Trigeminal neuralgia is a neurological disease that occurs in the distribution area of the trigeminal nerve on one or both sides of the face, with painful symptoms such as discharge and cutting, which is unbearable for people. The incidence of trigeminal neuralgia is high, the age is mostly after 40 years old, and there are more women than men. The pain can be severe when talking, brushing teeth or when the breeze is blowing, and can last for several seconds or minutes. Patients with trigeminal neuralgia often do not dare to wipe their faces, eat, or even swallow saliva, which affects their normal life and work. Therefore, this pain is called the “world’s first pain”, also known as painful twitching. The disease is a neurological disorder characterized by periodic episodes of severe paroxysmal pain in the trigeminal nerve distribution area of the face. The trigeminal nerve is the Vth pair of cerebral nerve that innervates the sensory and motor functions of the maxillofacial region, and has three branches in the face, namely the ophthalmic branch (the first branch), the maxillary branch (the second branch) and the mandibular branch (the third branch) of the trigeminal nerve, which innervate the sensory and masticatory muscles above the eye fissure, between the eye fissure and the mouth fissure, and below the mouth fissure, respectively. The cause of primary trigeminal neuralgia has not been identified. Secondary trigeminal neuralgia is often secondary to local infection, trauma, narrowing of the bone foramen through which the trigeminal nerve passes, tumors, vascular malformations, and blood circulation disorders. Patients with secondary trigeminal neuralgia often have abnormalities in physical examination and other auxiliary tests.
The diagnosis of this disease in modern medicine is based on its pain location, nature, number of attacks, time and triggers, etc. After excluding cranial occupying lesions, the diagnosis is not difficult. In terms of pathogenesis, there are theories such as viral infection theory, focal theory, ischemia theory, cervical nerve theory, genetic theory, and metabolic theory. The national and international incidence rates are 47.8/100,000 and 62.6/100,000, respectively, with more women than men, and the incidence rate may increase with age.
Disease classification Trigeminal neuralgia can be divided into two categories: primary (symptomatic) trigeminal neuralgia and secondary trigeminal neuralgia, among which primary trigeminal neuralgia is more common. Primary trigeminal neuralgia refers to trigeminal neuralgia in which no exact cause can be found. It may be caused by sclerosis of the supplying blood vessels and compression of the nerve, or the pain may be caused by thickening of the meninges and narrowing of the bone foramen through which the nerve passes, causing compression. Secondary trigeminal neuralgia: It refers to trigeminal neuralgia caused by tumor compression, inflammation, or vascular malformation. This type is different from the primary one in that the pain is often persistent and signs of lesions in the adjacent structures of the trigeminal nerve can be detected.
The etiology and pathogenesis of primary trigeminal neuralgia are unclear, but most believe that the lesion is in the periphery of the trigeminal nerve, i.e., in the sensory roots of the trigeminal hemianopsia. Based on microsurgical and electron microscopic observations, it may be associated with small vascular malformations, bony malformations in the rocky bone area, and other factors that cause painful episodes.
Clinical features The attack is sudden, without any aura, and is mostly one-sided. When the attack occurs, the pain is as intense as a knife cut or electric shock, lasting from a few seconds to 1-2 minutes, often accompanied by facial muscle convulsions, lacrimation, salivation, facial flushing, conjunctival congestion and other symptoms, with the aggravation of the disease, the interval becomes shorter and more frequent attacks, after a strong pain stimulation, the patient is abnormally nervous, unforgettable for life, causing great pain.
