Trigeminal neuralgia is a recurrent paroxysmal severe pain in the trigeminal nerve distribution area, i.e., the face, and is the most common of the neuropathic pain disorders. The prevalence rate is 182 per 100,000 people in China. The clinical manifestations are: facial pain is paroxysmal, brief and intense, with each attack lasting from a few seconds to a few minutes. The pain is electric, knife-like, and tear-like. The pain intervals are as normal. There are often trigger points in the trigeminal nerve distribution area on the diseased side, such as upper and lower lips, nose, roots of teeth, tongue, etc. Patients often have pain episodes triggered by washing, brushing, shaving, eating, and opening the mouth for speech. Therefore, it is clinically misdiagnosed as dental disease.
Before treating trigeminal neuralgia, we should first determine whether it is primary or secondary, such as secondary trigeminal neuralgia caused by tumor etc., surgery should be performed to remove the cause of tumor, if it is primary trigeminal neuralgia, drug treatment or surgery can be performed. In recent years, a large number of clinical studies and surgeries have confirmed that a considerable part of the etiology is caused by microvascular compression of the trigeminal nerve root. Also MRI angiography can detect such microvascular compression of the trigeminal nerve root. The treatment of trigeminal neuralgia by microvascular decompression has an efficiency of over 90%.
Surgical treatment of TN methods.
1.Trigeminal nerve sensory root partial excision
2.Percutaneous trigeminal nerve sensory root radiofrequency electrocoagulation destruction
3.Post-trigeminal root glycerol injection disruption
4.Percutaneous trigeminal nerve balloon compression
5.Γ-knife treatment
Etiology: For centuries, it has been divided into primary and secondary (tumor, occupying lesion, vascular lesion, skull base malformation, etc.). Recently, many scholars have proposed that “true primary TN does not exist at all.
Indications for MVD surgery
1.Typical TN manifestation, “trigger point” exists
2. Exclusion of multiple sclerosis and CPA tumors
3, drug tolerance, toxic side effects, poor efficacy
4, <65 years old, no serious organic disease, able to tolerate surgery
5, cannot receive other treatments after facial numbness
6.Preoperative cranial MR (3D-SPGR) examination
Radiofrequency treatment
Advantages.
1, safety, age and tolerance requirements are wide
2.Short hospitalization time
3, easy to repeat treatment
Disadvantages.
1, symptomatic non-allopathic treatment
2.Destructive
3.Alteration of facial sensation
4, Risk of corneal sensory loss
5, severe sensory abnormalities
6.Easy recurrence
MVD treatment
Advantages.
1.Preservation of nerve, non-destructive
2.No numbness and sensory abnormalities
3.No loss of corneal sensation
4, Targeted etiology, potentially curative
Disadvantages.
1.Requires general anesthesia
2.Craniotomy
3.Surgical complications
Pathological basis of surgical efficacy.
The effect of vascular compression on nerve roots is a progressive and proportional process, and the degree of trigeminal nerve root compression (simple contact, adhesions, axial displacement, atrophy) determines the extent of pain, the typicality of symptoms, and the efficacy of MVD surgery.