2014论文三叉神经痛的微创手术治疗_郑学胜.pdfVIP

临床进展 CHINESEC0MMUNITY D0CT0RS 三叉神经痛的微创手术治疗 郑学胜 200092上海交通大学医学院附属新华医院神经外科(上海交通大学颅神经疾病诊治中心) doi:10.3969/j.issn.1007-614x.2014.4.3 摘 要 三叉神经痛的病因是椎基底动脉及其分支压迫三叉神经根，导致三叉神经感觉根变性所致。药物治疗无效或 不能耐受药物不良反应的三叉神经痛患者应尽早接受微创外科治疗；微血管减压术是唯一 “治本”的疗法，也是唯一 以保护三叉神经功能为目标的微创手术方式，长期疗效最好，手术并发症最少，因此推荐微血管减压术作为三叉神经 痛的首选治疗方案。其它微创手术如三叉神经节射频消融术、球囊压迫术、伽玛刀都是毁损性手术，必然造成三叉神 经不可逆性功能障碍，严重者导致角膜溃疡、失明，只作为一些体弱患者的治疗选项，或微血管减压术治疗无效、复 发患者的补救措施。 关键词 三叉神经痛 微血管减压术 微创手术 Minimallyinvasivesurgeryfortrigeminalneuralgia ZhengXuesheng Shanghai Jiaotong University Affiliated Xinhua Hospital Neurosurgery(Shanghai Jiaotong University cranial nerve disorders treatmentcenter),200092 Abstract Thecauseoftrigeminalneuralgiaisvertebrobasilararteryanditsbranchestrigeminalnerveroot,rootcausetrigeminal sensorydegenerationcaused.Drugtherapyorpatientswithtrigeminalneuralgiacannottoleratethesideeffectsofthedrugassoon aspossibletoreceiveminimallyinvasivesurgicaltreatment;microvasculardecompressionsurgeryistheonlycuretherapy, minimallyinvasivesurgeryistheonlywaytoprotectthetrigeminalnervefunctionasthegoal,thebestlong-termefficacy,minimal complications,microvasculardecompressionisthereforerecommendedasthepreferredtreatmentfortrigeminalneuralgia.Other minimally invasive surgery,such as trigeminal ganglion radiofrequency ablation,balloon compression surgery,Gamma Knife surgeryisdamaged,willinevitablyleadtoirreversibletrigeminalnervedysfunction,severecasescanleadtocornealulcers, blindness,justassomeofthefrailpatientstreatmentoptions,ormicrovasculardecompressiontherapy,patientswithrecurrent remedies. Keywords TrigeminalNeuralgia;Microvasculardecompression;Minimallyinvasivesurgery 原发性三叉神经痛是由于脑血管压 用二线药物巴氯芬或拉莫三嗪，二线药 血管压迫的患者，三叉神经根萎缩、局 迫三叉神经根，导致三叉神经感觉根变 物的长