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題名 | 脊椎基底動脈系統引起之三叉神經痛:一病例報告=Trigeminal Neuralgia Caused by Tortuous Vertebrobasilar System--A Case Report |
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作者 | 夏中慶; 劉敏英; 林欣榮; | 書刊名 | 國防醫學 |
卷期 | 31:6 2000.12[民89.12] |
頁次 | 頁651-655 |
分類號 | 415.945 |
關鍵詞 | 三叉神經痛; 脊椎基底動脈系統; 乳突後顱骨切除術; Trigeminal neuralgia; Vertebrobasilar system; Retromastoidal craniectomy; |
語文 | 中文(Chinese) |
中文摘要 | 大部分三叉神經痛的原因是由於上小腦動脈、前下小腦動脈或局部的靜脈壓迫所引起的。而由脊椎基底動脈系統壓迫三叉神經並產生臨床症狀的報告,在某些文獻中只有0.9%到5.7%的比例。顯微減壓手術治療血管性三叉神經病已被廣泛接受而且認定有效。 一位六十七歲患有高血壓疾病的男性,主訴半年來右臉頰間歇性疼痛。近日來因疼痛加劇且使用藥物難以控制,而至門診求治。病患敘述這樣疼痛可能因說話、咀嚼或刷牙等動作而誘發出來。在理學檢查中,並未發現有臉部麻木感或面神經麻痺等症狀。術前,我們安排了經顯影劑強化的腦部斷層掃瞄來排除其它可能的病因,結果發現在橋腦(pons)的右前外側的一彎曲、擴張的血管組織(脊椎基底動脈系統)並壓迫至橋腦。因此我們為病患實施了乳突後顱骨切除術,並使用Teflon棉球作為三叉神經的減壓材料。術後,病患症狀立刻得到緩解,且經過一年的門診追蹤未再復發過。 |
英文摘要 | In most cases, trigeminal neuralgia is caused by vascular compression by the distal vertebrobasilar trunk (superior cerebellar artery, anterior inferior cerebellar artery) or regional veins. The symptomatic trigeminal nerve compression caused by vertebrobasilar system had been reported in only 0.9% to 5.7% of cases in large trigeminal neuralgia series. Microvascular decompression for trigeminal neuralgia has become widely accepted as the defective surgical treatment. A 67-year-old hypertensive man had history of intermittent severe pain in the right periorbital region for half a year and was referred to our clinic due to repeated exacerbation of intractable right facial pain, which was poorly responsive to medication. The pain was triggered by talking, eating or teeth brushing. Hypesthesia of the region or facial spasm were not observed. Pre-operative contrast-enhanced CT was performed to rule out lesions other than vascular compression, which demonstrated a strongly enhancing, vascular structure (vertebrobasilar system) lying right anterolateral to and compressing the pons. Then the patient underwent microsurgical exploration via a retromastoidal craniectomy and decompression with Teflon sponge successfully. |
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