微创三叉神经消融术：经口入路靶向V2
Minimally Invasive Trigeminal Ablation: Transoral Approach for Targeting V2.
作者信息
Ward Max, Blanco Conor, Mammis Antonios, Umanoff Michael, Paskhover Boris
机构信息
Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Saint Barnabas Medical Center, RWJ-Barnabas Health Department of Otolaryngology-Head and Neck Surgery, Livingston, New Jersey, USA.
出版信息
World Neurosurg. 2018 Dec;120:211-213. doi: 10.1016/j.wneu.2018.08.223. Epub 2018 Sep 7.
BACKGROUND
Trigeminal neuralgia (TN) is a chronic orofacial pain syndrome, which manifests as severe pain in the distribution of any trigeminal nerve branch. Though traditionally responsive to anticonvulsant therapy, TN can become refractory to medications and require surgical intervention.
CASE DESCRIPTION
We present a case of V2 TN that was treated with minimally invasive trigeminal ablation. The patient presented with a 6-year history of type 1 TN and had failed the maximum tolerated doses of carbamazepine and gabapentin. There was no evidence of vascular compression on neuroimaging. After the patient refused stereotactic radiosurgery, she was offered minimally invasive trigeminal ablation. At 5 months postoperatively the patient reported complete alleviation of pain with tolerable sensorineural numbness.
CONCLUSIONS
The endoscopic approach allows for precise targeting of V2, which is ideal in patients undergoing targeted neuroablation for pain. This is the first documented case of a transoral endoscopic approach toward ablative V2 TN management.
背景
三叉神经痛（TN）是一种慢性口腔面部疼痛综合征，表现为任何三叉神经分支分布区域的剧痛。虽然传统上对抗惊厥治疗有反应，但TN可能会对药物产生耐药性，需要手术干预。
病例描述
我们报告一例经微创三叉神经消融术治疗的V2区TN病例。该患者有1型TN病史6年，已服用卡马西平和加巴喷丁的最大耐受剂量但治疗失败。神经影像学检查未发现血管压迫迹象。在患者拒绝立体定向放射外科治疗后，为其提供了微创三叉神经消融术。术后5个月，患者报告疼痛完全缓解，伴有可耐受的感觉神经性麻木。
结论
内镜方法可精确靶向V2区，这对于接受疼痛靶向神经消融术的患者是理想的。这是第一例经口内镜方法治疗V2区TN的文献记载病例。
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