微血管减压术治疗三叉神经痛及舌咽神经痛1150例报告

目的:探讨用微血管减压术治疗三叉神经痛、舌咽神经痛等神经血管压迫综合症治疗方法的改进措施和提高治疗效果的临床经验。方法:系统回顾1984年6月至1999年12月我们采用微血管减压术治疗神经血管压迫综合症病例1150例,其中三叉神经痛1120例,舌咽神经痛30例。结果:有效1112例,有效率为96.7％,本组无死亡。并发症发生率由5年前5.6％下降到近5年的1.6％。结论:提高微血管减压术的治愈率和减少并发症,有多方面因素值得考虑。     

三叉神经痛患者微血管减压术并发症的观察与护理

<正>三叉神经痛(trigeminal neuralgia,TN)是以面部三叉神经分布区域内反复发作的剧烈放电样疼痛为特征的一类疼痛。1929年,Dandy[1]首先提出三叉神经受压可能是三叉神经痛的原因。至20世纪70年代,Jannet-ta等[2]开创了经枕下入路微血管减压术(microvascular decompression,MVD)并大为推广。近年来,微血管减压术是神经外科治疗药物难治性三叉神经痛、面肌痉挛和舌咽神经痛等颅神经疾病最有效的手术治疗方     

96例三叉神经痛患者血管减压术后并发症的观察与护理

三叉神经是第5对颅神经,由眼支（第一支）、上颌支（第二支）和下颌支（第三支）汇合而成,分别支配眼裂以上、眼裂和口裂之间、口裂以下的感觉和嚼肌收缩.血管压迫是三叉神经痛的主要致病原因,约95％～98％三叉神经痛的原发性患者在术中能找到压迫血管[1].治疗三叉神经痛的手段主要有药物治疗、封闭治疗和手术治疗3种.大部分患者在药物治疗无效后可行三叉神经局部封闭术,但术后面部麻木发生率及复发率均较高,并非理想的治疗方法.三叉神经痛是终生携带性疾病,症状常随着年龄的增长逐渐加重.2010年1月至2011年12月,我科对96例三叉神经痛患者实施微血管减压术获得满意效果.现将护理体会报告如下.     

三叉神经痛微血管减压术并发症的观察及护理对策

目的探讨三叉神经痛微血管减压术术后并发症的观察以及护理对策。方法回顾性分析近3年来我科79例三叉神经痛微血管减压术所产生的并发症的观察和护理经验。结果术后头晕65例(82.3%),恶心、呕吐44例(55.7%),头痛29例(36.7%),患侧轻度面瘫23例(29.1%),面部麻木16例(20.25%),唇周疱疹14例(17.7%),耳鸣或听力下降13例(16.5%),高热7例(8.86%),肺部感染3例(3.80%),脑脊液漏2例(2.53%),头皮下积液2例(2.53%),后颅窝硬膜下血肿1例(1.27%)。均经对症治疗,症状于短期内好转或消失。死亡1例(1.27%)。结论了解手术产生并发症的机理,严密观察及时给予预防和处理,对减少手术后并发症有十分重要的意义。     

微血管减压术治疗三叉神经痛的疗效及其并发症的预防与处理

目的探讨微血管减压术治疗三叉神经痛的疗效及其并发症的预防与处理策略。方法采用微血管减压术治疗93例三叉神经痛患者,对其临床疗效及术后并发症等临床资料进行回顾性分析。结果 93例中89例术后疼痛症状消失,有效率为95.70%。术后并发症的发生情况：皮下积液4例,脑脊液漏1例,听力下降3例,耳鸣3例,面神经功能障碍4例,手术无效4例,死亡1例。结论微血管减压术治疗三叉神经痛是一种十分成熟的技术,规范手术的各种操作和积极应用监测技术能够尽量避免各种并发症的发生,显著提高手术的安全性。     

