Wilkinson H A
Newton-Wellesley Hospital, Wellesley Hills, Massachusetts, USA.
J Neurosurg. 1999 May;90(5):828-32. doi: 10.3171/jns.1999.90.5.0828.
Trigeminal neuralgia or tic douloureux is a disease affecting older individuals, and thus, office-based "minimally invasive" therapy is inherently attractive. The author sought to determine whether injection of peripheral trigeminal branches with neurolytic solutions offers a simple, less invasive therapy, with low risk for patients with one- or two-division trigeminal neuralgia that is unresponsive to pharmacotherapy.
This retrospective study focused on a review of case charts from 18 patients treated for tic douloureux. Sixty injections of 10% phenol in glycerol were given to the 18 patients, six of whom had undergone other neurosurgical procedures. The median patient age was 74 years, ranging from 36 to 94 years. There were nine women and nine men. Forty-six injections were administered into the infraorbital nerve in its canal in the midface, 11 percutaneous injections were administered into the mandibular nerve just proximal to the mandibular canal in the ramus of the jaw, and three injections were administered into supraorbital nerves. Eighty-seven percent of injections brought marked or total relief initially. Of those injections that provided initial relief, 37% still provided relief after 1 year and 30% after 2 years, with relief lasting for a median of 9 months after each injection. Most patients whose pain recurred after months of relief requested a repeated procedure, rather than undergo a ganglion nerve block procedure or open surgery. There were no serious complications or dysesthetic pain. Facial sensory loss generally recovered within 6 months and was well tolerated.
Office-based injection of trigeminal branches is a useful technique for neurosurgeons who treat trigeminal neuralgia. It is easily repeated and can provide immediate pain relief of intermediate duration.
三叉神经痛是一种影响老年人的疾病，因此，基于门诊的“微创”治疗具有内在吸引力。作者试图确定向三叉神经周围分支注射神经溶解剂是否为对药物治疗无反应的单支或双支三叉神经痛患者提供一种简单、侵入性较小且风险较低的治疗方法。
这项回顾性研究重点回顾了18例三叉神经痛患者的病历。对这18例患者进行了60次10%甘油苯酚注射，其中6例患者曾接受过其他神经外科手术。患者年龄中位数为74岁，范围在36至94岁之间。有9名女性和9名男性。46次注射是在面部中部眶下神经管内进行，11次经皮注射是在颌骨升支下颌管近端的下颌神经处进行，3次注射是在上眶神经处进行。87%的注射最初带来了明显或完全缓解。在那些最初缓解的注射中，37%在1年后仍有缓解，2年后为30%，每次注射后缓解持续时间中位数为9个月。大多数在缓解数月后疼痛复发的患者要求重复该操作，而不是接受神经节阻滞手术或开放手术。没有严重并发症或感觉异常性疼痛。面部感觉丧失一般在6个月内恢复，且耐受性良好。
对于治疗三叉神经痛的神经外科医生来说，可以在门诊进行三叉神经分支注射，这是一种有用的技术。它易于重复，可立即缓解疼痛且持续时间适中。
