鼻内镜下行上颌神经和眶下神经切除治疗三叉神经痛的护理

江苏省苏北人民医院2004年8月～2007年2月对22例（22侧）三叉神经上颌支痛的患者，采取经鼻内镜下上颌窦径路翼腭窝内上颌神经和眶下神经全长切除，取得满意效果，现将护理体会报告如下。     

原发性三叉神经痛的中医辨治

原发性三叉神经痛的中医辨治王庆吉０６６１０２河北省秦皇岛市北戴河三中医务室原发性三叉神经痛，多发于４０岁以上的女性，在上颌支的眶下孔、下颌支的颏孔和眼支的眶上切迹常有压痛点。多因负担过重、劳累、情志不舒等内伤、外感因素而发病。三叉神经检查正常，没有神...     

经上颌窦内窥镜三叉神经上颌支切除术的手术配合

目的 探讨微创中颅底三叉神经上颌支切除术的配合要点及配合流程。方法 对40例41侧三叉神经上颌支痛的老年患者实施在内镜下经上颌窦至翼腭窝在圆孔处切除上颌神经0．5～1cm。结果 手术顺利，术后无感染，效果良好。结论 充分的术前准备，完善的器械设备系统，精湛的操作技能，术中医、护、患的密切配合是手术成功的关键。     

经上颌窦内镜翼腭窝三叉神经上颌支部分切除术的护理

目的探讨经上颌窦内窥镜翼腭窝三叉神经上颌支部分切除术的术前术后护理。方法术前对39例老年三叉神经上颌支单独痛患者进行心理护理,解除其思想顾虑,完善各项术前准备工作,术后严密观察生命体征,面部、鼻腔、口腔、颅内有无出血及感染,同时注重术后患者的生理、心理需求。结果患者术后恢复好,局部疼痛消失,未出现任何护理并发症。结论做好经上颌窦内窥镜翼腭窝三叉神经上颌支部分切除术患者的术前术后护理,可减轻患者的心理负担,对防止术后并发症,促使早日康复有临床意义。     

鼻内镜下行上颌神经和眶下神经切除治疗三叉神经痛的护理

江苏省苏北人民医院2004年8月～2007年2月对22例(22侧)三叉神经上颌支痛的患者,采取经鼻内镜下上颌窦径路翼腭窝内上颌神经和眶下神经全长切除[1-3],取得满意效果,现将护理体会报告如下.     

三叉神经痛的诊断和治疗

三叉神经痛是一种常见的周围神经病,多见于中年和老年人。一、三叉神经的解剖生理特点 (一)三叉神经为第五对颅神经,也是颅神经中最粗大的一条神经,共分三支。第一支为眼支,第二支为上颌支,第三支为下颌支。 (二)三叉神经为混合神经,既有感觉纤维(大部分),也有运动纤维(小部分)。眼支(感觉纤维):分布于眶内、额、顶、上睑部     

眶下管减压术治疗三叉神经痛9例分析

目的：初步探讨眶下管减压术治疗三叉神经痛的临床疗效。方法：对2004-08/2007-08辽宁省鞍山市铁东区口腔医院收治的三叉神经痛第二支患者9例在局麻下经口内上颌前庭沟处切开,向上剥离黏骨膜,显露眶下孔和眶下神经,直视下用骨凿去除眶下管下壁,直至眶下沟,松解梳理眶下神经。治疗后平均随访22（6-40）个月,记录患者麻木、疼痛等相关情况。结果：术后疼痛均大幅缓解或消失,同时伴有眶下区、上唇的不同程度麻木。术后1-3个月随着麻木的消失,4例患者疼痛复发,2例口服小剂量卡马西平可控制,2例无效。其余5例患者随访期内未见疼痛复发迹象。结论：三叉神经痛是一种顽固的疼痛性疾病,眶下神经管减压术能够对部分眶下神经痛患者起到积极的治疗作用。     

经皮穿刺圆孔射频治疗上颌神经痛的临床研究

目的:探讨经皮穿剌圆孔射频治疗上颌神经痛的疗效。方法:对21例内科治疗失败或有创治疗后复发的上颌神经痛患者,在X线引导下,将头端塑形的普通射频穿刺针,以前下方入路经皮经翼腭窝穿刺圆孔,对上颌神经干行射频温控热凝处理。以视觉模拟评分法(visual analoguescale,VAS)记录患者术前、术后72小时以及术后随访期内疼痛程度来评价治疗疗效。结果:对21患者成功施行23次上颌神经干射频热凝术。21例患者术前VAS评分7.4±1.6分。术后72小时所有患者VAS评分均为0分。手术后随访时间4周到9周(平均31周),未出现上颌神经痛复发。术后上颌神经分布区面部麻木感发生率95.2%(20/21),面部肿胀发生率38.1%(8/21),无角膜感觉神经功能损伤病例发生。结论:经皮穿刺圆孔射频温控热凝处理上颌神经干治疗三叉神经上颌支痛是安全和有效的。     

经上颌窦内窥镜三叉神经上颌支切除术的手术配合

目的探讨微创中颅底三叉神经上颌支切除术的配合要点及配合流程.方法对40例41侧三叉神经上颌支痛的老年患者实施在内镜下经上颌窦至翼腭窝在圆孔处切除上颌神经0.5～1 cm.结果手术顺利,术后无感染,效果良好.结论充分的术前准备,完善的器械设备系统,精湛的操作技能,术中医、护、患的密切配合是手术成功的关键.     