舌咽神经痛显微神经外科手术治疗的疗效观察

目的探讨舌咽神经痛(GPN)的多种有效显微神经外科手术方法的临床疗效。方法选择1991年至2007年入住我院的GPN患者21例,11例行迷走神经根上部1~2根丝切断术(R),6例行显微外科减压术(MVD),4例MVD同时行R术,对所有患者进行平均6.5年的随访观察。结果21例患者术后疼痛全部消失;2例术后出现咽部不适、偶发性干咳,其中1例7 d后逐步缓解,1例出现轻度声嘶、吞咽功能障碍,3 d后未见好转。随访全部病例无复发。结论采取何种术式应根据术中有无责任血管压迫及责任血管压迫的方式而定,经随访观察证明,三种显微外科手术均为舌咽神经痛安全有效的治疗方法,值得进一步推广使用。     

微血管减压术治疗三叉神经痛并发症的护理与观察

血管减压手术是治疗三叉神经痛的一种新方法.作者观察了126例患者的术后护理及并发症情况,发现如低颅压综合征、周围性面瘫、脑脊液漏、口唇疱疹是常见的并发症,颅内出血是最为凶险的并发症.术后精心细致的护理,对于及时发现和处理并发症极为重要,也是确保手术成功的重要保证.     

微血管减压术治疗三叉神经痛并发症的护理与观察

血管减压手术是治疗三叉神经痛的一种新方法。作者观察了126例患者的术后护理及并发症情况，发现如低颅压综合征、周围性面瘫、脑脊液漏、口唇疱疹是常见的并发症，颅内出血是最为凶险的并发症。术后精心细致的护理，对于及时发现和处理并发症极为重要，也是确保手术成功的重要保证。     

脑损伤患者额叶前皮质微结构MRI变化与认知功能损伤的相关性分析

目的 探讨脑损伤患者额叶前皮质微结构MRI变化与认知功能损伤的相关性。方法 选取2020年3月—2022年3月收治的脑损伤120例,根据有无认知功能损伤分为损伤组与无损伤组,每组60例;另选取60例体检健康者作为对照组。比较3组蒙特利尔认知评估量表(MoCA)各维度评分及总分,并比较有无认知功能损伤、不同认知功能损伤程度患者额叶前皮质微结构MRI变化[扩散各向异性分数(FA)、平均扩散率(MD)、轴向扩散峰度(AK)、平均扩散峰度(MK)、径向扩散峰度(RK)],分析额叶前皮质微结构MRI变化与认知功能损伤程度的相关性。结果 损伤组视空间与执行、注意力与计算力、语言功能、抽象能力、延迟记忆领域评分及MoCA总分低于无损伤组、对照组(P<0.01);损伤组前、旁扣带脑回右侧FA、AK及MK低于无损伤组(P<0.01);轻度认知功能损伤患者前、旁扣带脑回右侧FA、AK及MK高于中重度认知功能损伤患者(P<0.01);右侧FA、AK及MK与认知功能损伤程度呈负相关(P<0.01)。结论 脑损伤患者额叶前皮质微结构MRI变化可用于早期评估认知功能损伤,为临床评估脑损伤患...     

经皮球囊压迫术与微血管减压术治疗三叉神经痛的临床疗效比较

目的 探讨经皮穿刺球囊压迫术(PBC)与微血管减压术(MVD)治疗三叉神经痛的优缺点及近期疗效。方法 选取30例三叉神经痛患者,其中15例行PBC治疗(PBC组), 15例行MVD治疗(MVD组)。比较2组患者基本情况和住院总费用、手术时间、住院总时间以及术后并发症发生率;评估2组术后疼痛程度。结果 PBC组住院总费用低于MVD组,手术时间及住院总时间短于MVD组,差异有统计学意义(P<0.05); PBC组患者平均年龄高于MVD组,差异有统计学意义(P<0.05)。2组术后疼痛缓解率比较,差异无统计学意义(P>0.05)。MVD组术后面部麻木发生率低于PBC组,差异有统计学意义(P<0.05)。结论 MVD和PBC术后近期疗效相似。MVD术后并发症发生率低于PBC, PBC更适用于老年患者。     

