摘要目的 探讨非动脉压迫因素导致三叉神经痛(TN)的显微外科手术治疗方式、疗效以及并发症.方法 回顾性纳入2006年5月至2016年12月中日友好医院神经外科同一术者采用显微手术治疗的、临床资料完整的251例TN患者,其中36例患者(14.3％)为非动脉压迫导致.36例患者中,19例(52.8％)为单纯静脉压迫,其中12例行常规显微血管减压术(MVD),7例(年龄>60岁)减压后加行三叉神经感觉根选择性部分切断术(PR);17例(47.2％)探查未发现责任血管,其中12例将三叉神经感觉根自脑干至麦氏囊全程充分解剖,5例(年龄>60岁)加行三叉神经感觉根PR.采用Brisman疗效评价标准评估疗效.结果 19例单纯静脉压迫的患者中,12例常规行MVD治疗的患者有11例术后即刻有效,1例无效;7例因无法满意减压加行PR的患者术后均即刻有效.17例无明确责任血管的患者中,12例行全程充分松解三叉神经的患者有11例术后即刻有效,1例无效;5例加行PR的患者术后均即刻有效.术后即刻总有效率为94.4％(34/36).术后3例(8.3％)出现脑神经相关并发症:患侧耳鸣1例,复视1例,咀嚼无力1例.36例患者术后随访时间为14～142个月,平均(67.0±9.2)个月,总有效率为88.9％(32/36),复发率为5.9％(2/34).无效及复发的患者后续行射频及伽玛刀治疗后好转;3例脑神经相关并发症的患者经保守治疗均恢复.结论 单纯静脉压迫者应充分松解游离责任静脉后行MVD;无血管压迫者应充分松解三叉神经感觉根周围的粘连;年龄>60岁者可加行三叉神经感觉根PR.非动脉压迫的TN经上述治疗后,疗效满意,而且并未增加手术并发症.

abstractsObjective To discuss the microsurgical treatment, outcomes and complications of trigeminal neuralgia ( TN) caused by non-arterial compression factors. Methods A total of 251 patients with complete clinical data of TN undergoing microsurgical treatment at Department of Neurosurgery, China-Japan Friendship Hospital from May 2006 and December 2016 by the same surgeon were retrospectively enrolled into this study. Among them, 36 ( 14. 3％) patients were caused by non-arterial compression factors. Of the 36 patients, 19 (52. 8％) were caused by single offending venous compression, of which 12 cases underwent microvascular decompression ( MVD) , 7 cases over 60 years old underwent selective partial rhizotomy (PR) after MVD; 17 (47. 2％) cases had no offending vessels, of which 12 cases underwent radical release of trigeminal nerve root, and the trigeminal nerve root was completely dissected from the brain stem to the Meckel's cave, and 5 cases over 60 years old underwent additional PR. Evaluation of efficacy was based on the Brisman criteria. Results Among 19 patients with single venous compression, 11 cases of 12 patients showed immediate effect post MVD, and 1 case did not; all the 7 patients with unsatisfactory decompression undergoing PR showed immediate effect after operation. Among 17 patients without definite offending vessels, 11 cases of 12 patients with completely trigeminal nerve release demonstrated immediate effect after operation, 1 case did not; and 5 cases with additional PR showed immediate effect after operation. The total effective rate was 94. 4％ ( 34/36 ) immediately after operation. Postoperative neurological complications occurred in 3 (8. 3％) cases including 1 case of tinnitus, 1 case of diplopia and 1 case of masticatory weakness. Thirty-six patients were followed up from 14 to 142 months, and the average follow-up time was 67. 0 ± 9. 2 months. The total effective rate was 88. 9％ (32/36) and the recurrence rate was 5. 9％ (2/34). The patients with no relief or recurrence obtained improvement after radiofrequency and gamma knife therapy. Three patients with neurological complications recovered after conservative treatment during the follow-up period. Conclusions MVD could be performed in patients with single venous compression after complete dissociation of the offending vein. Adhesion around the trigeminal nerve sensory root should be fully released in patients without offending vessels compression. PR of the trigeminal nerve sensory root should be performed in patients over 60 years old. After the treatment of TN with non-arterial compression, the outcome was satisfactory, and there was no increase in operative complications.