Slavin Konstantin V, Nersesyan Hrachya, Colpan Mustafa E, Munawar Naureen
Section of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA.
Head Face Med. 2007 Jul 25;3:30. doi: 10.1186/1746-160X-3-30.
Facial pain may be divided into several distinct categories, each requiring a specific treatment approach. In some cases, however, such categorization is difficult and treatment is ineffective. We reviewed our extensive clinical experience and designed an algorithmic approach to the treatment of medically intractable facial pain that can be treated through surgical intervention.
Our treatment algorithm is based on taking into account underlying pathological processes, the anatomical distribution of pain, pain characteristics, the patient's age and medical condition, associated medical problems, the history of previous surgical interventions, and, in some cases, the results of psychological evaluation. The treatment modalities involved in this algorithm include diagnostic blocks, peripheral denervation procedures, craniotomy for microvascular decompression of cranial nerves, percutaneous rhizotomies using radiofrequency ablation, glycerol injection, balloon compression, peripheral nerve stimulation procedures, stereotactic radiosurgery, percutaneous trigeminal tractotomy, and motor cortex stimulation. We recommend that some patients not receive surgery at all, but rather be referred for other medical or psychological treatment.
Our algorithmic approach was used in more than 100 consecutive patients with medically intractable facial pain. Clinical evaluations and diagnostic workups were followed in each case by the systematic choice of the appropriate intervention. The algorithm has proved easy to follow, and the recommendations include the identification of the optimal surgery for each patient with other options reserved for failures or recurrences. Our overall success rate in eliminating facial pain presently reaches 96%, which is higher than that observed in most clinical series reported to date
This treatment algorithm for the intractable facial pain appears to be effective for patients with a wide variety of painful conditions and may be recommended for use in other institutions.
面部疼痛可分为几个不同类别，每个类别都需要特定的治疗方法。然而，在某些情况下，这种分类很困难且治疗无效。我们回顾了丰富的临床经验，并设计了一种算法方法来治疗可通过手术干预治疗的药物难治性面部疼痛。
我们的治疗算法基于考虑潜在的病理过程、疼痛的解剖分布、疼痛特征、患者的年龄和医疗状况、相关的医疗问题、既往手术干预史，以及在某些情况下的心理评估结果。该算法涉及的治疗方式包括诊断性阻滞、外周神经去神经手术、开颅进行颅神经微血管减压、使用射频消融的经皮神经根切断术、甘油注射、球囊压迫、外周神经刺激手术、立体定向放射外科、经皮三叉神经束切断术和运动皮层刺激。我们建议一些患者根本不接受手术，而是转介接受其他医疗或心理治疗。
我们的算法方法被用于连续100多名药物难治性面部疼痛患者。在每种情况下，临床评估和诊断检查之后都会系统地选择合适的干预措施。该算法已被证明易于遵循，建议包括为每位患者确定最佳手术方案，其他方案则用于治疗失败或复发的情况。我们目前消除面部疼痛的总体成功率达到96%，高于迄今为止大多数临床系列报道的成功率。
这种针对难治性面部疼痛的治疗算法对于各种疼痛状况的患者似乎都有效，可推荐在其他机构使用。
