三叉神经痛和微血管减压

Trigeminal Neuralgia and Microvascular Decompression,Liu Zhan, Department of neurosurgery，2nd Affiliated Hospital,1. Definition of Trigeminal Neuralgia,Trigeminal neuralgia(TN, orTGN), also known asprosopalgia,suicide disease, orFothergills disease,is aneuropathicdisorder characterized by episodes of intensepain in the face, originating from thetrigeminal nerve.,2. Prevalence and Incidence,2.1 150,000 people are diagnosed with TN every year（annual occurrence is 3-5/100,000)2.2 Over the age of 50 (52-69).2.3 More common in women than in men（F/M，1.74/1).,3.Etiology of TN,4. Pathology of TN,4.1 TN is a kind of non-nociceptive pain, which is caused by compression or damage to nerves instead of stimulation to algesiroreceptor .4.2 Peripheral and central theory of TN: MVC, demyelination, ectopic impulse in trigeminal nerve, sensory reflex epilepsy, etc.,5. Clinical characters of TN,5.1 Dermatome of TN,The ophthalmic branch (V1) is responsible for sensation from the scalp, forehead, upper eyelid and tip of the nose.The maxillary branch (V2) sensation covers the lower eyelid, the side of the nose, the upper lip and cheek, and the upper teeth and gums.The mandibular branch (V3) is responsible for sensation of the lower teeth and gums, lower lip, chin, jaw, and part of the ear. It is also responsible for supplying the muscles involved with chewing (mastication), those muscles involved with chewing.,5.2 Major clinical features of TN,5.3 Diagnostic criteria of TN (From HIS):,5.4 Different Diagnosis of Facial Pain,General causes of orofacial pain,General principles in the medical management of facial pain. TCAs, tricyclic antidepressants.,6. Treatment for TN,6.1 Medical Treatment：6.1.1 Carbamazapine is the gold standard for initial treatment.,6.3 Operation for TN:,6.3.1 Percutaneous procedures: Radiofrequency thermal; Glycerol injection; Microcompression;,6.3.2 Open Surgery (MVD):6.3.2.1 Theoretical Basis:6.3.2.2 Preoperative evaluation: 3D MRI: 3D time of flight (3D- TOF) , 3D constructive interference in steady state( 3D -CISS) , fast imaging employing steady- state acquisition (FIESTA).,In 3D-TOF, signal of venous is isointensive.,The image of