三叉神经痛微创手术治疗.docVIP

三叉神经痛微创手术治疗 　　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 Minimally invasive surgery for trigeminal neuralgia Zheng Xuesheng Shanghai Jiaotong University Affiliated Xinhua Hospital Neurosurgery（Shanghai Jiaotong University cranial nerve disorders treatment center），200092 Abstract The cause of trigeminal neuralgia is vertebrobasilar artery and its branches trigeminal nerve root，root cause trigeminal sensory degeneration caused.Drug therapy or patients with trigeminal neuralgia can not tolerate the side effects of the drug as soon as possible to receive minimally invasive surgical treatment；microvascular decompression surgery is the only”cure” therapy，minimally invasive surgery is the only way to protect the trigeminal nerve function as the goal，the best long-term efficacy，minimal complications，microvascular decompression is therefore recommended as the preferred treatment for trigeminal neuralgia.Other minimally invasive surgery，such as trigeminal ganglion radiofrequency ablation，balloon compression surgery，Gamma Knife surgery is damaged，will inevitably lead to irreversible trigeminal nerve dysfunction，severe cases can lead to corneal ulcers，blindness，just as some of the frail patients treatment options，or microvascular decompression therapy，patients with recurrent remedies. Key words Trigeminal Neuralgia；Microvascular decompression；Minimally invasive surgery 原发性三叉神经痛是由于脑血管压迫三叉神经根，导致三叉神经感觉根变性，典型症状表现为三叉神经分布区阵发性剧烈的刀割样、烧灼样、电击样或针刺样疼痛，发作间歇期没有疼痛，有“扳机点”现象，洗脸、刷牙、吃饭可诱发疼痛。典型三叉神经痛经过一段时间后可转变成不典型三叉神经痛，表现为持续性钝痛，扳机点不明显，可伴有面部麻木、感觉迟钝。由于疼痛剧烈，患者的治疗愿望很强烈。 卡马西平、奥卡西平是治疗三叉神经痛的一线药物，对多数患者有效，然而药物不能根治，经过一段时间的治疗，药物疗效逐渐下降；并且卡马西平和奥卡西平的不良反应较大，部分患者不能耐受；此时就应考虑外科手术治疗，而不是尝试其他的二线药物治疗方案。只有在不能进行外科手术的情况