Sumatriptan alleviates pain in patients with trigeminal neuralgia

OBJECTIVES: Arterial compression of the trigeminal root may lead to trigeminal neuralgia. 5-HT1B/1D receptor agonists may inhibit vasodilation and inflammation near the irritated trigeminal root. A recent study showed attenuation of mechanical allodynia by a 5-HT1A receptor agonist in a rat model of trigeminal neuralgia. The present study examined the effectiveness of a 5-HT1A/1B/1D receptor agonist, sumatriptan, on pain relief in patients with trigeminal neuralgia. METHODS: The study was conducted in 15 patients with idiopathic trigeminal neuralgia. The patients had been suffering from painful paroxysms for at least 1 month. Each patient was injected with 1 mL of saline subcutaneously (placebo), followed 15 minutes later with subcutaneous sumatriptan (3 mg in 1 mL saline). This was followed the next day by oral sumatriptan (50 mg twice daily) for 1 week. RESULTS: The visual analog scale did not change after saline, but significantly decreased after subcutaneous sumatriptan. Both 1 week after oral sumatriptan and 1 week after discontinuation of the drug, visual analog scale scores resulted in a significant decrease from the baseline. Adverse events after subcutaneous sumatriptan occurred in 4 patients: fatigue in 4 and nausea in 2. Side effects from the oral medication appeared in 4 patients: fatigue in 2, nausea in 1 and chest discomfort in 1. These side effects subsided soon after discontinuation of sumatriptan. CONCLUSIONS: Our results indicate that subcutaneous injection followed by oral administration of sumatriptan produces prompt and continuous analgesia in patients with trigeminal neuralgia.     

Increased prefrontal cortex activity on near-infrared spectroscopy after interpersonal counseling in individuals with attention deficit hyperactivity disorder

[Purpose] The number of patients with attention deficit hyperactivity disorder has been increasing. These patients show low activity in the prefrontal cortex, which can be improved by pharmacotherapy and neurofeedback training. This exploratory study aimed to examine whether the hemodynamic response in the prefrontal cortex during an inhibition response in patients with attention deficit hyperactivity disorder tendencies increased after interpersonal counseling. [Participants and Methods] Participants (n=5) received three interpersonal counseling sessions. Interpersonal counseling focuses on the patient’s current problems and devises specific coping strategies, and it can be performed by healthcare personnel such as physiotherapists. Prefrontal cortex activity during a suppression reaction task was measured by using near-infrared spectroscopy at baseline and post-interpersonal counseling. The outcome was a difference in the oxyhemoglobin level from baseline to post-interpersonal counseling. [Results] The oxyhemoglobin level in the prefrontal cortex significantly increased post-interpersonal counseling. [Conclusion] These results suggested that interpersonal counseling could improve the hemodynamic response in the prefrontal cortex under inhibition in individuals with attention deficit hyperactivity disorder tendencies, suggesting that interpersonal counseling may be effective for treating attention deficit hyperactivity disorder symptoms.     

基于功能性近红外光谱技术的不同吞咽任务态前额叶皮质功能研究

目的：采用功能性近红外光谱技术（functional near-infrared spectroscopy,fNIRS）研究不同吞咽任务态前额叶皮质激活情况。方法：纳入19例健康成人受试,在fNIRS采集过程中执行经注射器小口吞咽及经吸管连续吞咽任务,分析不同吞咽任务态前额叶皮质激活模式的差异。结果：在执行小口吞咽任务态,前额叶中显著激活的亚区为双侧的腹外侧前额叶皮层（ventrolateral prefrontal,VLPFC）;执行连续吞咽任务态,前额叶中显著激活的亚区为右侧腹外侧前额叶皮层、双侧的背外侧前额叶皮层（dorsolateral prefrontal cortex,DLPFC）及双侧的眶额皮层（orbitofrontal cortex,OFC）,其中右侧额极区（frontopolar prefrontal cortex,FPC）激活呈边缘化显著。经配对t检验发现,连续吞咽任务在右侧背外侧前额叶皮层（DLPFC）及右侧额极区（FPC）中的激活程度明显高于小口吞咽任务（P<0.05）。结论：fNIRS可应用于吞咽相关的脑功能研究。前额叶参与吞咽过程,并且以接近自然状态...     

Patient-conducted anodal transcranial direct current stimulation of the motor cortex alleviates pain in trigeminal neuralgia

Background

Transcranial direct current stimulation (tDCS) of the primary motor cortex has been shown to modulate pain and trigeminal nociceptive processing.

