135例带状疱疹发病及后遗神经痛相关因素临床回顾研究

目的探求与带状疱疹发病及发生后遗神经痛可能的相关因素。方法收集2007年1月至2012年8月期间北京东直门医院皮肤科135例符合入选标准的带状疱疹患者的住院病历进行回顾性分析。应用SPSS 17.0统计软件进行统计学处理。结果年龄与疱疹前驱痛、疼痛程度均无明显相关性;年龄、疱疹前驱痛、皮损疼痛程度、基础慢性病及开始治疗时间均可能是发生带状疱疹后遗神经痛的相关因素。结论带状疱疹发病、发生后遗神经痛均有一定相关因素,早发现、早治疗,尤其对于老年患者或伴有基础慢性病者防治更有意义。     

天麻素胶囊治疗三叉神经痛的临床研究

目的：探讨天麻素胶囊联合卡马西平治疗三叉神经痛的疗效。方法将60例三叉神经痛患者随机分为两组,治疗组30例给予天麻素胶囊联合卡马西平治疗,对照组30例单纯服用卡马西平,观察两组临床疗效。结果治疗组总有效率为90％,高于对照组总有效率73．3％,差异有统计学意义（ P＜0．05）。结论天麻素胶囊治疗原发性三叉神经痛有较好的临床疗效,值得临床应用。     

经典三叉神经痛的治疗新进展

各种病因导致的三叉神经痛严重影响患者的生命健康,因对其发病机制不甚清楚,所以目前尚缺乏有效的治疗方法。临床中主要的治疗方法有药物治疗、手术治疗、放射治疗、中医治疗、基因治疗和其他疗法等,每种方法各有利弊,其中基因治疗是研究的热门方向。本文对各种方法治疗三叉神经痛的进展作一综述。     

运用磁共振弥散张量成像观察显微血管减压术后三叉神经的结构变化

目的：利用磁共振弥散张量成像（DTI）序列,观察显微血管减压术（MVD）后,三叉神经痛（TN）患者三叉神经的微观结构改变。方法9例原发性 TN 患者术前及术后行 DTI 扫描,测算两侧三叉神经向异性分数（FA）、平均弥散率（MD）、轴向弥散率（AD）、垂直弥散率（RD）和两侧各弥散参数差值比。按手术疗效分为治愈和未治愈两组,分析两组患者在手术前后,两侧三叉神经各 DTI 参数及两侧间各弥散参数差值比的变化。结果男性6例,女性3例;平均年龄52．1岁,平均病程5．1年。于术后第一次复查（平均12．3个月）时行 DTI ,术后疗效随访平均66个月。治愈组6例,均有明显的血管压迫,三叉神经有受压变形;未治愈组3例,2例有血管压迫,1例患者仅有严重的蛛网膜粘连而无血管压迫。治愈组术前患侧明显下降的 FA 值及明显上升的 MD 、RD 值,术后复查时均恢复。而未治愈组的各弥散参数及差值比则在手术前后无明显变化。结论 MVD 术后疼痛消失的患者,患侧三叉神经的脱髓鞘变恢复正常。然而术后疼痛仍然存在的患者,神经的脱髓鞘变依然存在。三叉神经的脱髓鞘变与 TN 关系密切。     

Varying length of central myelin along the trigeminal nerve might contribute to trigeminal neuralgia

Several studies have suggested that vascular compression of more distal portions of the trigeminal nerve (Vth cranial nerve: VN) may cause trigeminal neuralgia (TN). However, neurosurgeons performing microvascular decompression intraoperatively cannot identify which type of myelin is being compressed by blood vessels. The aim of this study was to clarify the histological anatomy of central and peripheral myelin in the human VN. Histological analyses were conducted using photomicrographs from 134 cisternal segments of the VN from the brains of 67 cadavers. The three dimensions of the VN were measured in these sections: distance from the point at which the lateral‐most pontine VN merges with the boundary between central and peripheral myelin (line‐a), distance along the medial aspect (line‐b), and the length of the transitional zone (TZ), known as the Obersteiner‐Redlich zone. Twenty‐nine of 134 VNs were available for study. The length of central myelin ranged from 0.69 to 8.66 mm (mean, 3.56 mm; median, 3.10 mm) along the lateral aspect and from 0.36 to 5 mm (mean, 1.81 mm; median, 1.40 mm) along the medial aspect of the VN. The length of the TZ ranged from 0.31 to 3.37 mm (mean, 1.75 mm; median, 1.63 mm). We report here, for the first time, that some individuals had much longer spans of central myelin than those reported previously. Some cases of TN may thus be caused by vascular compression of VN peripheral myelin, especially in cases where central myelin is extended to an unprecedented degree. Clin. Anat. 32:541–545, 2019. © 2019 Wiley Periodicals, Inc.     

Efficacy of microsurgical vascular decompression in trigeminal neuralgia

ObjectivesAnalysis of the long-term efficacy of microvascular decompression surgery in trigeminal neuralgia.Material and methodsA single-center retrospective study included patients undergoing microvascular decompression surgery for trigeminal neuralgia after failure of well-conducted medical or complementary therapy, with visualization of nerve compression syndrome on MRI.ResultsEighty-seven patients were included. Nerve compression was alleviated without interposition of polytetrafluoroethylene in 79.3% of cases. Postoperative efficacy on pain was immediate in 97.7% of cases. There were no postoperative deaths, and the rate of severe complications was low (2.3%). The efficacy of microvascular decompression surgery was total at 2 years in 90.8% of cases and at 10 years in 92.3%, without resumption of medical treatment. The failure rate was 10.3%; 26.3% of these patients had been previously treated by a lesional technique (P: 0.043) and 33.3% by interposition of polytetrafluoroethylene (P: 0.003).ConclusionsWith confirmed clinical and radiological diagnosis, microvascular decompression surgery for trigeminal nerve compression was safe, with total effectiveness in the immediate, short and long terms. It should be considered in first line in case of failure or intolerance of well-conducted medical treatment.     

射频治疗术治疗原发性三叉神经痛的护理

目的探讨射频治疗术治疗三叉神经痛的疗效及其护理措施。方法对113例原发性三叉神经痛患者均采用射频手术治疗，同时配合精心的护理实施，术后半个月采用VAS评价疗效。结果113例患者均手术顺利，无严重并发症发生，术前与术后半个月VAS比较差异具有显著意义（t=2．4024，P=O．0213）。结论射频治疗术治疗三叉神经痛疗效显著，系统的护理措施是保证射频治疗术治疗原发性三叉神经痛治疗效果的关键。     

The role of the otolaryngologist in the evaluation and management of headaches

Background

Headaches are commonly evaluated in otolaryngology and often represent a diagnostic dilemma. This review addresses rhinogenic headache as well as trigeminal neuralgia and migraine, both of which can masquerade as sinus headache and whose management increasingly involves otolaryngology intervention. Discussion considers diagnostic criteria and novel therapies and derives an algorithm for clinical decision-making.