Since the etiology and pathology of trigeminal neuralgia are still unclear, Chinese medicine believes that it is due to “wind, cold and dampness” and heavy cold attacks on the head. The aim of treatment is to stop the pain. There are still various methods of pain relief with effective herbal therapy. They can be roughly divided into non-invasive and invasive treatments. Non-invasive treatment methods include Western medicine, Chinese medicine, herbal acupuncture therapy, physical therapy and gamma knife treatment for the head. They are suitable for patients with short duration of disease and mild pain. It can also be used as a complementary treatment to invasive treatment methods. Invasive treatment methods include surgical therapy, nerve block therapy, radiofrequency thermal coagulation therapy, and gamma knife therapy. Medical diagnosis of primary
The diagnosis of patients with primary trigeminal neuralgia can be made by detailed questioning of the patient’s medical history, pain location, nature of pain and other clinical manifestations. In addition, the examination reveals that most patients have a thin general condition due to the long-term impact of eating. Painful expressions, greasy face and reluctance to speak during painful episodes, and even in the interval patients are reluctant to speak or rarely speak. However, the neurological examination of the patient was normal, and there were no obvious abnormal changes in various sensory and motor sensations of the trigeminal nerve, corneal reflexes, and mandibular reflexes. In some patients, the local pain and sensation in the face is reduced due to previous treatment, which should be differentiated from the facial hyperalgesia caused by secondary trigeminal neuralgia. The skull base radiograph shows no pathological changes in the foramen ovale and foramen ovale. In conclusion, the diagnosis of trigeminal neuralgia is generally not difficult based on the location and nature of the pain and the absence of other neurological symptoms and signs. It is generally believed that the diagnosis of trigeminal neuralgia should have the following characteristics.
1. gender and age: the age is mostly above 40 years old, with more middle-aged and elderly people. There are more women than men, about 3:2.
The pain is more on the right side than on the left side, and the pain starts from a point on the face, mouth or jaw and spreads to one or more branches of the trigeminal nerve, with the second and third branches being the most common, and the first branch being rare. The pain does not extend beyond the midline of the face and does not exceed the area of distribution of the trigeminal nerve. Occasionally, there is bilateral trigeminal neuralgia, accounting for 3%.
3.The nature of pain: such as inverted cutting, needling, tearing, burning or electric shock-like severe and unbearable pain, or even painful.
4, the pattern of pain: the attack of trigeminal neuralgia is often without warning, while the pain attacks are generally regular. Each pain attack lasts from only a few seconds to 1 to 2 minutes and stops abruptly. At the beginning of the disease, the number of attacks is small and the interval is long, ranging from several minutes to several hours, but with the development of the disease, the attacks become more frequent, the interval is gradually shortened, and the pain is gradually increased and intense. The pain episodes decrease at night. There is no discomfort during the interval. 5, triggering factors: talking, eating, washing, shaving, brushing teeth and wind blowing can trigger a pain attack, so that the patient is on tenterhooks, depressed, careful and cautious actions, and even afraid to wash their faces, brush their teeth, eat, and speak carefully, for fear of causing an attack.
6, trigger point: trigger point is also known as “trigger point”, often located in the upper lip, nose, gums, corner of the mouth, tongue, eyebrows and other places. Light touch or stimulate the trigger point can stimulate pain attacks.
7. Expression and facial changes: During the attack, it often suddenly stops talking, eating and other activities, and the painful side can show spasms, i.e. “painful spasms”, frowning and clenching teeth, opening the mouth to cover the eyes, or rubbing the face with the palm of the hand to cause local skin roughness, thickening, loss of eyebrows, conjunctival congestion, tearing and salivation. The expression is mental tension and anxiety.
8, neurological examination: no abnormal signs, a few have facial hypesthesia. Such patients should be further questioned about their medical history, especially whether they have a history of hypertension, and a comprehensive neurological examination, including lumbar puncture, skull base and internal auditory tract radiography, cranial CT, MRI, etc., if necessary, to help differentiate them from secondary trigeminal neuralgia.
Secondary Secondary trigeminal neuralgia is also known as symptomatic trigeminal neuralgia. It is trigeminal neuralgia caused by various intracranial and extracranial organic diseases. It appears similar to primary trigeminal neuralgia in facial pain episodes, but its pain level is milder, the duration of pain episodes is longer, or the pain is persistent and worsens in paroxysms.