Methods

Ten patients with classical trigeminal neuralgia (TN) were stimulated daily for 20 minutes over two weeks using anodal (1 mA) or sham tDCS over the primary motor cortex (M1) in a randomized double-blind cross-over design. Primary outcome variable was pain intensity on a verbal rating scale (VRS 0–10). VRS and attack frequency were assessed for one month before, during and after tDCS. The impact on trigeminal pain processing was assessed with pain-related evoked potentials (PREP) and the nociceptive blink reflex (nBR) following electrical stimulation on both sides of the forehead before and after tDCS.

Results

Anodal tDCS reduced pain intensity significantly after two weeks of treatment. The attack frequency reduction was not significant. PREP showed an increased N2 latency and decreased peak-to-peak amplitude after anodal tDCS. No severe adverse events were reported.

Conclusion

Anodal tDCS over two weeks ameliorates intensity of pain in TN. It may become a valuable treatment option for patients unresponsive to conventional treatment.     

Idiopathic trigeminal neuralgia: sensory features and pain mechanisms

We present a case report of a patient with the typical sensory features of idiopathic trigeminal neuralgia (ITN). The pain was elicited by innocuous stimuli, summated with repeated stimulation, radiated outside the stimulus zone, referred to a distant site, persisted beyond the period of stimulation, and exhibited a variable refractory period. Unusual sensory features included multiple trigger zones that changed over time and involved all 3 trigeminal divisions. Our sensory evaluation indicated that the pain was evoked by repetitive activation of rapidly adapting, A beta, low-threshold mechanoreceptive afferents. However, activation of such mechanoreceptive afferents alone never produces pain in normal situations and often leads to a suppression of pain responsivity. The findings support the idea that the mechanism of pain in ITN involves pathophysiological mechanisms in the central nervous system. Our hypothesis is that structural and functional changes in the trigeminal system result in an alteration in the receptive field organization of wide-dynamic-range (WDR) neurons. There appears to be an alteration in the surround inhibition mechanism of these neurons leading to an expansion of their touch receptive fields. This results in touch stimuli producing activity in WDR neurons that mimics the activity produced under normal conditions by noxious stimuli. Since WDR neurons participate in the encoding of the perceived intensity of noxious stimuli, a series of punctate tactile stimuli are now perceived as localized, pin-prick or electric shock-like sensations. Similar pathophysiological mechanisms may explain, in part, the pain of peripheral neuropathies associated with postherpetic neuralgia, diabetes and causalgia.     

Gabapentin supplemented with ropivacain block of trigger points improves pain control and quality of life in trigeminal neuralgia patients when compared with gabapentin alone

OBJECTIVE: Pain control in trigeminal neuralgia (TN) is achieved using anticonvulsivants, mainly carbamazepine. When this drug cannot be used, other drugs like gabapentin (GBP) have been used to provide adequate pain control. To improve the therapeutic effect of GBP, we evaluated the clinical efficacy of associating GBP with ropivacain (ROP) analgesic block of facial trigger points in TN patients. DESIGN: Thirty-six TN patients were randomly assigned during 4 weeks to 1 of the following protocols: Protocol I-daily oral GBP administered in a titrated dose; Protocol II-ROP applied as analgesic block to TN trigger points once a week; Protocol III-daily oral GBP plus ROP once a week. Protocol II had to be discontinued in 7/12 patients owing to insufficient pain control. Pain intensity was evaluated by the Visual Analog Scale (VAS) and disability was assessed by Sickness Impact Profile. RESULTS: When compared with Protocol I, Protocol III (GBP+ROP) patients showed (1) a reduction of VAS score after 7 and 28 days of treatment, an effect that was still present 6 and 12 months later; (2) a faster reduction of VAS score using a significantly lower dose of GBP; (3) a smaller total and daily GBP dose at the end of the treatment, which resulted in a total absence of adverse side effects; and (4) an improvement of the functional well-being measured by the Sickness Impact Profile. The number needed to treat (NNT) (GBP+ROP vs. GBP protocols) to obtain 1 GBP+ROP-treated patient with at least 50% pain relief was 1.71 (day 7) and 2.40 (day 28). CONCLUSIONS: The association of GBP and ROP is safe, without side effects and results in an important clinical benefit associated to an improvement of the functional health status of TN patients when compared with GBP alone. This may constitute a therapeutic alternative for pain control in TN patients who cannot be treated with carbamazepine.     

