depending on the vascular conditions identified during surgery。 Ten patients were treated with microsurgery， 12 with endoscopic surgery and 24 with combined endoscopic surgery and microsurgery。 After having identified the responsible vessel(s)， a vascular decompression for the affected trigeminal nerve was performed and the nerve decompression was achieved by a polyester pad。 Long-term postoperative follow-ups were conducted via telephone interviews or outpatient visits。 Results A total of 46 patients received the microvascular decompression surgery。 Among them， 43 cases (93。5%) achieved immediate and complete pain relief of BNI grade I after surgery， and 3 cases (6。5%) achieved partial pain relief of BNI grade Ⅱ。 Four patients developed facial numbness and sensory reduction， 2 developed facial paralysis (of House-Brackmann grade Ⅱ of 1 patient and grade Ⅲ of the other)， 8 developed pneumocephalus， 4 developed postoperative fever， and 2 developed subcutaneous effusion。 After treatment， the pneumocephalus and fever were cured， subcutaneous effusion was disappeared in 1 patient， but remained in the other。 The mean follow-up period for the 46 patients was 16。2 (1-33) months。 During the follow-up， 2 of the 3 patients of BNI grade Ⅱ immediately after surgery had complete remission to BNI grade Ⅰ and the other had recurrence and aggravation at BNI grade Ⅳ。 Conclusion The complexity of the responsible vessels is one of the important factors to be considered in the microvascular decompression strategy for trigeminal neuralgia。 An individualised surgical plan according to a specific vascular condition identified in the surgery， is a best possible or worthiness surgical strategy in the treatment for a TN。
Analysis of individualised strategy in microvascular decompression for trigeminal neuralgia
Objective To investigate the clinical efficacy of individualised microvascular decompression (MVD) for trigeminal neuralgia (TN), so as to provide individualised treatment strategies and new thoughts for treatment. Methods Clinical data of 46 patients who had TN and treated in the Department of Neurosurgery at the First Affiliated Hospital of Anhui Medical University from January 2021 to September 2023 were retrospectively studied. The study consisted of 19 males and 27 females, with an average age of morbidity at (58.3 ± 9.0) years old. Preoperative pain ratings and surgical outcomes were evaluated using the Barrow Neurological Institute (BNI) pain rating scale, and of which 27 patients were rated at BNI grade IV and 19 at grade V before surgery. A posterior trans-sigmoid sinus approach was applied in surgery on all patients, which could be performed in various ways depending on the vascular conditions identified during surgery. Ten patients were treated with microsurgery, 12 with endoscopic surgery and 24 with combined endoscopic surgery and microsurgery. After having identified the responsible vessel(s), a vascular decompression for the affected trigeminal nerve was performed and the nerve decompression was achieved by a polyester pad. Long-term postoperative follow-ups were conducted via telephone interviews or outpatient visits. Results A total of 46 patients received the microvascular decompression surgery. Among them, 43 cases (93.5%) achieved immediate and complete pain relief of BNI grade I after surgery, and 3 cases (6.5%) achieved partial pain relief of BNI grade Ⅱ. Four patients developed facial numbness and sensory reduction, 2 developed facial paralysis (of House-Brackmann grade Ⅱ of 1 patient and grade Ⅲ of the other), 8 developed pneumocephalus, 4 developed postoperative fever, and 2 developed subcutaneous effusion. After treatment, the pneumocephalus and fever were cured, subcutaneous effusion was disappeared in 1 patient, but remained in the other. The mean follow-up period for the 46 patients was 16.2 (1-33) months. During the follow-up, 2 of the 3 patients of BNI grade Ⅱ immediately after surgery had complete remission to BNI grade Ⅰ and the other had recurrence and aggravation at BNI grade Ⅳ. Conclusion The complexity of the responsible vessels is one of the important factors to be considered in the microvascular decompression strategy for trigeminal neuralgia. An individualised surgical plan according to a specific vascular condition identified in the surgery, is a best possible or worthiness surgical strategy in the treatment for a TN.

Trigeminal neuralgiaMicrovascular decompressionNeuro-microsurgical operationNeuroendoscopyRetrospectively study

洪文明、陈东辉、张芳、汪惊涛、王斌、程宏伟

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安徽医科大学第一附属医院神经外科，合肥　230022

2安徽医科大学附属六安市人民医院神经外科，安徽　六安　237008

3安徽医科大学护理学院，合肥　230032

三叉神经痛 微血管减压术 神经显微手术 神经内镜 回顾性研究

国家自然科学基金安徽省自然科学基金安徽省高校自然科学研究项目安徽医科大学第一附属医院博士科研启动基金教育部重点实验室(安徽医科大学)开放课题教育部重点实验室(安徽医科大学)开放课题安徽省质量工程项目安徽省质量工程项目

820037952108085QH3302023AH053318BSKY2019016AYPYS2022-5KFJJ-2020-012021XJJYXM122022ZYXWJXALK057

2024

10.3760/cma.j.cn441206-20231009-00049

中华显微外科杂志
中华医学会

中华显微外科杂志

北大核心
影响因子：2.321
ISSN：1001-2036
年,卷(期)：2024.47(1)
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