Ferri Francisco, Forleiter Craig M, Montorfano Lisandro, Konstantinidis Michael, Borghei-Razavi Hamid, Mascaro-Pankova Andres
Department of General Surgery, Cleveland Clinic Florida, Weston, Fla.
Department of Plastic and Reconstructive Surgery, Cleveland Clinic Florida, Weston, Fla.
Plast Reconstr Surg Glob Open. 2020 Nov 30;8(11):e3264. doi: 10.1097/GOX.0000000000003264. eCollection 2020 Nov.
Trigeminal Neuralgia (TN) is defined as a recurrent, unilateral, brief, electric shock-like pain and is associated with a significant deterioration in quality of life due to the debilitating nature of the pain. The first line treatment is medical therapy, and surgical treatment is reserved for patients with inadequate pain control or undesirable side effects. Surgical options for treatment may include microvascular decompression (MVD), stereotactic radiosurgery, percutaneous radiofrequency rhizotomy, and percutaneous balloon compression of trigeminal ganglion. MVD is considered the procedure of choice due to its high efficacy and safety profile; however, it carries a recurrence rate of 1%-5% annually and 15%-35% long term. Although re-operative MVD has been reported for recurrent cases, it carries a high risk of complications due to arachnoid adhesions and distorted anatomy. Peripheral neurectomy is a simple, expeditious, low-risk procedure that is well tolerated by patients and can be done even under local anesthesia. We report a case of a 69-year-old man who presented with a debilitating TN in the V1 and V2 territory refractory to MVD, stereotactic radiosurgery, and percutaneous balloon compression of the trigeminal ganglion, who had been treated with neurectomy of the left supraorbital, supratrochlear, and infraorbital nerves, with an excellent outcome at 6 months follow-up. Peripheral neurectomy is an effective alternative for patients with refractory TN who failed multiple surgical interventions. Previous publications have reported an elevated long-term recurrence rate after this procedure, perhaps due to peripheral nerve regeneration or neuroma formation. It is not yet studied whether using nerve conduits may lead to a decrease in recurrence.
三叉神经痛（TN）被定义为一种反复发作的、单侧的、短暂的、电击样疼痛，由于疼痛使人衰弱的性质，其与生活质量的显著下降相关。一线治疗是药物治疗，手术治疗则适用于疼痛控制不佳或出现不良副作用的患者。治疗的手术选择可能包括微血管减压术（MVD）、立体定向放射外科、经皮射频神经根切断术以及经皮球囊压迫三叉神经节。由于其高疗效和安全性，MVD被认为是首选的手术方法；然而，它每年的复发率为1%-5%，长期复发率为15%-35%。虽然已有复发性病例行再次手术MVD的报道，但由于蛛网膜粘连和解剖结构扭曲，其并发症风险很高。周围神经切除术是一种简单、迅速、低风险的手术，患者耐受性良好，甚至可以在局部麻醉下进行。我们报告一例69岁男性患者，其V1和V2区域的顽固性TN对MVD、立体定向放射外科和经皮球囊压迫三叉神经节均无效，该患者接受了左侧眶上神经、滑车上神经和眶下神经切除术，随访6个月时效果极佳。对于多次手术干预失败的顽固性TN患者，周围神经切除术是一种有效的替代方法。以往的文献报道该手术后长期复发率较高，可能是由于周围神经再生或神经瘤形成。使用神经导管是否会导致复发率降低尚未得到研究。