Most often seen in middle-aged and young adults under 40 years of age, there is usually no trigger point and the triggering factors are not obvious; a few may reveal areas of trigeminal nerve damage and features of primary disease manifestations. Cerebrospinal fluid, X-ray skull base radiograph, CT or MRI examination, and nasopharyngeal biopsy are helpful for diagnosis. Sometimes the attacks of secondary trigeminal neuralgia are very similar to primary trigeminal neuralgia and can be easily misdiagnosed if subtle early manifestations of secondary lesions are not noted. There are many diseases that cause facial pain, both extracranial and intracranial, vascular and neurological diseases can cause facial pain. Traditional treatment methods
Acupuncture, local injection, and surgery, but these three are injurious treatments, which can leave serious sequelae and complications if not treated properly, and acupuncture treatment is not effective for the chronic period of more than three months.
Trigeminal neuralgia examination and laboratory tests
Necessary selective tests.
1, blood routine, blood electrolytes Generally no specific changes, blood picture may be slightly high at the onset.
2. Blood glucose, immunological items, cerebrospinal fluid examination If abnormal, it has differential diagnostic significance.
Imaging examinations Angiography, CT and MRI: some patients can find malformed vessels at the skull base. The following tests have differential diagnostic significance if they are abnormal. 1.Electroencephalogram, fundus examination. 2.Cranial base radiography. 3.Chest X-ray, electrocardiogram.
Western medicine treatment
1.Carbamazepine (carbamazepine) Start twice a day, later 3 times a day. 0.2~0.6g per day, divided into 2~3 times, the extreme amount is 1.2g per day. 24h~48h after taking the drug, there is analgesic effect.
2, phenytoin sodium (sodium phenytoin) alias Darentin (D1antinSodium, Phen-toin), a white powder, odorless, taste slightly bitter. Easily soluble in water, almost insoluble in ether or chloroform, easily deliquescent in air.
Chinese medicine treatment According to Huangdi Neijing, a classical Chinese medical text, trigeminal neuralgia belongs to the category of “headache”, “migraine”, “facial pain”, etc., and in ancient medical books there are The ancient medical books have recorded the names of “first wind”, “brain wind” and “head wind”, such as “Suwen*Wind Theory”: “The symptoms of first wind, head and face sweating and evil wind, when the first wind A day is very sick.” Because the top of the upside down, only the wind can be that, external wind and cold evil, looking for the warp on the top of the upside down clear orifices cause this disease, mental factors can also trigger this disease. The head is the meeting of all the yang, the essence of qi and blood of the five viscera and six bowels are all gathered in the head, all the evil qi, wind, fire, phlegm, dampness, blood in the meridians, phlegm blocking blood stagnation, qi stagnation, blood clotting, blocking the meridians, resulting in “pain if not pass”.
Acupuncture treatment
1.General acupuncture therapy Acupuncture treatment is clinically convenient, safe and quick, with few side effects. Main acupoints: Fengchi, Cataract, Shimonoseki, Hand Sanli, Hegu. Supporting points: Sun, Yangbai, Laozhu, and Touwei for the 1st branch pain. For the 2nd and 3rd branch pain, add Sun, Sibai, Shimonoseki, Aural Hui, Dicang, Chengjue, Yingxiang. Perform the heavy stimulation method and keep the needles in place.
2.Acupuncture of the peripheral branches of the trigeminal nerve Acupuncture of the supraorbital foramen, infraorbital foramen, posterior superior alveolar foramen and chin foramen, direct acupuncture of the peripheral branches of the trigeminal nerve, waiting for pain and numbness in the distribution area of the ipsilateral branches, and obtaining rapid analgesic effect. The needling technique held is a strong stimulation by lifting and twisting, regardless of yin and yang, the patient is in the prone position, the technique should be light, so as not to cause dizziness, or fear.
3, the use of bee acupuncture therapy: bee sting needles contain bee needle liquid, the nervous system has a significant effect. Combined with the principles of acupuncture acupuncture treatment, often receive good results.
