Urgent care peripheral nerve blocks for refractory trigeminal neuralgia

Objective

After medication failure, patients with refractory trigeminal neuralgia (TGN) often present urgently and seek more potent or invasive therapies such as opioids or surgical options. Peripheral nerve blocks, safe and simple, may offer extended pain relief prior to opioid use or more invasive ganglion level procedures.

Subclinical sensory abnormalities in trigeminal neuralgia

Trigeminal neuralgia is considered as a paroxysmal single nerve phenomenon. Abnormal sensory perception has been previously described in 15-25% of patients with clinical examination. Quantitative sensory testing (QST) was used to evaluate sensory perception in patients with idiopathic trigeminal neuralgia (ITN). Nine patients and 10 normal control subjects were evaluated in all six trigeminal branches. QST abnormalities were found in the symptomatic division and in the other two branches on the same side. Minor contralateral changes were also found. Differences consisted of cold and warm hypoaesthesia and higher cold and heat pain thresholds in patients. All differences proved statistically significant. Our findings suggest that trigeminal neuralgia is not only a paroxysmal single nerve disorder, but also that other higher structures may be involved.     

Consumer views on management of trigeminal neuralgia

OBJECTIVE: To assess consumers' views on treatments used for trigeminal neuralgia and to compare their assessments with those of clinicians. METHODS: A short self-administered questionnaire was distributed to 133 individuals with trigeminal neuralgia and 21 clinicians attending national support group meetings in the United States and United Kingdom. RESULTS: Responses were obtained from 82% of those with trigeminal neuralgia and from 50% of the clinicians. All sufferers had used medical therapies (mean of three drugs), and 40% to 50% had undergone surgical treatment. All of the attendees with trigeminal neuralgia reported at least one side effect (mean +/- SD, 4.9 +/- 1.8). The clinicians underestimated the number of side effects, but both groups agreed that drowsiness and cognitive impairment are side effects that are particularly disliked. The mean current quality-of-life score, measured on a scale of 1 to 5 (5 = worse), was 2.7 +/- 1.5. Only 37% of sufferers gave an opinion as to the best form of treatment. CONCLUSIONS: Therapy leads to side effects which tend to be underestimated by clinicians. Patients currently find it difficult to make decisions about treatment. More collaborative research with active involvement of sufferers would improve the evidence base on which decisions can be made.     

三叉神经痛微血管减压术的手术体会

目的探讨三叉神经痛微血管减压（MVD）术的疗效与责任血管的解剖特点。方法回顾性分析25例接受三叉神经痛MVD术患者的临床资料及手术体会。结果术中见21例三叉神经根部有接触或压迫的血管,占84％,最常见的责任血管是小脑上动脉,共13例（52％）,其次为小脑前下动脉,共6例（24％）。动脉性责任血管占76％,岩上静脉作为责任血管2例（8％）;附近无任何血管压迫但术中发现三叉神经覆盖的蛛网膜明显增厚者4例占16％。手术治愈率为96％。结论MVD是治疗三叉神经痛安全、微创、有效的方法。提高显微外科操作技巧,不遗漏责任血管,是提高手术疗效和减少并发症的关键。     

伽玛刀治疗原发性三叉神经痛疗效观察

目的 探讨伽玛刀治疗原发性三又神经痛的疗效.方法 2003年1月至2008年3月,我院应用伽玛刀治疗原发性三又神经痛120例;治疗靶点为三叉神经根,用4 mm准直器,靶点中心计量为80～90 Gy.疗效评估采用患者自我报告疼痛的控制程度及药物用量的变化.结果 所有患者进行了随访,平均随访期(20.0±4.5)个月.本组病例中治愈69例(57.5%);显效34例(28.3%)、有效12例(10.0%)、无效5例(4.2%);总有效率为95.8%.5例患者疼痛复发后行其他治疗.83例患者(69.2%)曾出现一过性、局限性的面部麻木.14例患者(11.7%)在疼痛缓解后留下持续性的面部麻木;部分患者还伴有味觉减退、口嚼无力等主诉.结论 伽玛刀治疗原发性三又神经痛能够显著缓解疼痛、提高生活质量,不良反应发生率较低:是一种较为理想的治疗方法.     

