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首页> 外文期刊>Techniques in Neurosurgery >Surgical Treatment of Trigeminal Neuralgia: Comparison of Microvascular Decompression, Percutaneous Ablation, and Stereotactic Radiosurgery
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Surgical Treatment of Trigeminal Neuralgia: Comparison of Microvascular Decompression, Percutaneous Ablation, and Stereotactic Radiosurgery

机译：三叉神经痛的外科治疗：微血管减压，经皮消融和立体定向放射外科手术的比较

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摘要

Trigeminal neuralgia (TN) represents a rare clinical entity within the spectrum of orofacial pain syndromes characterized by a severe, sudden, brief, most often unilateral, stabbing pain within the distribution of the fifth cranial nerve. These episodes are stereotyped and often have well-defined triggers including speaking, chewing, teeth cleaning, and exposure to wind or cold. Once a clear diagnosis of TN has been established, medical therapy is usually effective. For patients who cannot tolerate the side effects of medical therapy or, in particular young patients, who do not wish to be on life-long medications, surgical intervention is an option. The surgical treatment for TN can be divided into three therapies: microvascular decompression, percutaneous ablation, and Stereotactic radiosurgery. Each modality has advantages and specific indications in certain populations. Microvascular decompression is often considered a curative procedure; however, it is associated with a higher procedural morbidity and mortality. Percutaneous techniques are the oldest and most varied approaches designed to damage specific pain fibers (A-delta and poorly myelinated C-fibers) within the branches of the trigeminal nerve. Finally, Stereotactic radiosurgery has been used to irradiate (and damage) the trigeminal nerve at the root entry zone. Although each technique has been well described in the neurosurgical literature, head-to-head comparisons are lacking. The objective of this review is to explore the current surgical techniques for TN and provide a framework for comparison.
机译：三叉神经痛（TN）代表口面部疼痛综合征谱系中的罕见临床实体，其特征为第五颅神经分布内的严重，突然，短暂，最常见的单侧刺伤。这些发作是刻板印象，通常具有明确的触发因素，包括说话，咀嚼，清洁牙齿以及暴露于风或冰冷。一旦建立了明确的TN诊断，药物治疗通常是有效的。对于不能忍受药物副作用的患者，特别是不希望使用终身药物的年轻患者，手术干预是一种选择。 TN的外科治疗可分为三种疗法：微血管减压，经皮消融和立体定向放射外科手术。在某些人群中，每种方式都有其优势和特定的适应症。微血管减压通常被认为是一种治愈性手术;但是，它与更高的程序发病率和死亡率相关。经皮技术是设计用来破坏三叉神经分支内特定疼痛纤维（A-δ和髓鞘差的C纤维）的最古老，最多样化的方法。最后，立体定向放射外科手术已被用于辐照（和损伤）根部进入区的三叉神经。尽管在神经外科文献中已对每种技术进行了很好的描述，但仍缺乏头对头的比较。这篇综述的目的是探讨目前TN的外科手术技术，并提供一个比较的框架。

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