Trigeminal nerve peripheral branch closure therapy Trigeminal nerve peripheral branch closure is a common method of clinical treatment of trigeminal neuralgia. The injection sites are mainly the bony holes through which the trigeminal nerve branches pass, such as the supraorbital hole, infraorbital hole, inferior alveolar hole, chin hole, pterygopalatine hole and so on. The drugs used include anhydrous ethanol, phenol solution, doxorubicin, streptomycin, etc. The range of pain relief with trigeminal peripheral branch closure treatment is limited, and its effectiveness is also closely related to the operator’s skill level and the extent of the patient’s condition; therefore, most patients relapse within six months to two years.
The peri-trigeminal nerve branch block is divided into: supraorbital nerve block, infraorbital nerve block, posterior superior alveolar nerve block, maxillary nerve block, chin nerve block, inferior alveolar nerve block and mandibular nerve block according to the injection site.
The treatment of trigeminal neuralgia with semilunar ganglion block is now widely used in China and abroad. This injection therapy has been proven to be effective for many years and it can indeed cure trigeminal neuralgia permanently. However, because the injection technique is difficult to master, mainly because the accuracy of the puncture operation is difficult to grasp, the treatment effect varies greatly with each person’s technique. The semilunar ganglion in the cranial cavity is punctured through the oval hole, and nerve-destroying drugs such as glycerin, anhydrous ethanol, phenol solution, doxorubicin, and adriamycin are injected to block the 2nd, 3rd, or even all three branches of the trigeminal nerve, and a prolonged blocking effect can be obtained. It is used for the treatment of intractable trigeminal neuralgia, maxillofacial cancer pain and postherpetic pain. Treatment indications
1.This injection therapy is suitable for all patients with more severe and stubborn trigeminal neuralgia, especially the old, weak and chronically ill patients with contraindications to open surgery. 2.Trigeminal neuralgia involving both branches 2 and 3, 1 and 2 or all 3 branches, and the block by each peripheral branch is ineffective. 3.Stubborn trigeminal neuralgia after facial herpes zoster.
Some of the complications that may be caused by hemianopia block are mostly due to damage to nearby blood vessels, cerebral nerves and tissues caused by inappropriate direction of puncture (freehand puncture without instrument positioning) or too deep needle entry, or damage caused by a large dose of ethanol and flowing into the subarachnoid space. The incidence of complications is very low. Most of the complications of the semilunar ganglion block can be avoided with effort.
The main complications are: loss or abnormal sensation within the block; vertigo syndrome; difficulty in mastication; cerebral nerve damage;. Ipsilateral keratitis, corneal ulcers, etc. The relationship between injection therapy and craniotomy is complementary to each other.
Radiofrequency thermal coagulation therapy: Radiofrequency thermal coagulation therapy uses high temperature to act on the ganglia, nerve trunk and nerve roots to coagulate and denature their proteins, thus blocking the conduction of nerve impulses. At present, radiofrequency thermal coagulation therapy is more widely used in the clinic, and the therapeutic effect of thermal coagulation is good, because it is easy to operate and can be repeatedly implemented to finally achieve the purpose of analgesia.
Adverse reactions and complications Pain during operation This method needs to obtain the cooperation of the patient. Before treatment, it should be clearly explained that such treatment under local anesthesia is painful, and the patient’s understanding and cooperation must be obtained, and attention should be paid to slow heating from 60°C to reduce the pain caused by sudden high temperature.
Intracranial hemorrhage: The medial aspect of the semilunar ganglion is adjacent to the cavernous sinus and the internal carotid artery, so inadvertent puncture or entering the foramen ovale too deeply can easily damage and bleed, and in serious cases, intracranial hematoma can be formed. (Instrument location puncture can be completely avoided)
Cerebral nerve damage: e.g. mild facial palsy, etc.
