CAJ | 학술논문

目的探讨静脉压迫性三叉神经痛的手术治疗特点和疗效. 方法回顾性分析8年间33例原发性三叉神经痛患者术中静脉压迫的处理及结果.对静脉压迫的处理采取细小静脉予以电凝阻断,岩上静脉复合体分支可部分阻断.保留主干;全程解剖分离血管压迫后予以Teflon围套式包裹三叉神经. 结果静脉压迫可位于三叉神经脑池段全程:33例中22例既有静脉压迫也有动脉责任血管,11例责任血管为单纯静脉,其中3例为无名静脉,8例为靠近Meckel's腔的岩上静脉复合体;岩上静脉复合体按其引流模式分三种类型:微血管减压术后有效率为100%,平均随访2.5年无复发;术后主要并发症是三叉神经和小脑功能障碍,但经治疗后均明显改善. 结论岩上静脉复合体是三叉神经痛最常见的责任静脉,静脉压迫无论是主要还是次要压迫因素时,均需要妥善处理,对三叉神经充分有效减压.微血管减压术避免了遗漏静脉压迫,减少了复发,但术后并发症的发生率稍偏高.
목적 탐토정맥압박성삼차신경통적수술치료특점화료효. 방법 회고성분석8년간33례원발성삼차신경통환자술중정맥압박적처리급결과.대정맥압박적처리채취세소정맥여이전응조단,암상정맥복합체분지가부분조단.보류주간;전정해부분리혈관압박후여이Teflon위투식포과삼차신경. 결과 정맥압박가위우삼차신경뇌지단전정:33례중22례기유정맥압박야유동맥책임혈관,11례책임혈관위단순정맥,기중3례위무명정맥,8례위고근Meckel's강적암상정맥복합체;암상정맥복합체안기인류모식분삼충류형:미혈관감압술후유효솔위100%,평균수방2.5년무복발;술후주요병발증시삼차신경화소뇌공능장애,단경치료후균명현개선. 결론 암상정맥복합체시삼차신경통최상견적책임정맥,정맥압박무론시주요환시차요압박인소시,균수요타선처리,대삼차신경충분유효감압.미혈관감압술피면료유루정맥압박,감소료복발,단술후병발증적발생솔초편고.
Objective To explore the operative features and results of idiopathic trigeminal neuralgia (TN) caused by venous compression. Methods Surgical management technique and outcomes in 33 TN patients were retrospectively analyzed. Compressing venules were electrically coagulated and blocked, and the offending branches of superior petrosal vein complex (SPVC) were partially blocked with the vein trunk preserved. After the veins were divided away from the compressed nerve and the entire cisternal trigeminal nerve were exposed, Teflon graft was properly interpositioned to encircle the whole range of it. Results Location of the vein compression can be at all along the cistemal trigeminal nerve. In the 33 TN patients, 22 were attributed to vein compression associated with artery offence, and 11 to simple vein conflict venous compression, among them 3 to anonymous veins and 8 to SPVC near Meckel's cave. The drainage patterns of the SPVC were classified into 3 groups. The pain get completely relieved in all patients after microvascular decompression(MVD). No recurrence was found during the follow-ups of 2.5 years on average. Four patients developed trigeminal nerve impairment and 2 suffered from disordered cerebellum function after operation, but these complications were all improved through treatment. Conclusions SPVC is the most common offensive vein.Whether the venous compression is main compressing factor or not, it was essential to deal with them properly to get the trigeminal nerve completely decompressed from veins. MVD can accurately identify the venous compression and reduce the recurrence, however, it may result in higher postoperative complications.