Anesthesiology and Pain Department, Institut de Cancerologie de l'Ouest - Paul Papin, Angers, France,
Prog Neurol Surg. 2020;35:181-193. doi: 10.1159/000509623. Epub 2020 Aug 19.
Despite the high incidence of facial pain, targeted drug delivery remains a rarely used technique for treatment of otherwise refractory pain. Two distinct paths have been described. The intraventricular route allows direct access to intracerebral opioid receptors. The more recently introduced upper cervical or cisternal intrathecal route, is based on the same theories as classical intrathecal route. Intraventricular route was first described by A.K. Ommaya; its use remains limited, mostly with morphine, despite a high clinical efficiency, probably because of the invasive nature of the procedure and the need for daily direct injections. The ability to connect the catheter to an implantable pump may help to facilitate the acceptance of this approach. The also rarely used high cervical intrathecal or cisternal route is very efficient, because facial pain signals are transmitted mainly via the trigeminal nerve roots and synapse on the second-order neurons in an area that extends from the lower brainstem to the C1 and C2 levels of the spinal cord. The risks of cervical puncture may explain the rarity of its use. However, new devices allowing a simpler lumbar approach and the ongoing opioid crisis are the factors that may facilitate the wider use of this effective technique for the treatment of facial pain.
尽管面部疼痛的发病率很高，但靶向药物输送仍然是一种很少用于治疗其他难治性疼痛的技术。已经描述了两种不同的途径。脑室内途径允许直接进入颅内阿片受体。最近引入的上颈椎或鞘内蛛网膜下腔途径基于与经典蛛网膜下腔途径相同的理论。脑室内途径最初由 A.K. Ommaya 描述；尽管其临床效果很高，但由于该程序的侵袭性和每日直接注射的需要，其使用仍然有限，主要是用吗啡。将导管连接到可植入泵的能力可能有助于促进这种方法的接受。也很少使用的高位颈椎蛛网膜下腔途径非常有效，因为面部疼痛信号主要通过三叉神经根传递，并在延髓下部到脊髓 C1 和 C2 水平的区域中的二级神经元上发生突触传递。颈椎穿刺的风险可能解释了其使用的罕见性。然而，允许更简单的腰椎入路的新设备以及持续的阿片类药物危机可能会促进这种有效治疗面部疼痛技术的更广泛应用。