Intracranial infection: Strict aseptic operation can prevent secondary intracranial infection. Special attention is needed to prevent the introduction of oral bacteria into the skull by puncturing the buccal mucosa during repeated punctures.
Herpes zoster: It may appear in the affected area several days after the procedure, and the mechanism is not clear. Local application of nail violet or cortisone ointment may heal in a few days.
Keratitis: One of the more serious complications of hemispheric ganglion thermocoagulation is the loss of corneal reflexes, which can cause paralytic keratitis in severe cases and eventually lead to blindness. It is important to control the heating temperature and time during the operation and to check the change of corneal reflex at any time. In cases where loss of corneal reflex has occurred, patients should be instructed to wear glasses and use eye ointment to protect the cornea and prevent keratitis. In some cases, it takes several months for the corneal reflex to gradually return after it has disappeared.
Facial sensory disturbance: Most patients may have varying degrees of facial sensory disturbance after treatment. In the 315 cases summarized by Menzel, approximately 93.1% of patients had varying degrees of numbness or burning sensation in the face after treatment.
Therefore, before treatment, patients and their families have the right to inform the treating physician about the possible side effects of the treatment.
Advantages of radiofrequency thermocoagulation
1. the procedure is less dangerous, and serious complications rarely occur.
2, the degree of injury can be better monitored by available thermocouple electrodes, and the size of the injury can be effectively controlled
3, electrical stimulation localization and electrical impedance monitoring can be performed.
4, most radiofrequency thermocoagulation procedures can be performed under local anesthesia.
5. When applied correctly, its complication rate is very low.
6. the treatment can be repeated when needed.
7. Compared with microvascular decompression surgery, the operation is relatively easy and the pain relief is good. It can eliminate pain and preserve tactile sensation for the most part.
8. It is less invasive and patients do not need to be hospitalized.
Patients suitable for CT-guided radiofrequency thermal coagulation destruction of trigeminal neuralgia.
1. elderly and frail patients with trigeminal neuralgia who are not suitable for microvascular decompression treatment.
2, patients with recurrence after microvascular decompression.
3, Patients who have been taking higher doses of carbamazepine or/and phenytoin sodium for a long time.
4, patients who do not wish to be treated with microvascular decompression
5, younger patients in good general condition who can be treated with microvascular decompression of the trigeminal nerve root
6, patients with recurrence after controlled coagulation therapy: coagulation therapy may be performed again
7.Patients with recurrence after microvascular decompression therapy: controlled thermal coagulation can be used.
Contraindications to CT-guided radiofrequency thermal coagulation destruction of trigeminal neuralgia.
1, uncooperative people, including those with mental disorders.
2. Those with infected lesions in the skin and deep tissues of the puncture site.
3.Persons with bleeding tendency or those who are undergoing anticoagulation therapy.
4.Persons who are allergic to local anesthetics.
5.Patients with hypovolemia.
6.Severe cardiovascular and cerebrovascular diseases in the unstable stage. Peripheral nerve avulsion
Some experts believe that the arteries feeding the trigeminal nerve become sclerotic and ischemic, resulting in degeneration of nerve fibers due to disturbance of nutrient metabolism. The compression of the blood supply by the proliferation of the peripheral nerve tissue at the distal end of the nerve further reduces the blood supply and aggravates the degeneration of the nerve, leading to the demyelination of the nerve fibers and the phenomenon of “short-circuiting and crosstalk”. For this reason, peripheral nerve avulsion surgery has emerged in clinical practice. When performing this surgery, as much of the nerve should be avulsed proximally as possible to prevent recurrence of trigeminal neuralgia after surgery. This method is not used much because it is stretched and ineffective in the treatment of multi-branch pain or deep pain trigeminal neuralgia.
