Jannetta Peter J, McLaughlin Mark R, Casey Kenneth F
Department of Neurosurgery, Drexel University College of Medicine and Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
Neurosurg Focus. 2005 May 15;18(5):E5.
Vascular compression of the trigeminal nerve in the cerebellopontine angle is now generally accepted as the primary source or "trigger" causing trigeminal neuralgia. A clear clinicopathological association exists in the neurovascular relationship. In general, pain in the third division of the trigeminal nerve is caused by rostral compression, pain in the second division is caused by medial or more distant compression, and pain in the first division is caused by caudal compression. This discussion of the surgical technique includes details on patient position, placement of the incision and craniectomy, microsurgical exposure of the supralateral cerebellopontine angle, visualization of the trigeminal nerve and vascular pathological features, microvascular decompression, and wound closure. Nuances of the technique are best learned in the company of a surgeon who has a longer experience with this procedure.
目前，小脑脑桥角处三叉神经的血管压迫被普遍认为是导致三叉神经痛的主要根源或“触发因素”。神经血管关系中存在明确的临床病理联系。一般来说，三叉神经第三支的疼痛由头侧压迫引起，第二支的疼痛由内侧或更远端的压迫引起，第一支的疼痛由尾侧压迫引起。关于手术技术的讨论包括患者体位、切口和颅骨切除术的位置、小脑脑桥角上外侧的显微手术暴露、三叉神经和血管病理特征的可视化、微血管减压以及伤口缝合的细节。该技术的细微差别最好在有更长时间该手术经验的外科医生指导下学习。