大脑前额叶多通道近红外光谱信号数据的分类鉴别

背景：精神分裂症主要是通过症候学的方法进行诊断,近年来通过神经影像技术与模式识别的结合对精神分裂症患者与正常人进行鉴别的研究已经引起人们的兴趣。 目的：利用模式识别的方法对精神分裂症患者和正常人的大脑前额叶多通道近红外光谱信号数据进行分类鉴别,验证其可行性。 方法：使用言语流畅性测验作为激活任务,采集精神分裂症患者和正常人的大脑前额叶的近红外光谱信号数据。对采集数据进行预处理后计算各通道均值作为特征,计算接收者操作特征的曲线下方面积对通道特征进行分类性能排序,使用支持向量机按性能排序的特征组合做分类,然后用留一验证法计算分类性能指标,验证分类能力。 结果与结论：研究发现特征性能排序前8位的特征组合的准确度最高达到95.24%,并且这8个通道都位于右侧前额叶。推断右侧前额叶区域可能是影响精神分裂症患者的主要脑区,因此根据结果可以推断出近红外光谱数据通过与模式识别方法的结合可以成为辅助诊断精神分裂症病患者的一种手段。     

McGill疼痛问卷在三叉神经痛诊断和治疗中的应用

目的:通过采用McGill疼痛问卷(McGill pain questionnaire,MPQ)鉴别三叉神经痛,并观察射频热凝术的疗效,研究MPQ在面痛诊断上的重要性。方法:本研究共观察159例三叉神经痛患者,其中136例患有典型三叉神经痛(CTN),23例患有混合型三叉神经痛(MTN)。采用MPQ评估患者的疼痛,并观察其中124例术后患者疼痛的缓解情况。结果:CTN组的平均现有疼痛强度(PPI)值为4.20±0.34,MTN组的平均PPI值为3.50±0.57,明显低于CTN组(P0.001);与MTN患者相比,CTN患者在疼痛分级指数(PRI)-感觉项上报告了更高的强度(P0.001);两组间PRI-情感和PRI-评价项上有明显区别,CTN组的得分更高(P0.001);RFT术后CTN患者显示了高的立即疼痛缓解率,达到93.6%。MTN患者的结果没有CTN组的好,只有58.8%的患者疼痛明显缓解。结论:MPQ可以很好鉴别不同类型的三叉神经痛,鉴于射频热凝治疗两种三叉神经痛疗效的差异,使用MPQ在面痛诊断中有重要意义。     

血管压迫性原发性三叉神经痛压迫位点与面部痛区关系的MRI研究

目的 探讨MRI分析血管压迫性原发性三叉神经痛（PTN）患者神经血管压迫（NVC）位点空间方位与面部痛区关系的价值。方法 回顾性分析123例单侧血管压迫性PTN患者三维时间飞跃法MRA（3D TOF MRA）、三维稳态进动快速成像、增强3D TOF MRA图像,依据三叉神经断面解剖特点将NVC位点空间方位划分为8个,结合神经断面长轴转位情况分析其中60例单支血管单点压迫PTN患者NVC位点空间方位与面部痛区的一致性;测量123例患者206个NVC位点到神经入脑干处距离（d）、神经根总长度（L）,计算d/L比值。结果 60例单支血管单点压迫PTN患者中,57例（57/60,95.00%）NVC位点空间方位与面部痛区符合,3例（3/60,5.00%）不符合;其中d/L ≤ 1/4的NVC位点占58.33%（35/60）,d/L ≤ 1/2的NVC位点占85.00%（51/60）。全部123例患者中,206个NVC位点平均d值为（2.50±1.35）mm,92个（92/206,44.66%）NVC位点d/L ≤ 1/4,153个（153/206,74.27%）NVC位点d/L ≤ 1/2。结论 采用MRI判断血管压迫性PTN患者的NVC位点空间方位与面部痛区的关系并测量NVC位点距神经入脑干处的距离,有助于判定责任血管。