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。     

A型肉毒毒素治疗三叉神经痛和带状疱疹后神经痛的临床疗效

目的：观察A型肉毒毒素治疗三叉神经痛和带状疱疹后神经痛的临床效果。方法：选取33例三叉神经痛或带状疱疹后神经痛患者，进行疼痛区域A型肉毒毒素皮下或皮内注射治疗，评估患者治疗时、治疗2周后、治疗3个月后疼痛情况（NRS）、睡眠状况及生活质量（QOL），判断治疗效果，观察药物不良反应。结果：患者使用A型肉毒毒素治疗2周后、3个月后疼痛评分、睡眠评分显著低于治疗时（P<0.05），生活质量显著高于治疗时（P<0.05），治疗效果好，不良反应少。结论：A型肉毒毒素治疗三叉神经痛和带状疱疹后神经痛效果显著，可成为神经病理性疼痛治疗的一种新途径。     

Fatal paranasal sinusitis presenting as trigeminal neuralgia

Trigeminal neuralgia is rare in patients with paranasal sinusitis. The authors describe a case of paranasal sinusitis that appeared as an insidious onset of trigeminal neuralgia along the distribution of ophthalmic and maxillary branches, followed by rapid intracranial invasion with temporal meningoencephalitis and subdural empyema, and finally a fatal outcome.     

Unilateral black hairy tongue in trigeminal neuralgia

Unilateral hairlike discoloration of the tongue is described in a patient with ipsilateral mandibular division trigeminal neuralgia. This unusual physical sign coincided with the patient's painful trigger zone and was attributed to hypertrophy of keratinized filiform papillae, where guarded avoidance of mechanical stimulation over time prevented normal desquamation.     

Prevalence of hypertension in patients with trigeminal neuralgia

It is unclear whether hypertension (HTN) is a predisposing factor for the development of trigeminal neuralgia (TN). The purpose of this study was to determine the prevalence of HTN in TN patients and controls at the USC Orofacial Pain and Oral Medicine Center. A retrospective chart review was conducted from a database of over 3,000 patient records from 2003 to 2007. We identified patients diagnosed with TN with or without HTN. A total of 84 patients (54 females; 30 males) between the ages of 33 and 93 years were diagnosed with TN; 37% had TN with HTN and 32% of controls had HTN. The increased prevalence of HTN in the TN patients was not statistically significant (P = 0.50). Since, both TN and HTN are seen in the elderly, it is likely that HTN is simply a co-existing condition in patients with TN and not a risk factor for its development.     

继发性三叉神经痛诊疗策略

目的探讨继发性三叉神经痛的诊断及治疗策略。 方法回顾使分析北京大学人民医院神经外科2017年1月至2022年3月临床收治的继发性三叉神经痛患者,共34例,并参考相关文献。 结果34例继发性三叉神经痛病例均由占位性病变引起,所有患者均接受手术治疗,31例肿瘤完全切除,3例部分切除,其中10例术中发现血管压迫三叉神经,行三叉神经微血管减压术。术后33例患者的疼痛症状消失,1例患者明显减轻。 结论相应CPA区占位性病变是继发性三叉神经痛的首要病因,原发性因素可同时存在,头颅CT及MRI检查必不可少,手术是治疗继发性三叉神经痛的首选治疗手段。术中切除肿瘤后,应注意是否存在血管压迫神经情况,做到三叉神经充分减压。     

神经妥乐平在高龄原发性三叉神经痛患者中的应用

目的观察应用神经妥乐平在高龄原发性三叉神经痛患者的临床效果和安全性。方法应用数字评分法对23例原发性三叉神经痛患者疼痛进行评估并比较治疗前后的结果。结果患者治疗后疼痛程度下降。结论神经妥乐平对高龄三叉神经痛患者的止痛效果明显,安全性高。     

