原发性三叉神经痛的显微手术治疗

目的 探讨原发性三叉神经痛病因及显微血管减压治疗.方法 回顾性分析显微血管减压术治疗的60例原发性三叉神经痛病例资料.结果 术后疼痛完全缓解58例(96.7%),明显缓解、对症处理能够控制满意者2例.出现术侧耳鸣2例,面瘫2例,脑脊液漏1例.随访3～48个月,无复发病例.结论 三叉神经入脑干区受血管压迫是原发性三叉神经痛的常见病因.显微血管减压术是有效的治疗方法.充分认识责任血管,术中注重手术技巧,是提高手术安全性和减少并发症的关键措施.     

显微血管减压术对三叉神经痛的疗效分析

目的：评价显微血管减压术治疗三叉神经痛的疗效。方法：回顾性分析本院18例原发性三叉神经痛患者的临床资料,均行乙状窦后入路显微血管减压术治疗。结果：术中可见三叉神经入脑干处有血管压迫者17例（94.4%）,其中动脉压迫14例,静脉压迫3例,另有蛛网膜粘连索带状压迫1例。术后早期疼痛完全缓解16例（88.9%）,部分缓解2例,总有效率达100%,无手术死亡。随访2～5年,维持完全缓解15例（83.3%）,部分缓解2例,复发1例（5.6%）,持久并发症1例（5.6%）。结论：显微血管减压术直接针对原发性三叉神经痛的病因,临床疗效理想,术中创伤和神经功能影响较小,并发症和术后复发率均较低。     

微血管减压术治疗典型及非典型三叉神经痛的疗效对比

目的 探讨微血管减压术治疗典型及非典型三叉神经痛的不同临床效果.方法 选取44例行微血管减压术治疗的典型三叉神经痛患者作为观察组,并选取同期行微血管减压术治疗的42例非典型三叉神经痛患者作为对照组,对其临床特征、术中所见及临床疗效进行对比.结果 观察组患者的平均发病年龄为59.8岁,平均病程为3.2年.疼痛累及三叉神经单一分支18例,疼痛累及三叉神经二个或三个分支26例.术中见动脉压迫37例,动脉及静脉混合压迫7例;42例患者术后疼痛完全缓解,2例患者疼痛症状明显减轻.对照组中平均发病年龄为56.3岁,平均病程为8.6年,疼痛均累及三叉神经二个或三个分支.术中见动脉压迫22例,动脉及静脉混合压迫20例;15例患者术后疼痛完全缓解,21例患者疼痛症状明显减轻,6例患者无效.结论 微血管减压术治疗典型三叉神经痛效果明显优于非典型三叉神经痛患者,其可能和典型三叉神经患者发病年龄晚、病程短、压迫多为动脉、疼痛多为单支分布且术中可充分减压等因素有关.     

微创血管减压术治疗三叉神经痛30例

目的探究原发三叉神经痛的病因以及微创血管减压术治疗原发性三叉神经痛的临床疗效。方法回顾性分析2009年8月至2010年8月收治的30例三叉神经痛患者,手术方法采用微创三叉神经根血管减压术,路径采用乙状窦后入路。结果术中发现30例患者三叉神经均存在血管性压迫,行血管减压术后全部患者疼痛均缓解消失,分别于3个月、6个月、1年后进行术后随访,复发2例,无1例死亡。结论原发性三叉神经痛是血管性压迫引起的颅部疾病,治疗方法首选微创乙状窦后入路三叉神经根血管减压术,它具有创伤微小、疗效显著、术后并发症少、无面部感觉障碍等后遗效应的优点,值得广泛临床应用。     

