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中华脑科疾病与康复杂志(电子版)

中华脑科疾病与康复杂志(电子版) ›› 2020, Vol. 10 ›› Issue (05) : 280 -283. doi: 10.3877/cma.j.issn.2095-123X.2020.05.006

所属专题： 文献；

颅神经疾患

静脉压迫导致三叉神经痛的影像学评估及显微血管减压术治疗
苏明明1, 王景1,†(), 汪鑫1, 李嘉明1, 郑朝辉1, 王学廉1, 屈延1, 高国栋1   
  1. 1. 710038　西安，空军军医大学唐都医院神经外科
  • 收稿日期:2020-07-22 出版日期:2020-10-15
  • 通信作者: 王景

Imaging evaluation and microvascular decompression for trigeminal neuralgia caused by venous compression

Mingming Su1, Jing Wang1,†(), Xin Wang1, Jiaming Li1, Chaohui Zheng1, Xuelian Wang1, Yan Qu1, Guodong Gao1   

  1. 1. Department of Neurosurgery, Tangdu Hospital, Forth Militery Medcal University, Xi’an 710038, China
  • Received:2020-07-22 Published:2020-10-15
  • Corresponding author: Jing Wang
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引用本文：

苏明明, 王景, 汪鑫, 李嘉明, 郑朝辉, 王学廉, 屈延, 高国栋. 静脉压迫导致三叉神经痛的影像学评估及显微血管减压术治疗[J]. 中华脑科疾病与康复杂志(电子版), 2020, 10(05): 280-283.

Mingming Su, Jing Wang, Xin Wang, Jiaming Li, Chaohui Zheng, Xuelian Wang, Yan Qu, Guodong Gao. Imaging evaluation and microvascular decompression for trigeminal neuralgia caused by venous compression[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2020, 10(05): 280-283.

目的

分析静脉压迫所导致三叉神经痛（TN）的术前影像学评估和显微血管减压术中责任静脉的处理。

方法

回顾分析空军军医大学唐都医院神经外科自2017年12月至2018年12月收治的15例存在静脉压迫的TN患者的临床资料，分析术前影像学评估及术中处理。

结果

所有患者均通过术前3D-TOF及3D-FIESTA检查，判断责任血管为单纯静脉型或动脉及静脉共同作用型，其中单纯静脉型11例，动脉及静脉共同作用型4例。通过术中分析，符合术前判断。所有患者静脉均得到有效保留，手术疗效满意。

结论

通过术前影像学评估能有效预判TN的责任血管，从而指导术中操作。针对静脉压迫型TN，术中应尽量保护静脉，避免因损伤静脉所导致的术后并发症。

关键词: 三叉神经痛, 静脉, 影像学评估, 显微血管减压术
Objective

To analyze the preoperative imaging evaluation of trigeminal neuralgia (TN) caused by venous compression and the management of offending veins during microvascular decompression.

Methods

The clinical data of 15 TN patients with venous compression admitted to Department of Neurosurgery, Tangdu Hospital, Forth Militery Medcal University from December 2017 to December 2018 were retrospectively analyzed, and preoperative imaging evaluation and intraoperative management were analyzed.

Results

All patients were judged to be solely vein type or combined action of artery and vein by preoperative 3D-TOF combined with 3D-FIESTA scan, among which, there were 11 cases of solely vein type and 4 cases of combined with artery and vein type. Through the intraoperative analysis, it was consistent with the preoperative judgment. Veins were effectively preserved in all patients and the outcomes was excellent.

Conclusion

Preoperative imaging evaluation can effectively predict the offending vessels of TN and guide the intraoperative operation. For venous compression TN, the veins should be protected as far as possible during the operation to avoid postoperative complications caused by vein injury.

Key words: Trigeminal neuralgia, Vein, Imaging evaluation, Microvascular decompression
图1 不同类型责任血管压迫的术前3D-TOF、3D-FIESTA及术中对比资料
表1 三叉神经痛患者的基本资料
序号 性别 年龄（岁） 病史（年） 侧别 疼痛范围 VAS（分） BNI疼痛强度评分（分）
1 男 51 5 右 V2 9 ⅢB
2 女 51 5 左 V3 10 Ⅴ
3 女 61 7 左 V1，V2 8 ⅢB
4 男 53 20 左 V3 8 Ⅳ
5 男 52 8 右 V2，V3 9 Ⅳ
6 男 77 33 左 V3 9 Ⅴ
7 女 61 2 右 V1 7 ⅢB
8 男 63 14 左 V2，V3 6 ⅢB
9 女 61 3 右 V1，V2 8 Ⅳ
10 女 56 5 右 V2，V3 9 Ⅳ
11 男 58 20 左 V2 9 Ⅴ
12 女 42 2 左 V3 7 ⅢB
13 女 62 3 右 V3 8 Ⅳ
14 男 51 4 左 V1，V2，V3 9 Ⅳ
15 女 37 3 右 V2，V3 7 ⅢB
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