Balloon compression of the semilunar ganglion Balloon compression is a technique that has been used internationally for the treatment of trigeminal neuralgia since the 1980s. The patient is under general anesthesia, tracheal intubation and controlled breathing. The duration of anesthesia varies from 20 to 160 minutes, depending on the proficiency of the puncture operator. Therefore, it is required that the anesthesia be terminated at any time and the patient be awake as soon as possible. Semilunar ganglion puncture is performed under an x-ray screen. A 14-gauge puncture needle with a needle core is punctured through the facial skin. The puncture needle is stopped at the foramen ovale and the core is withdrawn, and the Fogarty balloon is placed into the semilunar ganglion via the puncture needle. The catheter connector outside the balloon was connected with a syringe and 1 to 2 ml of fluid was injected to distend the balloon to form a pear-shaped capsule of approximately 1 × 1.5 cm (as seen on the x-ray screen) and maintained for several minutes. At the end of compression the fluid is withdrawn and the distended balloon is recovered. The balloon is removed along with the puncture needle and the puncture site is compressed to stop bleeding. The entire operation is performed under an x-ray screen. The success rate of the operation is around 90%, but the recurrence after six months is effective to be treated again, and the long-term effect is to be observed. Microvascular decompression
Microvascular decompression was first proposed by Professor Jannatta in 1967, and later Haines et al. conducted a more in-depth anatomical study on the relationship between the trigeminal nerve and microvessels and found that 92.5% of the cases with trigeminal neuralgia were characterized by the presence of tiny vessels compressing the trigeminal nerve root in the pontocerebrum. The vessels that compress the nerve and produce pain are called “responsible vessels”. The common responsible vessels are: (1) the superior cerebellar artery (55%), which can form a vascular loop that extends caudally and contacts the trigeminal nerve at the brainstem, mainly compressing the superior or superior medial aspect of the nerve root. The anterior inferior cerebellar artery (30%), which generally compresses the trigeminal nerve from below, may also form a pinch compression on the trigeminal nerve together with the superior cerebellar artery. The basilar artery, with age and hemodynamic effects, may bend to both sides and compress the trigeminal nerve root, generally to the side of the thinner vertebral artery. Other rare responsible vessels include the posterior inferior cerebellar artery, variant vessels (such as the permanent trigeminal artery), the transverse cerebral pontine vein, the lateral veins, and the basilar plexus. The responsible vessel can be one or multiple, and can be either an artery or a vein.
Under general anesthesia, a 4-cm longitudinal incision is made behind the affected ear, within the hairline, and a cranial opening of approximately 2 cm in diameter is made to access the pontocerebellar angle under the microscope. Once the responsible vessels are isolated, the source of irritation disappears, and the hyperexcitability of the trigeminal nucleus disappears and returns to normal. The vast majority of patients experience immediate postoperative pain disappearance and retain normal facial sensation and function without compromising quality of life.
Microvascular decompression is the only treatment that targets the cause of trigeminal neuralgia and preserves the anatomical integrity of the trigeminal nerve, so that normal neurological function of the trigeminal nerve can be preserved. In some patients, it can also eliminate the hypertensive state caused by vascular compression of the brainstem and achieve a radical cure for hypertension. Because microvascular decompression has the advantages of obvious pain relief, non-destructive, few side injuries, and very low recurrence rate, it is currently the safest and most effective method internationally recognized for the treatment of trigeminal neuralgia.
Except for patients who cannot tolerate surgery, all other patients with trigeminal neuralgia are suitable for microvascular decompression surgery. The most common surgical complications include hearing loss and facial hyperalgesia, but with the improvement of microsurgical techniques, the incidence of these complications is very low in large neurosurgical medical institutions, and except for hearing loss (incidence of about 1%) which is more difficult to recover, most of the symptoms of cranial nerve injury are mild and mostly The symptoms of most cranial nerve injuries are mild and can be gradually recovered.
