Snel Bart Jorrit, Cohen Steven P, Erdine Serdar, Day Miles R, Van Zundert Jan, Vissers Kris, Kallewaard Jan Willem
Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
Anesthesiology, Neurology, Physical Medicine & Rehabilitation and Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Pain Pract. 2025 Jun;25(5):e70051. doi: 10.1111/papr.70051.
Trigeminal neuralgia (TN) is a disorder characterized by recurrent, unilateral brief electric shock-like pains, abrupt in onset and termination, limited to the distribution of one or more branches of the trigeminal nerve, and triggered by innocuous stimuli.
The literature on the diagnosis and treatment of TN was retrieved and summarized.
The diagnosis is made almost entirely based on the patient's history. In classical TN, the neurological examination is typically normal, whereas the exam in secondary TN is focused on surveilling for signs of multiple sclerosis (MS) or a cerebellopontine tumor. The appropriate imaging technique is magnetic resonance imaging (MRI) with contrast of the trigeminal ganglion, which is recommended prior to interventional procedures. The treatment of a patient with TN is a team effort and should always be multidisciplinary, addressing all dimensions of pain. Carbamazepine or oxcarbazepine are first-line medical treatments. Microvascular decompression (MVD) is the technique of choice for patients without or with minor comorbidities. Percutaneous procedures for TN are mainly radiofrequency thermocoagulation of the branches of the trigeminal nerve introduced by Sweet and Wepsic in 1965, retrogasserian glycerol injection introduced by Hakanson in 1981, and balloon compression introduced by Mullan and Lichtor in 1983. Radiofrequency treatment is recommended in elderly patients or those with major comorbidities. Other techniques such as stereotactic radiosurgery and pulsed radiofrequency treatment are also discussed.
Recommendations are based on very low-quality evidence. MVD and radiofrequency are the preferred invasive treatments, although higher-quality evidence is necessary to better assess the risk-benefit ratios.
三叉神经痛（TN）是一种以反复发作的单侧短暂电击样疼痛为特征的疾病，起病和终止突然，局限于三叉神经一个或多个分支的分布区域，且由无害刺激触发。
检索并总结有关TN诊断和治疗的文献。
诊断几乎完全基于患者的病史。在典型的TN中，神经学检查通常正常，而在继发性TN中，检查重点是监测多发性硬化（MS）或桥小脑肿瘤的体征。合适的成像技术是三叉神经节增强磁共振成像（MRI），建议在进行介入手术前进行。TN患者的治疗需要团队协作，应始终采用多学科方法，解决疼痛的各个方面。卡马西平或奥卡西平是一线药物治疗。微血管减压术（MVD）是无或有轻微合并症患者的首选技术。TN的经皮手术主要有1965年Sweet和Wepsic引入的三叉神经分支射频热凝术、1981年Hakanson引入的半月神经节甘油注射术以及1983年Mullan和Lichtor引入的球囊压迫术。建议老年患者或有严重合并症的患者采用射频治疗。还讨论了其他技术，如立体定向放射外科和脉冲射频治疗。
建议基于非常低质量的证据。MVD和射频是首选的侵入性治疗方法，尽管需要更高质量的证据来更好地评估风险效益比。
