三叉神经痛和微血管减压PPT.ppt

Trigeminal Neuralgia and Microvascular Decompression Liu Zhan, Department of neurosurgery， 2nd Affiliated Hospital 1. Definition of Trigeminal Neuralgia Trigeminal neuralgia?(TN, or?TGN), also known as?prosopalgia,?suicide disease, or?Fothergills disease,?is a?neuropathic?disorder characterized by episodes of intense?pain in the face, originating from the?trigeminal 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 TN (Etiologic Point) Idiopathic TN (MVC 80%, AT, et) Symptomatic TN (MS 1.7-5%, Tumors 0.8-11.6%) 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. TN (Symptomatic Viewpoint) Typical TN (Paroxysmal Pain) Atypical TN (Paroxysmal and Constant Pain) 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 nerve in FIESTA stage is superior to it in 3D-TOF stage. 6.3.2.3 Operative technique：