In recent years, neuroendoscopy has also been applied to microvascular decompression, which observes the anatomical structures more clearly and helps to discover the responsible vessels ventral to the trigeminal nerve, reducing the strain and damage to adjacent structures such as cranial nerves, brainstem, cerebellum, and blood vessels. More superiorly, endoscopy can observe the relationship between the nerve and surrounding vessels and even the arachnoid and cerebellar curtain in all directions, so as to determine the compression factors and not miss the responsible vessels, especially angled endoscopy is clearer, which will further improve the cure rate and reduce complications. However, it is worth noting that the endoscopic observation method is different from the traditional direct vision observation, the depth perception is relatively slightly poor, and the tip of the endoscope enters the deep area, especially the angled endoscope, which is likely to cause damage to the peripheral nerves and blood vessels. In conclusion, the application of endoscopy in microvascular decompression surgery can overcome the shortcomings of direct microscopic view, avoid missing the responsible vessels, and determine the decompression effect, which can be used as an adjunct to microvascular decompression surgery, but it still needs to be operated carefully intraoperatively to avoid side injuries.
At present, microvascular decompression is the most popular and widely used treatment for trigeminal neuralgia at home and abroad, because it is the only treatment for trigeminal neuralgia that targets the “cause”. Compared with other treatments, its biggest advantage is that on the basis of long-term effective pain relief, it can preserve the normal sensation of the patient’s face, change the numbness and discomfort of the face after the previous treatment, improve the quality of life of the patient, and make the majority of patients willing to accept the treatment.
Gamma knife treatment Gamma knife has been introduced for more than 30 years and has become the most important tool in the field of stereotactic radiosurgery. The principle of gamma knife analgesia is to focus gamma rays on pre-selected nerve clusters or nociceptive conduction pathways in the brain related to pain, a large dose of radiation to destroy the nociceptive conduction pathways, blocking the conduction of nociception to achieve the analgesic effect. Gamma knife treatment of trigeminal neuralgia has also achieved certain efficacy.
Gamma knife treatment is to calculate the three-dimensional coordinates of the trigeminal nerve root through imaging positioning, and then focus the gamma rays on the target point, the treatment physician can block the nociceptive conduction through the control of the dose size. The treatment process is simple, less painful and easily accepted by patients. However, the cost of one treatment is about 20,000 yuan. The overall efficiency of the treatment of trigeminal neuralgia is more than 90%, of which the one-time cure of trigeminal neuralgia (complete pain relief rate) is about 60%, partial relief rate (pain relief and reduced frequency of attacks) is about 30%, and the recurrence rate and invalidation rate is about 1 or 2%. Moreover, Gamma Knife treatment for trigeminal neuralgia is not physically demanding for patients, especially for elderly patients and patients with systemic diseases that are not suitable for surgery. Patients rarely experience facial numbness after treatment, and if there is a numbing effect, it will disappear after a period of time.
According to current experience, the conditions suitable for Gamma Knife treatment are.
①Primary trigeminal neuralgia and persistent post-herpetic trigeminal neuralgia where other treatments have failed
② Diagnosed as secondary trigeminal neuralgia, there are smaller tumors or vascular malformations in the cranium by imaging, and the primary lesion can be treated with Gamma Knife. The pain will usually be relieved with the improvement of the primary lesion. Targeted therapy techniques
Targeted therapy refers to a type of targeted drug delivery system that enables targeted selection and concentration of drugs in target organs, target tissues and target cells with high efficacy and low toxic side effects, which is called the fourth generation of drug dosage form. The biggest difference with traditional therapy lies in the targeted treatment of focal cells, without harming healthy cells, so targeted therapy is also called “biological missile”. Targeted therapy is the representative of the fourth generation of drug formulations, and is also the trend and direction of disease treatment in the 21st century.
