| 王鼎,王海洋,郑闻浩,杜权.单纯静脉压迫致三叉神经痛的手术处理策略研究[J].浙江中西医结合杂志,2025,35(8): |
| 单纯静脉压迫致三叉神经痛的手术处理策略研究 |
| Surgical Management of Trigeminal Neuralgia Caused Solely by Venous Compression |
| 投稿时间：2024-10-14 修订日期：2025-03-24 |
| DOI： |
| 中文关键词: 静脉压迫,三叉神经痛,微血管减压 |
| 英文关键词:venous compression, trigeminal neuralgia, microvascular decompression |
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| 中文摘要: |
| 目的：探讨单纯静脉压迫致三叉神经痛的微血管减压术的疗效及手术策略。 方法：回顾性分析2018年1月至2021年12月本机构治疗的47例单纯静脉压迫并行微血管减压术患者的临床资料，总结并分析术中操作策略、术后疗效及术后并发症。 结果：47例患者中42例充分游离责任静脉并减压，3例切断责任静脉属支，2例单纯行三叉神经梳理，术后即刻有效率为82.9%，随访24个月有效率为68.1%，术后出现29例患侧麻木，积极治疗后均治愈或明显好转，15例患侧疱疹，积极治疗后治愈，1例后颅窝出血，积极治疗后遗留声音嘶哑功能障碍。 结论：静脉也可能作为单纯的责任血管引起原发性三叉神经痛，主要是岩上静脉，因其在后颅窝静脉回流中的重要性，手术处理上应尽量予以完整保留并减压，其属支的电凝切断应当慎之又慎，避免引起后颅窝出血等严重并发症。 |
| 英文摘要: |
| Purpose: This study aimed to investigate the surgical efficacy and strategy of microvascular decompression for trigeminal neuralgia caused solely by venous compression. Methods: The clinical data of 47 patients with venous compression treated at our institution between January 2018 and December 2021 were retrospectively analyzed to summarize the intraoperative strategy, postoperative efficacy and postoperative complications. Results: Of the 47 patients, the responsible vein was fully freed and decompressed in 42 patients, the branch of the responsible vein was severed in three patients, and internal neurolysis of the trigeminal nerve was performed in two patients, with a success rate of 82.9% immediately after surgery and a success rate of 68.1% after 2-year follow-up. 29 patients developed facial numbness after surgery, and were curative or improved after active treatment. 15 patients occurred facial herpes postoperative, and were curative after active therapy. One patient developed posterior fossa hemorrhage after surgery, and hoarseness was maintained after active treatment. Conclusion: Venous compression solely may cause primary trigeminal neuralgia; therefore, responsible vessels, mainly the superior petrosal vein, should be preserved intact and decompressed as much as possible during surgical management due to its role in posterior fossa venous drainage, and severance of its branches by electrocoagulation should be done with caution to avoid serious complications such as posterior fossa hemorrhage. |
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