原发性三叉神经痛患者行显微血管减压术的护理

目的总结原发性三叉神经痛患者行显微血管减压治疗的护理要点。方法对62例原发性三叉神经痛患者实施显微血管减压治疗,并做好术前后的护理工作。结果术后治愈52例,好转10例,术后2例发生伤口脑脊液漏,2例发生口唇疱疹,经对症处理后痊愈。结论显微血管减压治疗原发性三叉神经痛,具有较高的治愈率、止痛效果明显、损伤少等优点。术前应做好患者心理护理及疼痛护理,术后密切观察患者病情变化,做好并发症的观察及健康指导,其能减轻患者的痛苦,对患者的康复具有重要意义。     

影响原发性三叉神经痛伽玛刀治疗效果的相关因素分析

目的探讨伽玛刀治疗原发性三叉神经痛的疗效及影响预后的因素。方法回顾性分析75例原发性三叉神经痛的患者行伽玛刀治疗的效果,均经OUR-XGD旋转式伽玛刀治疗,采用4—8mm准直器,半月节照射采用多靶点,三叉神经根照射采用单靶点或双靶点,中心剂量70—90Gy,脑干表面受量〈15Gy。通过随访患者疼痛发作的频率和程度的减轻评价疗效。结果随访时间为3～72个月,平均37．6个月,总有效率90．7％。4例患者2～3年后复发,6例在伽玛刀治疗后半年出现患侧面部麻木感,无其他并发症。经统计学分析,某些因素与疗效相关。结论伽玛刀治疗原发性三叉神经痛一种安全有效的方法,靶点选择、剂量选择、照射部位是影响预后的因素,而病史长短及疼痛分布与预后无相关性。     

Coexistence of TACS and trigeminal neuralgia: pathophysiological conjectures

BACKGROUND: Trigeminal autonomic cephalgias (TACs) and trigeminal neuralgia are short-lasting unilateral primary headaches whose study is providing insights into craniofacial pain mechanisms. We report on 2 patients in whom trigeminal neuralgia coexists with the TACs paroxysmal hemicrania and SUNCT. CONCLUSION: Coexistence of trigeminal neuralgia with various TAC forms suggests a pathophysiological relationship between these short-lasting unilateral headaches.     

Duration of attacks of first division trigeminal neuralgia

Objective measurements of duration of attacks have been performed in 8 (5 female and 3 male) patients suffering from primary first division (V-1) trigeminal neuralgia. The mean age of the patients was 67.5 +/- 11.4 years, and the mean age at onset 64.0 +/- 9.7 years. During the study the patients were off treatment. A total of 192 attacks were witnessed by the authors and exactly timed by a stop-watch. The duration of attacks ranged from 2 to 32 s, with a mean of 6.5 +/- 6.1 s. The unweighted mean was 8.8 +/- 5.7 s, with a range of 2.4-17.5 s. With the present data the duration of attacks of V-1 neuralgia has been exactly determined, and the clinical distinction of V-1 neuralgia from other shortlasting headaches, particularly from SUNCT, has been substantially clarified.     

误诊为原发典型三叉神经痛的桥小脑角胆脂瘤的临床研究

目的：探讨三叉神经痛型桥小脑角胆脂瘤的发生机制、临床表现和治疗原则。方法：回顾性总结21例以原发典型三叉神经痛为主要表现的胆脂瘤患者的临床表现、肿瘤生长部位与大小、手术入路与技巧、结果和术后并发症等资料。结果：肿瘤全切16例,次全切5例。所有患者均表现为同侧三叉神经痛。术中发现10例肿瘤将三叉神经包绕在瘤内。术后三叉神经痛均消失,面部感觉减退2例,听力减退1例;1例疑似无菌性脑膜炎。结论：桥小脑角区胆脂瘤与三叉神经痛的关系复杂,应采取手术治疗,术中根据肿瘤和周围结构的关系以确定是否全切,术后注意无菌性脑膜炎等并发症。     

Familial trigeminal neuralgia: case reports and review of the literature

The paroxysmal facial pain of trigeminal neuralgia is usually idiopathic, but familial cases have been described. We describe a family with apparent autosomal dominant transmission of trigeminal neuralgia. Our cases and a review of the literature suggest that the etiology of trigeminal neuralgia may be vascular compression of the fifth cranial nerve. Autosomal dominant vascular and epileptic disorders are reviewed, and possible relationships to familial trigeminal neuralgia are considered.