三叉神经痛和面肌痉挛患者血管压迫术前MRI表现与手术所见对照研究

目的探讨术前MRI对三叉神经痛和面肌痉挛患者血管压迫的诊断价值及手术指导价值。方法回顾分析43例三叉神经痛和面肌痉挛患者术前MRI图像,观察两侧三叉神经、面神经根部有无血管压迫,将症状侧与无症状侧血管压迫情况进行比较;将12例行微血管减压术患者的术前MRI表现与术中发现进行对比。结果 18例三叉神经痛患者MRI显示症状侧有血管压迫15例,25例面肌痉挛患者症状侧有血管压迫22例,症状侧与无症状侧差异有统计学意义(P<0.05);12例手术患者,术前MRI与术中所见比较,MRI诊断三叉神经痛和面肌痉挛患者血管压迫总敏感度为90%,特异度100%;6例术前MRI仿真内窥镜重建提示神经血管的空间三维解剖关系与术中所见一致。结论术前MRI能清晰显示三叉神经、面神经根与毗邻血管之间的关系,对明确三叉神经痛和面肌痉挛的病因及指导手术有重要价值。     

77例原发性三叉神经痛患者经后颅窝乙状窦后入路微血管减压术的临床疗效分析

目的：评价经后颅窝乙状窦后入路微血管减压术治疗原发性三叉神经痛的手术技巧及治疗效果。方法对本院77例采用颅窝乙状窦后入路微血管减压术治疗的77例原发性三叉神经痛的手术过程及治疗结果进行回顾性分析。结果77例患者中,42例患者为单纯性动脉压迫,7例为单纯性静脉压迫,23例为动静脉压迫,5例患者术中责任血管术中较难识别。77例患者经手术治疗有效率为100.0%,随访9~24个月,复发率为6.5%,予以感觉根部分切断术后复发患者疼痛消失。结论经后颅窝乙状窦后入路微血管减压术治疗原发性三叉神经痛效果理想,安全性好,且术中对多发性责任血管进行有效确认能显著降低术后复发率。     

三叉神经根减压术治疗原发性三叉神经痛的临床研究

目的探讨三叉神经根减压术治疗原发性三叉神经痛的临床疗效。方法对36例原发性三叉神经痛患者,局麻下经乙状窦后入路行三叉神经根减压术,其中28例为血管与神经交叉压迫,4例为蛛网膜粘连,1例为胆脂瘤压迫,2例为血管压迫并蛛网膜粘连,1例未探及血管压迫,行神经根部前内侧切断。结果随访3个月～7年,无复发病例。结论乙状窦后入路三叉神经根减压术治疗原发性三叉神经痛临床效果满意,具有出血少、路径短、损伤小、并发症少等优点,但仍需进一步研究。     

微血管减压术治疗三叉神经痛的体会

<正>三叉神经痛(trigeminal neuralgia,TN)是指位于三叉神经分布范围内出现的反复短暂的阵发性剧痛,近年来的研究表明原发性三叉神经痛的病因95%以上为三叉神经在入脑干前0.5¹.0cm内(也称入、出根区)血管压迫所致[1],目前越来越多证据充分表明微血管减压术(MVD)是治疗原发性三叉神经痛有效安全的方法。1资料与方法     

经枕下——乙状窦后入路三叉神经微血管减压术手术体会

目的总结25例微血管减压术治疗三叉神经痛均获成功的手术体会。方法经枕下—乙状窦后入路,在三叉神经入脑干区(REN)寻找责任血管,将三叉神经与血管进行充分的游离,血管与脑干间置入Teflon棉。结果25例三叉神经痛患者术后症状全部消失,治愈率100%,无一例出现与手术有关的并发症。结论熟悉桥脑小脑角显微解剖结构,掌握显微手术操作技巧,对责任血管的正确辨认与处理是手术成功的关键。     

2例三叉神经微血管减压术护理体会

原发性三叉神经痛是较为常见的神经性疼痛疾患,大多数原发性三叉神经痛患者由于在小脑桥脑角处的三叉神经后根,受到异位血管的压迫而引起,而解除异常压迫后,疼痛得到缓解或消除。传统的治疗方法有:针灸、敷药、封闭术、射频损毁术,现代我们采用手术治疗。目前显微血管减压(MVD)已成为治疗三叉神经痛首选的手术方法。我院于2006年采用MVD治疗三叉神经痛2例,取得满意的效果,现将护理体会报道如下。     

