Golby A J, Norbash A, Silverberg G D
Department of Neurological Surgery, Stanford University School of Medicine, California 94305-5327, USA.
Neurosurgery. 1998 Sep;43(3):620-2; discussion 622-3. doi: 10.1097/00006123-199809000-00130.
OBJECTIVE AND CLINICAL IMPORTANCE: We present a case of trigeminal neuralgia resulting from infarction of the root entry zone of the trigeminal nerve. This is the first reported case of an unusual cause of trigeminal neuralgia.
A 71-year-old man presented with severe lancinating pain in the left V1 and V2 distributions. Magnetic resonance imaging of the brain demonstrated a small wedge-shaped infarct at the root entry zone of the left trigeminal nerve in the pons.
Medical management with carbamazepine was initially successful, but the patient later developed refractory pain and was unable to tolerate side effects of the medication. The patient underwent subsequent percutaneous glycerol rhizotomy, which resulted in complete resolution of his pain.
Infarction of the root entry zone may produce typical symptoms of trigeminal neuralgia similar to a multiple sclerosis plaque at the root entry zone. Treatment of trigeminal neuralgia must consider the underlying cause. Glycerol rhizotomy may provide relief of pain for patients in whom there is no evidence of vascular compression.
目的及临床意义：我们报告一例因三叉神经神经根入区梗死导致的三叉神经痛病例。这是首例报道的由不寻常病因引起的三叉神经痛病例。
一名71岁男性，左侧V1和V2分布区出现严重的刀割样疼痛。脑部磁共振成像显示脑桥左侧三叉神经神经根入区有一个小的楔形梗死灶。
最初使用卡马西平进行药物治疗取得成功，但患者后来出现顽固性疼痛且无法耐受药物副作用。患者随后接受了经皮甘油神经根切断术，疼痛完全缓解。
神经根入区梗死可能产生与神经根入区多发性硬化斑块相似的典型三叉神经痛症状。三叉神经痛的治疗必须考虑潜在病因。对于无血管压迫证据的患者，甘油神经根切断术可能缓解疼痛。
