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目的 ;评估桥小脑角区(CPA)小型占位致继发性三叉神经痛的手术疗效。方法回顾分析我科自2005年1月~2010年12月期间该类患者的临床资料,包括年龄、症状及体征、影像学表现、手术方式、疗效及并发症。结果 6年期间手术治疗三叉神经痛372例,其中CPA区小型病变(最大直径<3cm)致继发性三叉神经痛23例,约占6.2%;病种包括胆脂瘤12例、神经鞘瘤6例、脑膜瘤3例、蛛网膜囊肿2例;所有患者行乙状窦后入路显微镜下切除病变,3例另行三叉神经感觉根部分切断术;术后疼痛消失20例,面部麻木3例;术后并发症包括无菌性脑膜炎、脑脊液漏、颅内感染、短暂耳鸣及面瘫,均恢复,无死亡。随访1~5年,无疼痛复发。结论 CPA区小型占位所致继发性三叉神经痛患者由于病变小、易于全切,加之镜下暴露充分,手术疗效满意;术中若发现病变与三叉神经无确切关系,则需行微血管减压或三叉神经部分感觉根切断术。
Objective To evaluate the surgical outcome of secondary trigeminal neuralgia caused by small-sized cerebellopontine angle (CPA). Methods The clinical data of our patients from January 2005 to December 2010 were retrospectively analyzed, including age, symptoms and signs, imaging findings, surgical methods, curative effects and complications. Results 372 cases of trigeminal neuralgia were treated surgically during 6 years. Small lesions (maximum diameter <3 cm) in CPA caused 23 cases of secondary trigeminal neuralgia (about 6.2%). The disease types included cholesteatoma (12 cases), schwannoma 6 cases, 3 cases of meningiomas, 2 cases of arachnoid cysts; all patients underwent retrosigmoid microsurgical resection of the lesion, 3 cases of other trigeminal sensory root partial resection; 20 cases of postoperative pain disappeared, facial numbness in 3 cases Postoperative complications included aseptic meningitis, cerebrospinal fluid leakage, intracranial infection, brief tinnitus and facial paralysis, both recovered without death. Follow-up 1 to 5 years, no pain recurrence. Conclusions Patients with secondary trigeminal neuralgia due to small space occupying in CPA area are easy to be totally resected due to small lesion size. In addition, the microsurgical exposure is satisfactory and the surgical outcome is satisfactory. If there is no definite relationship between the lesions and the trigeminal nerve in the surgery, microvascular subtraction Partial pressure or trigeminal nerve root severing.