三叉神经痛大鼠三叉神经节中BDNF的表达变化

目的观察脑源性神经生长因子(brain-derived neurotropic factor,BDNF)及其高亲和力受体TrkB在三叉神经痛(trigeminal neuralgia,TN)大鼠三叉神经节(trigeminal ganglion, TG)中的表达变化。方法 TN大鼠模型由眶下神经慢性损伤压迫模型(ION-CCI)制备。♂SD大鼠随机分为假手术组(Sham组)和TN模型组。测定两组大鼠损伤侧机械阈值,应用实时荧光定量PCR、免疫组织化学技术和免疫荧光双标技术,检测损伤侧TG中BDNF及TrkB表达变化,并测定损伤侧TG中前炎症因子TNF-α、IL-1β的变化。结果建模2周后,与假手术组相比,TN组的机械痛阈明显下调,TG中BDNF及TrkB较假手术组明显升高,同时前炎症因子TNF-α、IL-1β水平也明显升高(P<0.05)。结论 TN状态下,ION-CCI大鼠TG中BDNF及TrkB表达升高,可能参与TN的发病机制,促进了TN的痛觉传递。     

磁共振成像三维稳态构成干扰序列在评估原发性三叉神经痛三叉神经形态学中的价值

目的探讨磁共振成像(MRI)三维稳态构成干扰(3D CISS)序列在原发性三叉神经痛(PTN)三叉神经形态学改变中的应用价值。方法回顾性分析 2017年 4月至 2019年 2月亳州市人民医院 PTN病人的影像及临床资料 36例,运用 3D CISS序列及多平面重组图像处理(MPR)技术,测量两侧三叉神经脑池段最大长度及面积、三叉神经 ?桥脑夹角及桥小脑角池截面,对其结果进行比较。结果三叉神经脑池段最大长度分别为(9.87±2.71)mm(症状侧)及(9.96±2.20)mm(非症状侧),二者比较差异无统计学意义(P＞0.05);三叉神经脑池段最大截面分别为(27.28±8.59)mm2(非症状侧)二者比较(症状侧)及(34.11±11.66)mm2,差异有统计学意义(P＜0.05);三叉神经 ?脑桥夹角分别为(41.80±8.02)°(症状侧)及(47.75±11.01)°(非症状侧),二者比较差异有统计学意义(P＜0.05);三叉神经桥小脑角池截面分别为(204.42±8.20)mm2(非症状侧)二者     

Dofetilide induced trigeminal neuralgia

Anti-arrhythmic medications are uncommonly used due to their pro-arrhythmic effect. However, just like any other class of medication, they can cause idiosyncratic reactions that may or may not be related to their mechanism of action. Those reactions can be severe enough to warrant discontinuation of a successful therapeutic intervention. In this case, we present a case of trigeminal neuralgia caused by dofetilide.KEY WORDS: Adverse effects, dofetilide, trigeminal neuralgia     

Effects of D-baclofen and L-baclofen on the trigeminal nucleus

D-Baclofen reduced the response to L-baclofen in the feline trigeminal nucleus, the spinal cord of the rat and in patients with trigeminal neuralgia, but not in slices of hippocampus or neocortex. The iontophoretic application of 10-20 nA L-baclofen depressed excitatory transmission in the trigeminal nucleus oralis, similar to the effect of 0.1-0.4 mg/kg L-baclofen, given intravenously. The concomitant iontophoresis of 10-20 nA D-baclofen reduced the effect of iontophoretically applied L-baclofen. However, larger doses of D-baclofen (30-60 nA) did not, while still larger doses (200-400 nA) by themselves depressed response of the neuron, similar to the action of small doses of L-baclofen. The iontophoresis of 30-40 nA L-baclofen had a stronger effect than that previously obtained with systemic administration and D-baclofen was not able to block it. These observations suggest that D-baclofen is a partial agonist at the GABAB receptor. Failure to observe a blocking effect of D-baclofen in slices of hippocampus or neocortex could be due to the larger doses used or to a difference in receptor types. The observations emphasise the need to test drugs at therapeutic concentrations in an appropriate model, in order to predict reliably their therapeutic actions.     

