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中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (07) : 643 -646. doi: 10.3877/cma.j.issn.1674-0785.2022.07.008

临床研究

继发性三叉神经痛诊疗策略
蒋亦林1, 伍刚1, 刘波1, 沈洁2, 刘如恩1,()   
  1. 1. 100044 北京,北京大学人民医院神经外科
    2. 100039 中国人民解放军总医院第七医学中心神经内科
  • 收稿日期:2022-04-28 出版日期:2022-07-15
  • 通信作者: 刘如恩

Diagnostic and therapeutic strategies for secondary trigeminal neuralgia

Yilin Jiang1, Gang Wu1, Bo Liu1, Jie Shen2, Ru'en Liu1,()   

  1. 1. Department of Neurosurgery, Peking University People's Hospital, Beijing 100044, China
    2. Department of Neurology, Seventh Medical Center, PLA General Hospital, Beijing 100039, China
  • Received:2022-04-28 Published:2022-07-15
  • Corresponding author: Ru'en Liu
引用本文:

蒋亦林, 伍刚, 刘波, 沈洁, 刘如恩. 继发性三叉神经痛诊疗策略[J]. 中华临床医师杂志(电子版), 2022, 16(07): 643-646.

Yilin Jiang, Gang Wu, Bo Liu, Jie Shen, Ru'en Liu. Diagnostic and therapeutic strategies for secondary trigeminal neuralgia[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(07): 643-646.

目的

探讨继发性三叉神经痛的诊断及治疗策略。

方法

回顾使分析北京大学人民医院神经外科2017年1月至2022年3月临床收治的继发性三叉神经痛患者,共34例,并参考相关文献。

结果

34例继发性三叉神经痛病例均由占位性病变引起,所有患者均接受手术治疗,31例肿瘤完全切除,3例部分切除,其中10例术中发现血管压迫三叉神经,行三叉神经微血管减压术。术后33例患者的疼痛症状消失,1例患者明显减轻。

结论

相应CPA区占位性病变是继发性三叉神经痛的首要病因,原发性因素可同时存在,头颅CT及MRI检查必不可少,手术是治疗继发性三叉神经痛的首选治疗手段。术中切除肿瘤后,应注意是否存在血管压迫神经情况,做到三叉神经充分减压。

Objective

To explore the diagnostic and therapeutic strategies for secondary trigeminal neuralgia (STN).

Methods

The clinical data of 34 STN cases admitted to our hospital from January 2017 to March 2022 were retrospectively analyzed in combination with the relevant literature.

Results

All the 34 cases of STN were caused by space-occupying lesions. All patients received surgical treatment; total excision was achieved in 31 cases, and subtotal excision achieved in 3. Ten cases were found with vascular compression of the trigeminal nerve during operation and underwent microvascular decompression. Postoperatively, pain disappeared in 33 cases and was significantly relieved in 1.

Conclusions

Space-occupying lesions in the CPA area is the primary cause of STN, and classic trigeminal neuralgia may coexist. CT and MRI of the head are essential for STN diagnosis. Surgery is the first choice of treatment for STN. Attention should be paid to vascular compression intraoperatively.

表1 病例资料
表2 患者术前伴随症状、术后短期并发症及病理结果(例)
图1 引起继发性三叉神经痛的占位性病变。图a为脑膜瘤,图b为听神经瘤,图c为骑跨脑干表皮样囊肿
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