三叉神经痛

三叉神经是第五对脑神经。它又分三大支:①眼神经——向前入眼眶,发支至眼球和额部皮肤。管理眼球的普通感觉及眼裂以上额部皮肤感觉。②上颌神经——向前入眼眶,经眶下孔至面部,管理口裂和眼裂之间的面部皮肤感觉。在未出眶下孔前,沿途还发支支配鼻腔、口腔上部粘膜及上颌牙齿等处的感觉。③下颌神经——向下穿颅底出颅后,分支支配舌前2/3及口腔部粘膜的感觉。并分出下齿槽神经,管理下颌     

Occipital neuralgia evoked by facial herpes zoster infection

Occipital neuralgia is a pain syndrome which may usually be induced by spasms of the cervical muscles or trauma to the greater or lesser occipital nerves. We report a patient with occipital neuralgia followed by facial herpes lesion. A 74-year-old male experienced sudden-onset severe headache in the occipital area. The pain was localized to the distribution of the right side of the greater occipital nerve, and palpation of the right greater occipital nerve reproduces the pain. He was diagnosed with occipital neuralgia according to ICHD-II criteria. A few days later, the occipital pain was followed by reddening of the skin and the appearance, of varying size, of vesicles on the right side of his face (the maxillary nerve and the mandibular nerve region). This was diagnosed as herpes zoster. This case represents a combination of facial herpes lesions and pain in the C2 and C3 regions. The pain syndromes can be confusing, and the classic herpes zoster infection should be considered even when no skin lesions are established.     

三叉神经周围支撕脱术联合阿霉素神经干注射治疗三叉神经痛的疗效观察

目的探讨三叉神经周围支撕脱术联合阿霉素神经干注射治疗三叉神经痛的临床效果。方法对26例三叉神经痛患者采用手术方法游离出三叉神经周围支,将神经干切断后对近中枢段行阿霉素注射,对远中枢段采用神经撕脱术。结果26例患者中25例于术后7d内三叉神经痛症状消失或明显减轻,1例于术后2周疼痛消失,近期疗效满意。结论对三叉神经痛患者采用三叉神经周围支撕脱术联合阿霉素神经干注射治疗可取得较好的治疗效果。     

神经阻滞技术与周围神经痛

介绍三叉神经痛、舌咽神经痛、枕神经痛、颈椎性神经根痛、肋间神经痛、坐骨神经痛、股神经痛、股外侧皮神经痛、髂腹股沟及髂腹下神经痛等10种周围神经痛的病因和发病机制、临床症状、诊断以及治疗方法。神经阻滞(nerveblock,NB)技术治疗这些疾病是来源于麻醉学的一种独特的方法。当药物疗法或其他方法不见效时改用这种技术可获显著效果,于是详述眶上NB,眶下NB,上颌NB,下颌NB,颏NB,半月神经节乙醇、甘油、热凝NB,舌咽NB,枕NB,肋间NB,腰大肌肌沟阻滞,股NB,股外侧皮NB,髂腹股沟及髂腹下NB等18种NB技术的实施方法。     

冠状切口额下入路手术后神经痛的发生及治疗

目的观察冠状切口经额下入路术后神经痛的临床特点,并探讨有效的治疗方法。方法132例择期行冠状切口经额下入路的神经外科患者,排除切口局部疼痛后记录神经痛的发生时间、程度和性质;所有拟诊为术后神经痛的患者首先应用非甾体类消炎镇痛药物口服及脱水治疗,对经药物治疗后疼痛视觉模拟评分(VAS)仍高于7分的患者行类固醇激素神经阻滞疗法。比较药物和神经阻滞对不同类型神经痛的治疗效果。结果眶上神经痛和颞浅神经痛均出现于冠状切口经额下入路术后第3～4天,第4～7天逐渐加重达到高峰,均为中、重度疼痛,呈持续性伴阵发性加重,向同侧额部、顶部、颞部或眶周放散,眶上切迹或颞浅动脉处压痛明显。本组患者术后发生眶上神经痛13例(9.8%),除1例药物治疗有效外,其余12例经神经阻滞治疗后疼痛明显减轻(北京市<0.01);颞浅神经痛4例(3%),3例经药物治疗、1例经神经阻滞治疗后痊愈。结论冠状切口经额下入路术后出现头痛时应注意鉴别眶上神经和颞浅神经痛,颞浅神经痛对非甾体类消炎镇痛药物反应良好,而大多数眶上神经痛需要神经阻滞治疗。     

