三叉神经痛和微血管减压课件

1、三叉神经痛和微血管减压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 Incidence2.1 150,000

2、 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 TNTN(Etiologic Point)Idiopathic TN (MVC 80%, AT, et) Symptomatic TN (MS 1.7-5%, Tumors 0.8-11.6%)4. Pathology of TN4.1 TN is a kind

3、 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 TN5.1 Dermatome of TN The

4、 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 sensa

5、tion 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 TNTN(Symptomatic Viewpoint)Typical TN(Paroxysmal Pain) Atypical TN(Par

6、oxysmal and Constant Pain)5.3 Diagnostic criteria of TN (From HIS):5.4 Different Diagnosis of Facial PainGeneral causes of orofacial painGeneral principles in the medical management of facial pain. TCAs, tricyclic antidepressants.6. Treatment for TN6.1 Medical Treatment：6.1.1 Carbamazapine is the go

7、ld 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 im