Determination Of Primary Trigeminal Neuragia Responsible Blood Vessels And Surgical Curative Effect

Objective To investigate the primary trigeminal neuralgia (PTN)responsible vessels preoperative identification, intraoperative determination and classification, pain mechanisms, the curative effect of microscopic vascular decompression(MVD).Method Review clinical data of162primary trigeminal neuralgia (PTN) patients that had been carried out the surgery treatment of microscopic vascular decompression (MVD) from august2004to present in the department of neurosurgery, The Second Hospital of Shandong University.162cases, male69, female92, aged22-88years old. Through analysis of intraoperative and postoperative surgical operation video, determine the responsible vessels origin and oppression and follow-up visit curative effect.Result43patients underwent high-resolution3D-MRA check,36cases revealed the presence of nerve contact with vessel, coincidence rate (36/43,83.72%),7(7/43,16.28%) patients did not find nerve and vessel contact. The most common responsible vessels in turn is SCAs65cases (40.12%), AICAs45cases (27.78%), many vessels26cases (16.05%), PIC As16cases (9.88%), vein6cases (3.70%), VAs4cases (2.47%); Press the root of the trigeminal nerve139cases (85.80%)(Among them1case-blood vessels through between the feelings and sports branch), midpiece1(0.62%), press distal15cases (9.26%), press the root and distal together7cases (4.32%);121patients (74.69%) found trigeminal nerve compression in indentation; The pain of all patients disappear after operation (including1is2times surgery). Postoperative concurrent facial numbness, shallow hypoesthesia of16cases (9.88%), week of mouth sores5cases (3.09%),4cases of subcutaneous effusion (2.47%). All have different degree of ease or disappear when leave hospital. Follow-up visit of132 cases of postoperative,2cases recurrence for eight years, the recurrence rate1.52%.Conclusion1.3D-MRA and3D-SPGRI methods will improve the detection rate of nerve and vessels contaction. So they have important reference value to treat TN patients;2. The responsible blood vessels not only oppress trigeminal nerve root, but also even oppress the far end can lead to a pain;3. Responsible vessel may is one or more, but which one cause pain without quantitative indicators, so we have to treat contacting or pressing vessels in order to avoid to omit authentically responsible vessels;4. The identification and treatment of responsible vessels is the key, we should pay attention to more vessels compression, venous pressure and distal pressure, because such forms easy to cause responsibile blood vessels missing after operation;5. MVD has the following advantages:definite curative effect, low recurrence rate, less complications and so on. This is a preferred method to PTN that difficult to be controlled by drugs;6. If pain not relief after MVD, the main reason is leaving over the responsible blood vessels, we can turn to secondary surgical exploration for help.