三叉神经痛和微血管减压.ppt

三叉神经痛和微血管减压三叉神经痛和微血管减压1.Definition of Trigeminal Neuralgia Trigeminalneuralgia(TN,orTGN),alsoknownasprosopalgia,suicidedisease,orFothergillsdisease,isaneuropathicdisordercharacterizedbyepisodesofintensepainintheface,originatingfromthetrigeminalnerve.2.Prevalence and Incidence2.1 150,000peoplearediagnosedwithTNeveryyear（annualoccurrenceis3-5/100,000)2.2Overtheageof50(52-69).2.3Morecommoninwomenthaninmen（F/MF/M，1.74/1)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 TN4.1TNisakindofnon-nociceptivepain,whichiscausedbycompressionordamagetonervesinsteadofstimulationtoalgesiroreceptor.4.2PeripheralandcentraltheoryofTN:MVC,demyelination,ectopicimpulseintrigeminalnerve,sensoryreflexepilepsy,etc.5.Clinical characters of TN5.1DermatomeofTNTheophthalmicbranch(V1)isresponsibleforsensationfromthescalp,forehead,uppereyelidandtipofthenose.Themaxillarybranch(V2)sensationcoversthelowereyelid,thesideofthenose,theupperlipandcheek,andtheupperteethandgums.Themandibularbranch(V3)isresponsibleforsensationofthelowerteethandgums,lowerlip,chin,jaw,andpartoftheear.Itisalsoresponsibleforsupplyingthemusclesinvolvedwithchewing(mastication),thosemusclesinvolvedwithchewing.5.2MajorclinicalfeaturesofTNTN(Symptomatic Viewpoint)Typical TN(Paroxysmal Pain)Atypical TN(Paroxysmal and Constant Pain)5.3DiagnosticcriteriaofTN(FromHIS):5.4DifferentDiagnosisofFacialPainGeneralcausesoforofacialpainGeneralprinciplesinthemedicalmanagementoffacialpain.TCAs,tricyclicantidepressants.6.Treatment for TN6.1MedicalTreatment：6.1.1Carbamazapineisthegoldstandardforinitialtreatment.6.3OperationforTN:6.3.1Percutaneousprocedures:Radiofrequencythermal;Glycerolinjection;Microcompression;6.3.2OpenSurgery(MVD):6.3.2.1TheoreticalBasis:6.3.2.2Preoperativeevaluation:3DMRI:3Dtimeofflight(3D-TOF),3Dconstructiveinterferenceinsteadystate(3D-CISS),fastimagingemployingsteady-stateacquisition(FIESTA).In3D-TOF,signalofvenousisisointensive.TheimageofnerveinFIESTAstageissuperiortoitin3D-TOFstage.6.3.2.3Operativetechnique：6.3.3Radiotherapy:TheEnd