Nomura T, Ikezaki K, Matsushima T, Fukui M
Department of Neurosurgery, Kyushu University, Faculty of Medicine, Fukuoka, Japan.
Neurosurg Rev. 1994;17(1):51-7. doi: 10.1007/BF00309988.
We investigated 164 patients who presented with trigeminal neuralgia as their initial symptom at our institute. Twenty-two patients (13.4%) had intracranial causative lesions other than vascular compression. There were 19 tumors (10 epidermoids, 5 meningiomas, and 4 neurinomas) and 3 vascular lesions (2 arteriovenous malformations and 1 aneurysm). Eleven patients (50%) demonstrated only trigeminal neuralgia without any other neurological deficits. Preoperative computed tomography could not identify any causative lesions in 6 of these 22 patients. In 3 of the 6 patients, a causative lesion was clearly detected only by magnetic resonance imaging, while in 1 of the 6 patients an arteriovenous malformation was detected by angiography alone. Intraoperatively tumor was encountered in 3 cases even though preoperative computed tomography could not detect any apparent causative lesions. A higher incidence of hypesthesia in the trigeminal nerve regions as well as a reduced corneal reflex was noted in patients with a mass lesion compared to those with vascular compression. We thus conclude that magnetic resonance imaging should be performed on all patients who complain of trigeminal neuralgia in order to rule out mass lesions, however, angiography is still considered useful for the diagnosis of some vascular lesions.
我们对在我院以三叉神经痛为首发症状就诊的164例患者进行了调查。22例患者（13.4%）存在除血管压迫以外的颅内致病病变。其中有19个肿瘤（10个表皮样囊肿、5个脑膜瘤和4个神经鞘瘤）以及3个血管病变（2个动静脉畸形和1个动脉瘤）。11例患者（50%）仅表现为三叉神经痛，无任何其他神经功能缺损。术前计算机断层扫描未能在这22例患者中的6例发现任何致病病变。在这6例患者中的3例，仅通过磁共振成像才清楚地检测到致病病变，而在这6例患者中的1例，仅通过血管造影检测到动静脉畸形。即使术前计算机断层扫描未检测到任何明显的致病病变，术中仍有3例发现肿瘤。与血管压迫患者相比，肿块病变患者三叉神经区域感觉减退的发生率更高，角膜反射也减弱。因此，我们得出结论，对于所有主诉三叉神经痛的患者均应进行磁共振成像检查，以排除肿块病变，然而，血管造影对于某些血管病变的诊断仍被认为是有用的。