Quiescent satellite glial cells of the adult trigeminal ganglion

Sensory ganglia comprise functional units built up by neurons and satellite glial cells (SGCs). In animal species there was proven the presence of neuronoglial progenitor cells in adult samples. Such neural crest-derived progenitors were found in immunohistochemistry (IHC). These findings were not previously documented in transmission electron microscopy (TEM). It was thus aimed to assess in TEM if cells of the human adult trigeminal ganglion indeed have ultrastructural features to qualify for a progenitor, or quiescent phenotype. Trigeminal ganglia were obtained from fifteen adult donor cadavers. In TEM, cells with heterochromatic nuclei, a pancytoplasmic content of free ribosomes, few perinuclear mitochondria, poor developed endoplasmic reticulum, lack of Golgi complexes and membrane trafficking specializations, were found included in the neuronal envelopes built-up by SGCs. The ultrastructural pattern was strongly suggestive for these cells being quiescent progenitors. However, further experiments should correlate the morphologic and immune phenotypes of such cells.     

显微手术治疗原发性三叉神经痛的临床体会

目的 探讨原发性三叉神经痛的病因及显微血管减压术的治疗效果.方法 回顾分析2010年1月至2014年12月收治的原发性三叉神经痛患者81例,行微血管减压术80例,同时行感觉根部分切断术22例,感觉根部分切断术加蛛网膜粘连松解1例,术中均严密缝合硬膜,术后随访半年以上,分析治疗效果.结果 81例患者中,术中发现有血管压迫80例,蛛网膜粘连1例,术后1天疼痛完全消失70例,术后1周疼痛完全消失8例,另外3例延迟缓解,术后无颅内感染及皮下积液等并发症,平均随访15个月.结论 显微手术行微血管减压术是治疗原发性三叉神经痛的最佳方法,根据情况可同时行感觉根部分切断术,疗效好,安全可靠,应作为原发性三叉神经痛患者的首选治疗方法.     

Therapeutic potential of cannabinoids in trigeminal neuralgia

Trigeminal neuralgia is a disorder of paroxysmal and severely disabling facial pain and continues to be a real therapeutic challenge to the clinicians. While the exact cause and pathology of this disorder is uncertain, it is thought that trigeminal neuralgia caused by irritation of the trigeminal nerve. This irritation results from damage due to the change in the blood vessels, the presence of a tumor or other lesions that cause the compression of the trigeminal root. The pain of trigeminal neuralgia is characterized by unilateral pain attacks that start abruptly and last for varying periods of time from minutes to hours. The quality of pain is usually sharp, stabbing, lancinating, and burning. The attacks are initiated by mild stimuli such as light touch of the skin, eating, chewing, washing the face, brushing the teeth, and exposure to wind. Although antiepileptic drug therapy may be beneficial in the treatment of trigeminal neuralgia, up to one-half of the patients become refractory or intolerant to these medications. At present there are few other effective drugs. In cases of lacking effect after pharmacotherapy, surgical options may be considered. Currently there is growing amount of evidence to suggest that the psychoactive ingredient in cannabis and individual cannabinoids may be effective in alleviating neuropathic pain and hyperalgesia. Evidence suggests that cannabinoids may prove useful in pain modulation by inhibiting neuronal transmission in pain pathways. Considering the pronounced antinociceptive effects produced by cannabinoids, they may be a promising therapeutic approach for the clinical management of trigeminal neuralgia.     

三叉神经痛的分子发病机制的研究进展

三叉神经痛(trigeminal neuralgia,TN)是指三叉神经的一支或几支分布区的反复性、阵发性剧痛,对病人的生活质量影响较大的一种较难完全治愈的疾病,临床一般分为原发性和继发性TN。关于原发性TN的病因和发病机制目前尚不明确。现在,随着分子生物学研究的进展,已经发现多种神经类物质和TN有着密切的联系。该文从分子方面对TN的发病机制研究进展情况作一综述,旨在为TN的治疗提供理论依据。