Zhonghua Yi Xue Za Zhi. 2025 Jul 8;105(25):2058-2071. doi: 10.3760/cma.j.cn112137-20250121-00184.
Neurovascular compression is the primary etiology of classical trigeminal neuralgia. Microvascular decompression can achieve clinical cure by relieving the compression of responsible blood vessels on the trigeminal nerve. However, secondary trigeminal neuralgia caused by primary neurological diseases such as multiple sclerosis and tumors, as well as idiopathic trigeminal neuralgia with unclear etiology, exhibit distinct pathogenesis, diagnostic criteria, and treatment principles compared to classical trigeminal neuralgia. Due to the lack of standardized diagnostic and therapeutic guidelines for these types of trigeminal neuralgia internationally, clinical practice often faces issues such as unclear diagnosis and classification, poor treatment outcomes, and frequent complications, which have drawn significant attention from experts. Therefore, the Specialized Committee on Neurorestoratology of Chinese Medical Doctor Association, Specialized Committee on Peripheral Nerve Surgery of Chinese Medical Doctor Association, and International Association of Neurorestoratology, in collaboration with experts from neurosurgery and painology departments across 25 domestic medical centers, systematically developed 19 recommendations based on the latest medical evidence and multidisciplinary clinical experience. These recommendations address diagnosis, differential diagnosis, imaging examinations, pharmacological treatment, and surgical interventions, aiming to standardize the clinical management of trigeminal neuralgia.
神经血管压迫是典型三叉神经痛的主要病因。微血管减压术可通过解除责任血管对三叉神经的压迫实现临床治愈。然而，由多发性硬化症和肿瘤等原发性神经系统疾病引起的继发性三叉神经痛，以及病因不明的特发性三叉神经痛，与典型三叉神经痛相比，其发病机制、诊断标准和治疗原则都有所不同。由于国际上缺乏针对这类三叉神经痛的标准化诊断和治疗指南，临床实践中常面临诊断和分类不明确、治疗效果不佳以及并发症频发等问题，这些问题已引起专家的高度关注。因此，中华医学会神经修复学分会、中华医学会神经外科学分会周围神经外科学组和国际神经修复学会，与国内25家医疗中心的神经外科和疼痛科专家合作，基于最新医学证据和多学科临床经验，系统制定了19条推荐意见。这些推荐意见涉及诊断、鉴别诊断、影像学检查、药物治疗和手术干预等方面，旨在规范三叉神经痛的临床管理。
