Objective To assess the results of microvascular decompression (MVD) in treating cranial nervehyperactive dysfunction. Methods From October 2002 to January 2007, 106 patients with cranial never hyperactivedysfunction were treated with MVD. Among them, there were 47 males and 59 females with an average age of 62 years (42-85 years), including 56 cases of trigeminal neuralgia, 33 cases of hemifacial spasm and 17 cases of spasmodic torticoll is. MRI showed obvious nerve root compression in 60 patients (56.6%), suspected nerve root compression in 33 patients (31.1%) and no nerve root compression in 13 patients (12.3%). The disease course was 2-300 months with median course of 54 months. The typical manifestations before operation were pain and myospasm in corresponding innervation region. Results The superior cerebellar artery was the most common offending vessel in trigeminal neuralgia (44.6%, 25/56), the anterior inferior cerebellar artery in hemifacial spasm (33.3%, 11/33), and the vertebra-basilar artery in spasmodic torticol is (82.4%, 14/17). Compl ications of facial paralysis, hypoacusia, facial numbness, dizziness, pain of neck and shoulder, muscles weakness of neck and subcutaneous dropsy occurred in 31 patients (29.2%). All patients were followed up for 6-42 months. The total response rate was 90.6%. The curative rate of MVD was 83.9% (47/56) in trigeminal neuralgia, 81.8% (27/33) in hemifacial spasm and 41.2% (7/17) in spasmodic torticol is, respectively. Five patients failed to response (4.7%), 2 of them were cured after re-operation and 3 abandoned further treatrment. Five patients suffered recurrence 3-8 months after operation (4.7%), 2 of them recovered after re-operation, 1 got rel ief by Gamma-knife treatment, and 2 abandoned further treatment. Conclusion MVD has a good therapeutic effect on the disease caused by vascular compression of cranial nerve. Comprehensive preoperative evaluation, skillful operational technique and intraoperative electrophysiological monitoring should be implemented to enhance the therapeutic effects of MVD and to prevent possible compl ications.
目的 分析和总结采用双靶点伽玛刀治疗三叉神经痛术后疼痛缓解时间规律，为伽玛刀的临床治疗提供参考。 方法 2005年1月－2011年1月，共147例原发性三叉神经痛患者于四川大学华西医院接受Leksell C型伽玛刀治疗。使用4 mm准直器在三叉神经根制作2个等中心靶点，中心剂量80~90 Gy，控制脑桥照射剂量＜20 Gy。术后定期对患者进行随访，对疼痛缓解时间进行统计分析。 结果 130例患者获得随访，随访时间11～64个月，平均28.7个月。术后疼痛完全缓解95例（73.1%），部分缓解29例（22.3%），无效6例（4.6%）。疼痛缓解时间4 h～12个月，平均3.6周，其中疼痛完全缓解患者的疼痛缓解时间明显短于部分缓解患者（P＜0.05）。53例（40.8%）患者于术后出现术侧轻度面部麻木。 结论 患者术后疼痛缓解时间可能是预测伽玛刀治疗效果的重要因素，但疼痛缓解时间个体差异大，应进行长期随访观察。
【摘要】 目的 探讨伽玛刀治疗三叉神经痛MRI定位的最佳扫描序列。 方法 选择2004年7月-2006年3月行伽玛刀手术的原发性三叉神经痛患者60例，随机分为3组，每组各20例。伽玛刀术前上头架定位，然后对3组分别采用快速自旋回波序列（Turbo Spin Echo，TSE）、增强三维小角度激发快速梯度回波序列（enhanced three-dimensiunal fast low angle shot，enhanced 3D-FLASH）、三维结构干涉稳态序列（three-dimensional constructive interference in steady state，3D-CISS）进行扫描，观察三叉神经及周围血管的显示情况。 结果 ①TSE扫描20例三叉神经，14例显示优，血管显示一般。②增强3D-FLASH扫描三叉神经，18例显示优，2例显示良，周围血管显示优。③3D-CISS扫描三叉神经，20例均显示优，周围血管显示良。 结论 3D-CISS和增强3D-FLASH序列的融合影像能够清晰地显示三叉神经根及周围血管，有利于伽玛刀的精确定位，具有较高的临床应用价值，可以作为伽玛刀治疗原发性三叉神经痛的常规定位方法。【Abstract】 Objective To evaluate the optimal MRI localization sequences of gamma knife radiosurgery for trigeminal neuralgia. Methods From July 2004 to March 2006, sixty patients with primary trigeminal neuralgia were divided into three groups, using MR Turbo Spin Echo ( TSE), enhanced three-dimensiunal fast low angle shot 3D-FLASH and three-dimensional constructive interference in steady state ( 3D-CISS) sequence for stereotactic localization, respectively. The trigeminal nerve and surrounding vessels were observed. Results Only 14 trigeminal nerves were precisely displayed by MR TSE sequence, while 20 by 3D-CISS and 18 by 3D-FLASH. The display of surrounding vessels was excellent, good, and general by 3D-FLASH, 3D-CISS, and MR TSE, respectively. Conclusion 3D-CISS and enhanced 3D-FLASH fusion image can help achieve accurate orientation of gamma knife, which provides clear images of the trigeminal nerve and the surrounding vessels. Therefore it is of high value in clinical application, which can be used as the conventional localization method for gamma knife radiosurgery in the treatment of primary trigeminal neuralgia.
目的:探讨原发性三叉神经痛微血管减压的手术效果及其影响因素。方法:选择正规药物治疗无效的三叉神经痛患者行核磁共振检查,排除继发性病因引起三叉神经痛的患者,对30例原发性三叉神经痛患者行微血管减压术。结果:28例患者术后疼痛立即消失,1例患者症状明显缓解,1例无效,无死亡患者,有效率为97％,随访1年有１例复发。结论:术前核磁共振检查能否发现责任血管,对手术和术后效果影响大;但同时与术者的经验和显微操作熟练程度密切相关。