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中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (07) : 643 -646. doi: 10.3877/cma.j.issn.1674-0785.2022.07.008

临床研究

继发性三叉神经痛诊疗策略
蒋亦林1, 伍刚1, 刘波1, 沈洁2, 刘如恩1,()   
  1. 1. 100044 北京,北京大学人民医院神经外科
    2. 100039 中国人民解放军总医院第七医学中心神经内科
  • 收稿日期:2022-04-28 出版日期:2022-07-15
  • 通信作者: 刘如恩

Diagnostic and therapeutic strategies for secondary trigeminal neuralgia

Yilin Jiang1, Gang Wu1, Bo Liu1, Jie Shen2, Ru'en Liu1,()   

  1. 1. Department of Neurosurgery, Peking University People's Hospital, Beijing 100044, China
    2. Department of Neurology, Seventh Medical Center, PLA General Hospital, Beijing 100039, China
  • Received:2022-04-28 Published:2022-07-15
  • Corresponding author: Ru'en Liu
引用本文:

蒋亦林, 伍刚, 刘波, 沈洁, 刘如恩. 继发性三叉神经痛诊疗策略[J/OL]. 中华临床医师杂志(电子版), 2022, 16(07): 643-646.

Yilin Jiang, Gang Wu, Bo Liu, Jie Shen, Ru'en Liu. Diagnostic and therapeutic strategies for secondary trigeminal neuralgia[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(07): 643-646.

目的

探讨继发性三叉神经痛的诊断及治疗策略。

方法

回顾使分析北京大学人民医院神经外科2017年1月至2022年3月临床收治的继发性三叉神经痛患者,共34例,并参考相关文献。

结果

34例继发性三叉神经痛病例均由占位性病变引起,所有患者均接受手术治疗,31例肿瘤完全切除,3例部分切除,其中10例术中发现血管压迫三叉神经,行三叉神经微血管减压术。术后33例患者的疼痛症状消失,1例患者明显减轻。

结论

相应CPA区占位性病变是继发性三叉神经痛的首要病因,原发性因素可同时存在,头颅CT及MRI检查必不可少,手术是治疗继发性三叉神经痛的首选治疗手段。术中切除肿瘤后,应注意是否存在血管压迫神经情况,做到三叉神经充分减压。

Objective

To explore the diagnostic and therapeutic strategies for secondary trigeminal neuralgia (STN).

Methods

The clinical data of 34 STN cases admitted to our hospital from January 2017 to March 2022 were retrospectively analyzed in combination with the relevant literature.

Results

All the 34 cases of STN were caused by space-occupying lesions. All patients received surgical treatment; total excision was achieved in 31 cases, and subtotal excision achieved in 3. Ten cases were found with vascular compression of the trigeminal nerve during operation and underwent microvascular decompression. Postoperatively, pain disappeared in 33 cases and was significantly relieved in 1.

Conclusions

Space-occupying lesions in the CPA area is the primary cause of STN, and classic trigeminal neuralgia may coexist. CT and MRI of the head are essential for STN diagnosis. Surgery is the first choice of treatment for STN. Attention should be paid to vascular compression intraoperatively.

表1 病例资料
表2 患者术前伴随症状、术后短期并发症及病理结果(例)
图1 引起继发性三叉神经痛的占位性病变。图a为脑膜瘤,图b为听神经瘤,图c为骑跨脑干表皮样囊肿
1
Andersen A S S, Bendtsen L, Maarbjerg S, et al. Trigeminal neuralgia-diagnosis and treatment [J]. Cephalalgia, 2017, 37(7): 648-657.
2
夏养华, 牛朝诗, 凌士营, 等. 继发性三叉神经痛的诊断与手术治疗-附36例临床分析 [J]. 立体定向和功能性神经外科杂志, 2010, 23(4): 210-213.
3
杨大伟. 探讨继发性三叉神经痛外科治疗方案的选择 [D]. 大连医科大学, 2021.
4
Arrighi-Allisan A E, Delman B N, Rutland J W, et al. Neuroanatomical determinants of secondary trigeminal neuralgia: application of 7T Ultra-High-Field multimodal magnetic resonance imaging [J]. World Neurosurg, 2020, 137: e34-e42.
5
Peciu-Florianu I, Régis J, Levivier M, et al. Trigeminal neuralgia secondary to meningiomas and vestibular schwannoma is improved after stereotactic radiosurgery: A systematic review and meta-analysis [J]. Stereotact Funct Neurosurg, 2021, 99(1): 6-16.
6
Khan Afridi E A, Khan S A, Qureshi W U, et al. Frequency of cerebellopontine angle tumours in patients with trigeminal neuralgia [J]. J Ayub Med Coll Abbottabad, 2014, 26(3): 331-333.
7
Lagares A, Rivas J J, Jiménez L, et al. Central dem yelination in the pathogenesis of trigeminal neuralgia associated with cerebellopontine angle tumors: case report with ultrastructural trigeminal root analysis [J]. Neurosurgery, 2010, 66(4): E841-E842.
8
齐猛, 张雷, 梁建涛, 等. 原发性和继发性三叉神经痛临床特征及手术效果分析 [J]. 中国现代神经疾病杂志, 2018, 18(9): 663-668.
9
Cabral G, Lorga T, Caetano A, et al. Secondary trigeminal neuralgia: do not forget the pontine ischemic infarction [J]. Eur Neurol, 2021, 84(5): 391-392.
10
孙瑞坦, 蔡鸣, 朴翔宇. 普瑞巴林治疗带状疱疹引起的继发性三叉神经痛疗效观察 [J]. 中国卫生产业, 2012, 9(14): 75-76.
11
刘霄, 李锴, 郭亚洲, 等. 桥小脑角区表皮样囊肿继发三叉神经痛的临床分析(附7例报告及文献复习) [J]. 中国临床神经科学, 2018, 26(6): 682-687.
12
Cheng T M, Cascino T L, Onofrio B M. Comprehensive study of diagnosis and treatment of trigeminal neuralgia secondary to tumors [J]. Neurology, 1993, 43(11): 2298-302.
13
李红梅. 继发性三叉神经痛误诊2例 [J]. 中国实用医药, 2011, 6(13): 215-216.
14
Noma N, Ozasa K, Young A. Altered somatosensory processing in secondary trigeminal neuralgia: A case report [J]. J Indian Prosthodont Soc, 2021, 21(3): 308-310.
15
赵君, 王升志, 李光华, 等. 内镜下经乙状窦后入路显微手术治疗继发性三叉神经痛 [C]. 第八次全国口腔颌面-头颈肿瘤会议, 2009: 100-102.
16
Ma S, Agarwalla P K, Van Loveren H R, et al. Successful microvascular decompression for trigeminal neuralgia secondary to a persistent trigeminal artery [J]. Oper Neurosurg (Hagerstown), 2019, 16(1): 18-22.
17
Di Stefano G, Maarbjerg S, Truini A. Trigeminal neuralgia secondary to multiple sclerosis: from the clinical picture to the treatment options [J]. J Headache Pain, 2019, 20(1): 20.
18
Guo H, Wang X, Song C, et al. Trigeminal neuralgia secondary to osteoid osteoma of the petrous bone: report of 4 cases and brief review of literature [J]. World Neurosurg, 2018, 114: e713-e718.
19
鲁明, 李兴可, 赵绍云. 唤醒麻醉下经皮三叉神经半月节球囊压迫术治疗3例继发性三叉神经痛 [J]. 立体定向和功能性神经外科杂志, 2018, 31(5): 312-314.
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