3D-FIESTA-C与3D-TOF-MRA 序列在血管压迫三叉神经痛中责任血管显示的比较研究

目的：比较三维双激发平衡式稳态自由进动序列（3D‐FIESTA‐C）与三维时间飞跃法磁共振血管成像（3D‐TOF‐MRA）在血管压迫三叉神经痛中责任血管显示的应用价值。方法回顾性分析行微血管减压术（M VD ）的60例三叉神经痛患者的磁共振资料,所有患者均采用3D‐T O F‐M RA和3D‐FIES T A‐C序列扫描,从原始及重建图像综合评判患侧三叉神经脑池段与周围血管的空间关系,以术中镜下所见为金标准,对比分析3D‐TOF‐MRA和3D‐FIESTA‐C序列预判接触血管的效能。结果判定是否存在责任血管,3D‐TOF‐MRA和3D‐FIESTA‐C序列灵敏度分别为85．7％、89．3％,特异度为75．0％、100％,准确率为85．0％、90．0％（P＝1．000）。在责任血管中,3D‐TOF‐MRA和3D‐FIESTA‐C序列判定责任动脉灵敏度分别为94．1％、88．2％（P＝0．244）,而责任静脉灵敏度为0．00％、88．2％（P＝0．009）。结论3D‐FIESTA‐C与3D‐TOF‐MRA序列均能有效显示责任血管,3D‐FIESTA‐C对责任静脉的显示优于3D‐TOF‐MRA ,可作为术前病因诊断的有力补充。     

CT引导下经皮圆孔穿刺射频温控热凝术治疗三叉神经痛(第Ⅱ支)的疗效及安全性

目的探讨薄层CT引导下经皮穿刺圆孔射频热凝术治疗药物无效或复发性三叉神经痛(第Ⅱ支)的疗效及安全性。方法对药物无效或复发性三叉神经痛(第Ⅱ支)的22例患者行CT引导下经皮穿刺圆孔射频热凝术治疗,采用巴罗神经学研究所(BNI)分级评定标准评价患者术后疗效,观察术后并发症情况。结果 22例患者术后即刻疼痛完全缓解率达95.45%(21/22),1例患者术后疼痛有所缓解,但服药后可以控制(BNI分级Ⅲ级)。2例患者术后复发,均再次行射频术,术后即刻疼痛均完全缓解(BNI分级Ⅰ级)。随访3~19个月,平均(7.73±4.69)个月。所有患者均无任何严重并发症发生。结论薄层CT引导下经皮穿刺圆孔射频热凝治疗药物无效或复发性三叉神经痛(第Ⅱ支)的疗效可靠、并发症少,可作为药物无效或复发性三叉神经痛的一种理想微创治疗手段。     

恩再适注射液肌注治疗LDH术后残余神经痛的临床疗效观察

目的：：观察恩再适注射液肌注治疗LDH(腰椎间盘突出症)术后残余神经痛的临床疗效。方法：选择年龄于40~59岁之间的LDH患者90例(男女各45例)经正规保守治疗4周无效且VAS≥5分患者,行腰4－5或腰5－骶1髓核摘除、椎间融合术后第2周仍存在下肢疼痛或(和)麻木者,按照完全随机等分法分三组、每组30例：A组(维生素B1＋B12注射液组),B组(注射用腺苷钴胺组),C组(恩再适注射液组),通过上述三组治疗3~6周后,观察恩再适注射液组治疗LDH术后残余神经痛的临床疗效。结果：C组(恩再适注射液组)临床疗效显著优于A、B两组。结论：恩再适注射液可显著改善LDH术后残余神经痛症状,具有显著临床疗效。     

临床药师参与1例三叉神经痛治疗的体会

临床药师参与了1例三叉神经痛患者的治疗。通过开展疼痛评估、药学监护,利用药学专业知识提供合理化用药建议和用药指导,并规范了镇痛药物的应用,提高了患者用药的依从性和安全性。     

Iatrogenic injury to oral branches of the trigeminal nerve: records of 449 cases

The aims of this study were threefold: (1) to describe iatrogenic lesions to oral branches of the trigeminal nerve, signs and symptoms, and functional status, (2) to report on a simple neurosensory examination method, and (3) to discuss means of prevention of iatrogenic injury. The etiology and functional status of 449 injuries to oral branches collected over 18 years were retrospectively reviewed. A simple scheme of a clinical neurosensory examination was applied to enable a quantified rating of the perception. Injury to the lingual nerve (n = 261) is not only the most prevalent type of lesion, it also seems to be the most devastating type of lesion. Third molar surgery (n = 319) counts for the majority of injuries to the lingual, inferior alveolar, and buccal nerves. Lesions related to the injection of local analgesics was the second most frequent etiology (n = 78), and the lingual nerve was affected more frequently and severely than other oral branches of the trigeminal nerve. The female gender was overrepresented in incidence of injured nerves but no difference was found in the severity of affection between females and males. All grades of loss of neurosensory functions were found, and a range of neurogenic malfunctions was reported. Methodological obstacles in clinical neurosensory examination of trigeminal nerve injury and the magnitude of neurosensory impairment are discussed. Many nerve injuries are avoidable by critical reevaluation of indications, increased awareness of potential hazards, and modified surgical procedures.     

Occipital neuralgia as a presenting symptom of cervicomedullary dural arteriovenous fistula

Dural arteriovenous fistulas (DAVFs) at the cervicomedullary junction are rare and have a wide variation in presentation. We report a case of occipital neuralgia (ON) as a rare presenting symptom of cervicomedullary DAVF causing intramedullary hemorrhage at the C1 level. It is important to consider the underlying causes of ON, and precise neurological examinations and radiological evaluations are needed.     

化疗引起的神经痛治疗靶点温度选择性TRP通道的研究进展

作为钙离子渗透性的瞬时受体电位(TRP),5种通道(TRPV1~4和TRPM2)被不同的高温激活,两种通道(TRPV1和TRPV8)被低温激活。越来越多的证据表明,TRPA1和TRPM8拮抗剂可预防顺铂、奥沙利铂和紫杉醇诱导的线粒体氧化应激、炎症、冷痛和痛觉过敏。TRPV1在顺铂引起的感觉神经元热痛觉和机械异常中有应答。TRPA1、TRPM8和TRPV2蛋白表达水平主要通过这些治疗方法在背根(DRG)和三叉神经节中增加。主要总结了5种温度调节TRP通道(TRPA1、TRPM8、TRPV1、TRPV2和TRPV4)。