三叉神经痛和微血管减压课件

1、TrigeminalNeuralgiaandMicrovascularDecompressionLiuZhan,Departmentofneurosurgery，2ndAffiliatedHospital1TrigeminalNeuralgiaandMicrov1. Definition of Trigeminal Neuralgia Trigeminal neuralgia(TN, orTGN), also known asprosopalgia,suicide disease, orFothergills disease,is aneuropathicdisorder characteri

2、zed by episodes of intensepain in the face, originating from thetrigeminal nerve. 21. Definition of Trigeminal Ne2. Prevalence and Incidence2.1 150,000 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，1.7

3、4/1). 32. Prevalence and Incidence2.13.Etiology of TNTN(Etiologic Point)Idiopathic TN (MVC 80%, AT, et) Symptomatic TN (MS 1.7-5%, Tumors 0.8-11.6%)43.Etiology of TNTNIdiopathic T4. Pathology of TN4.1 TN is a kind of non-nociceptive pain, which is caused by compression or damage to nerves instead of

4、 stimulation to algesiroreceptor .4.2 Peripheral and central theory of TN: MVC, demyelination, ectopic impulse in trigeminal nerve, sensory reflex epilepsy, etc. 54. Pathology of TN4.1 TN is a 5. Clinical characters of TN5.1 Dermatome of TN The ophthalmic branch (V1) is responsible for sensation fro

5、m 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,

6、and part of the ear. It is also responsible for supplying the muscles involved with chewing (mastication), those muscles involved with chewing.65. Clinical characters of TN5.5.2 Major clinical features of TN75.2 Major clinical features ofTN(Symptomatic Viewpoint)Typical TN(Paroxysmal Pain) Atypical

7、TN(Paroxysmal and Constant Pain)8TNTypical TNAtypical TN85.3 Diagnostic criteria of TN (From HIS):95.3 Diagnostic criteria of TN 5.4 Different Diagnosis of Facial Pain105.4 Different Diagnosis of FacGeneral causes of orofacial pain11General causes of orofacial paGeneral principles in the medical man

8、agement of facial pain. TCAs, tricyclic antidepressants.12General principles in the medi6. Treatment for TN6.1 Medical Treatment：6.1.1 Carbamazapine is the gold standard for initial treatment.136. Treatment for TN6.1 Medical14146.3 Operation for TN:6.3.1 Percutaneous procedures: Radiofrequency therm

9、al; Glycerol injection; Microcompression;156.3 Operation for TN:6.3.1 Per6.3.2 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).166.3.2 Open Surgery (MVD):16In 3D-TOF, signal of venous is isointensive.17In 3D-TOF, signal of venous isThe image of nerve in FIESTA stage is superior to it in 3D-TOF stage.18The image of nerve in FIE