三叉神经周围支撕脱术治疗三叉神经痛疗效观察

目的探讨三叉神经周围支撕脱术治疗三叉神经痛的近期疗效。方法对23例确诊为原发性三叉神经痛者,施行神经撕脱术。第一支1例,第二支11例,第三支11例。结果本组23例,22例有效,1例无效。8例在术后10d有一过性跳疼。术后半年至8年复发的6例中,第二支2例,第三支4例,其中3例又再次手术。结论三叉神经痛周围支撕脱术治疗三叉神经痛近期疗效好,远期疗效还待进一步观察。     

Anesthesia (15)

Use of computed tomography for maxillary nerve block in the treatment of trigeminal neuralgia. (Dokkyo University School of Medicine, Mibu, Tochigi, Japan) Reg Anesth Pain Med 2000;25:417–419.
A report of a 90-year-old woman who had a 30-year history of episodic pain in her right maxillary region is presented. An attempt to block the nerve with classic technique was made, but eliciting paresthesia could not identify the nerve. In addition, bleeding was noted after repeated attempts. To minimize complications and confirm the correct position of the needle tip, the block was planned with a suprazygomatic approach using computed tomography (CT) guidance. The needle was inserted without paresthesia. The CT scan showed the needle tip was placed at the entrance of the pterygopalatine fossa and the distribution of contrast medium spread appropriately around the pterygopalatine fossa. After confirming the clinical effect and lack of complications of the block using the local anesthetic, 0.5 mL of 7% phenol was injected. The technique resulted in complete sensory loss in the area innervated by the maxillary nerve and did so without complications.
Comment by Andrew D. Rosenberg, MD.
This is an interesting article in which the authors describe their technique for treating trigeminal neuralgia. The authors were faced with a significant problem, which was to perform a maxillary nerve block in a patient with difficult anatomy. The approach and technique were clearly thought out with an excellent result. The axial cuts demonstrate needle position under CT scan and the appropriate spread of contrast material through the pterygopalatine fossa.     

Greater occipital nerve neuralgia caused by pathological arterial contact: treatment by surgical decompression

Occipital nerve neuralgia is a rare cause of severe headache, and may be difficult to treat. We report the case of a patient with occipital nerve neuralgia caused by pathological contact of the nerve with the occipital artery. The pain was refractory to medical treatment. Surgical decompression yielded complete remission.     

综合康复治疗肩周炎的疗效观察

目的：观察口服普瑞巴林联合经皮电刺激治疗腹部带状疱疹后遗神经痛（PHN）的临床效果。方法：腹部PHN患者52例,随机分为2组各26例。对照组口服普瑞巴林300mg,每天2次;观察组在此基础上给予患处经皮神经电刺激（TENS）治疗。用视觉模拟疼痛评分（VAS）和睡眠质量评分（QS）评价效果,并观察治疗后的不良反应。结果：治疗1、2、3及4周后,2组VAS和QS评分均显著下降（均P〈0．05）,观察组降低较对照组更明显（均P〈0．05）。2组不良反应比较差异无统计学意义。结论：口服普瑞巴林300mg联合TENS治疗可有效缓解腹部PHN,改善睡眠质量。且无明显不良反应。     

Postoperative headache following acoustic neuroma resection: occipital nerve injuries are associated with a treatable occipital neuralgia

Objective.— To demonstrate that occipital nerve injury is associated with chronic postoperative headache in patients who have undergone acoustic neuroma excision and to determine whether occipital nerve excision is an effective treatment for these headaches. Background.— Few previous reports have discussed the role of occipital nerve injury in the pathogenesis of the postoperative headache noted to commonly occur following the retrosigmoid approach to acoustic neuroma resection. No studies have supported a direct etiologic link between the two. The authors report on a series of acoustic neuroma patients with postoperative headache presenting as occipital neuralgia who were found to have occipital nerve injuries and were treated for chronic headache by excision of the injured nerves. Methods.— Records were reviewed to identify patients who had undergone surgical excision of the greater and lesser occipital nerves for refractory chronic postoperative headache following acoustic neuroma resection. Primary outcomes examined were change in migraine headache index, change in number of pain medications used, continued use of narcotics, patient satisfaction, and change in quality of life. Follow‐up was in clinic and via telephone interview. Results.— Seven patients underwent excision of the greater and lesser occipital nerves. All met diagnostic criteria for occipital neuralgia and failed conservative management. Six of 7 patients experienced pain reduction of greater than 80% on the migraine index. Average pain medication use decreased from 6 to 2 per patient; 3 of 5 patients achieved independence from narcotics. Six patients experienced 80% or greater improvement in quality of life at an average follow‐up of 32 months. There was one treatment failure. Occipital nerve neuroma or nerve entrapment was identified during surgery in all cases where treatment was successful but not in the treatment failure. Conclusion.— In contradistinction to previous reports, we have identified a subset of patients in whom the syndrome of postoperative headache appears directly related to the presence of occipital nerve injuries. In patients with postoperative headache meeting diagnostic criteria for occipital neuralgia, occipital nerve excision appears to provide relief of the headache syndrome and meaningful improvement in quality of life. Further studies are needed to confirm these results and to determine whether occipital nerve injury may present as headache types other than occipital neuralgia. These findings suggest that patients presenting with chronic postoperative headache should be screened for the presence of surgically treatable occipital nerve injuries.