Tai Alexander X, Nayar Vikram V
Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Rd NW, PHC 7, Washington, DC, 20007, USA.
Curr Treat Options Neurol. 2019 Jul 31;21(9):42. doi: 10.1007/s11940-019-0583-0.
To review current treatments for trigeminal neuralgia, with an emphasis on determining which patients may benefit from neurosurgical procedures.
A detailed history is the most helpful tool for diagnosing trigeminal neuralgia (TN) and predicting response to neurosurgical treatments. Patients with classic trigeminal neuralgia will describe severe, unilateral, intermittent facial pain that is triggered by innocuous sensory stimuli. In most cases, pain is caused by compression of the trigeminal nerve by a blood vessel near the brainstem. Magnetic resonance imaging is necessary to rule out TN secondary to multiple sclerosis or tumor. Modern high-resolution T2 images may demonstrate neurovascular contact, particularly when analyzed by a neurosurgeon with expertise in TN. Initial management involves a trial of medication, usually carbamazepine or oxcarbazepine. Microvascular decompression (MVD) is safe and effective surgery, for patients with classic TN related to neurovascular compression. For patients with TN secondary to multiple sclerosis, and for patients who are otherwise poor candidates for MVD, neurosurgical options include percutaneous trigeminal rhizotomy and radiosurgery. Neurosurgical procedures are less effective in relieving atypical facial pain. In the clinical evaluation of a patient with facial pain, it is important to distinguish classic trigeminal neuralgia from atypical facial pain. A patient with classic trigeminal neuralgia would benefit from neurosurgical consultation. The advent of high-resolution MRI and MRA sequences now allows a neurosurgeon to detect when neurovascular compression is likely, and select the optimal procedure for treatment.
回顾三叉神经痛的当前治疗方法，重点是确定哪些患者可能从神经外科手术中获益。
详细的病史是诊断三叉神经痛（TN）和预测对神经外科治疗反应的最有用工具。典型三叉神经痛患者会描述由无害的感觉刺激引发的严重、单侧、间歇性面部疼痛。在大多数情况下，疼痛是由脑干附近血管对三叉神经的压迫引起的。磁共振成像对于排除继发于多发性硬化或肿瘤的三叉神经痛是必要的。现代高分辨率T2图像可能显示神经血管接触，尤其是由具有三叉神经痛专业知识的神经外科医生进行分析时。初始治疗包括试用药物，通常是卡马西平或奥卡西平。对于与神经血管压迫相关的典型三叉神经痛患者，微血管减压术（MVD）是一种安全有效的手术。对于继发于多发性硬化的三叉神经痛患者以及其他不适合进行MVD的患者，神经外科选择包括经皮三叉神经切断术和放射外科手术。神经外科手术在缓解非典型面部疼痛方面效果较差。在面部疼痛患者的临床评估中，区分典型三叉神经痛和非典型面部疼痛很重要。典型三叉神经痛患者将从神经外科会诊中获益。高分辨率MRI和MRA序列的出现现在使神经外科医生能够检测何时可能存在神经血管压迫，并选择最佳治疗方法。
