查詢結果分析
來源資料
相關文獻
- 顯微血管減壓手術治療三叉神經痛:手術成果報告並著重於手術預後因素的研究
- 三叉神經痛:外科手術之療效
- Partial Sensory Rhizotomy as an Alternative Treatment of Trigeminal Neuralgia
- Microsurgical Management of Intracranial Epidermoid Cysts
- 三叉神經痛全方位治療
- 三叉神經痛之中醫治療
- Radiofrequency Thermocoagulation of the Gasserian Ganglion for Trigeminal Neuralgia
- 肇因於對側聽神經瘤之三叉神經痛﹣﹣病例報告
- Trigeminal Neuralgia Caused by Nasopharyngeal Carcinoma with Skull Base Invasion--A Case Report
- Stereotactic Fractionated Radiotherapy for Trigeminal Neuralgia: A Preliminary Report
頁籤選單縮合
題名 | 顯微血管減壓手術治療三叉神經痛:手術成果報告並著重於手術預後因素的研究 |
---|---|
作者姓名(中文) | 黃俊一; 陳敏雄; 李良雄; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 24:3 民80.05-06 |
頁次 | 頁687-693 |
分類號 | 416.29 |
關鍵詞 | 顯微血管減壓手術; 三叉神經痛; |
語文 | 中文(Chinese) |
中文摘要 | 自民國71年11月起至78年12月止,臺北榮民總醫院神經外科,共有150例三叉神經痛的病人,接受經由乳突後顱骨切除及顯微血管減壓(MVD)手術的治療。133 例(88.7%)因血管壓迫而造成三叉神經痛,17例(11.3%)因小腦橋腦角腫瘤引起。在133例由血管壓迫所造成的原因中,127例(95%)的肇因血管為動脈(單獨式聯合靜脈)引起,其中以上小腦動脈壓迫最多佔72%(91/127) ,單獨靜脈引起有3例(2.4%),不確定有血管壓迫只有2例(1.6%)。早期2例因採坐姿手術,死於手術中發生肺氣栓併發症,其餘148例經過長達9個月至7年(平均47個月)的術後追踪,其結果顯示:疼痛緩解率良好者88%,有進步10%,失敗2%。我們的研究發現影響MVD手術預後因素為:腫瘤引發的三叉神經痛,MVD手術的效果不比非腫瘤引發的差(94%對87%);肇因血管為靜脈時預從遠比動脈差,易再復發。但MVD手術前曾作過近端三叉神經節或根部破壞手術者並不影響MVD手術的結果,以及發病長短與MVD的預從無顯著相關。本文手術併發症少而且不嚴重,手術死亡率1.3%(2/150)。坐姿手術為造成死亡最大原因。後來108例改採側臥或仰側姿勢作手術,不但手術中不再發生肺氣栓全併發症,而且不再有死亡病例發生。我們的結果顯示MVD手術為安全有效的治療方法,因此三叉神經痛的病人,若是藥物無法控制,或藥物副作用無法忍受,且無手術禁忌時,或其他近端神經破壞手術失敗時,MVD手術治療為一種最佳選擇。 |
英文摘要 | From November, 1982 to December, 1989, the 150 cases of trigeminal neuralgia underwent retromastoid craniectomy and microvascular decompression (MVD) at Veterans General Hospital-Taipei. Among them, trigeminal neuralgia was caused by neurovascular compression (NVC) in 133 cases (88.7%), and by cerebellopontine angle (CPA) tumors in 17 cases (11.3%). Of the 133 cases with NVC, 127 cases (95%) were caused by arterial compression (either alone or combined with veins), 3 cases (2.4%) by venous compression, and the offending vessel could not be definitely identified in only 2 cases (1.6%). The most commonly seen offending artery was the superior cerebellar artery, which accounted for 72% (91/127) of the cases. Two mortality were encountered in our 150 cases, both of them received MVD in the sitting position and complicated with pulmonary embolism. The remaining 148 cases were followed up postoperatively. The follow-up period ranged from 9 months to 7 years, with an average of 47 months. Eighty-eight percent of patients showed the excellent results of pain relief, another 10% of patients showed their improvement, and only 2% of patients failed to respond to MVD. In this study, we found several factors might contribute to the prognosis of MVD: Trigeminal neuralgia caused by CPA tumors responded to MVD no worse than those caused by NVC (94% vs. 87%). Among those with NVC, arterial compression showed a better prognosis and fewer recurrence than venous compression. The duration of symptoms as well as previous proximal ablative procedures did not affect the results of MVD. The operative complications were few and minor. The mortality rate of operation was 1.3% (2/150), and was related to the sitting position. Neither operative mortality nor air embolism were seen in our later 108 cases after we modified the sitting position to the lateral decubitus or the supine-lateral position. Our results suggested MVD is a safe and effective procedures and we recommended it as a procedure of choice for patients with the typical trigeminal neuralgia. We also reserved MVD for those who failed to respond to medication, those who could not tolerate the side effect of medication, and those who failed to respond to proximal ablative procedures. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。