Targeted agents initially meant anti-cancer agents in a narrow sense, but with the gradual deepening of research, the application field has been broadened, and there are breakthroughs in drug delivery routes, target specificity and persistence, etc. At present, targeted therapy technology has been successfully applied to the treatment of trigeminal neuralgia, through the skin drug delivery system, through the external application of the solar plexus, drug molecules enter the nerve channel through the solar plexus (trigeminal nerve meniscus) and act on It can regulate the cerebral blood vessels in both directions, unblock the nerve microcirculation, smooth the blood supply to the face, eliminate the spasm of blood vessels and nerves, relieve the severe pain of trigeminal nerve, target the nerve myelin sheath, accelerate the growth of nerve myelin sheath, repair the damaged nerve outer membrane, and eliminate the short circuit of nerve so as to completely cut off the root cause of recurrence of trigeminal neuralgia, such as the strong effect patch of Headache Ning.
In terms of specificity, directionality and retention of pharmacological activity, targeted therapy has high superiority and relatively low toxicity to normal cells, which is ideal for patients who are not suitable for surgery, afraid of surgery and relapse after surgery.
Prevention and daily maintenance
1, the diet should be regular, preferably choose soft, easy to chew food. Patients with pain induced by chewing should eat a liquid diet, do not eat fried things, should not eat irritating, too acidic and sweet food and hot food; diet should be nutritious, usually should eat more vitamin-rich and detoxifying food; eat more fresh fruits, vegetables and legumes, less fatty meat and more lean meat, food should be light.
2, eat gargle, talk, brush teeth, wash face action should be gentle. In order to avoid inducing plate machine point and cause trigeminal neuralgia.
3, pay attention to head and face warmth, avoid local freezing, moisture, do not use too cold, too hot water to wash the face; usually should maintain emotional stability, should not be excited, should not be fatigued and stay up late, often listen to soft music, calm mood, maintain adequate sleep.
4, keep a happy spirit, avoid mental stimulation; try to avoid touching the “trigger point”; regular living, indoor environment should be quiet, neat, fresh air. At the same time, the bedroom should not be attacked by wind and cold. Appropriate participation in sports, physical exercise, enhance physical fitness.
To be distinguished from the following diseases
1, toothache: trigeminal neuralgia is often misdiagnosed as toothache, and often the healthy teeth are removed, and even the removal of all teeth is still ineffective, so attention should be paid. The pain caused by dental disease is persistent pain, mostly confined to the gum area, localized with toothache and pathogenic lesions, X-ray and dental examination can confirm the diagnosis.
2, paranasal sinusitis: such as frontal sinusitis, maxillary sinusitis, etc., for limited persistent pain, there may be fever, nasal congestion, thick runny nose and local pressure pain, etc. 3, glaucoma: acute attack of unilateral glaucoma is misdiagnosed as trigeminal nerve branch 1 pain, glaucoma is persistent pain, does not radiate, may have vomiting, accompanied by congestion of the conjunctiva, shallow anterior chamber and increased intraocular pressure, etc.
4.Temporomandibular arthritis: pain is limited to the temporomandibular joint cavity, it is persistent, there is pressure pain at the joint site, joint movement disorder, pain is closely related to jaw movement, X-ray and specialist examination are feasible to assist the diagnosis.
5.Migraine: The pain area is beyond the range of trigeminal nerve, and there are mostly visual aura before the attack, such as blurred vision, dark spots, etc., which may be accompanied by vomiting. The pain is persistent and long, often half a day to 1-2 days.
6, trigeminal neuritis: short history, pain is persistent, trigeminal nerve distribution area sensory hypersensitivity or hypoesthesia, may be accompanied by motor impairment, in the affected trigeminal nerve branches have obvious pressure pain. The neuritis mostly develops after a cold or paranasal sinusitis, etc.
7. Cerebellar pontine horn tumor: the pain attack may be the same as trigeminal neuralgia or atypical, but mostly seen in young people under 30 years old, with hyperalgesia in the trigeminal nerve distribution area, and may gradually produce other symptoms and signs in the cerebellar pontine horn of the cerebellum. X ray, CT intracranial scan and MRI can help to confirm the diagnosis.
8.Tumor invasion of skull base: most common is nasopharyngeal carcinoma, often accompanied by epistaxis and nasal congestion, which can invade most cerebral nerves and enlarged cervical lymph nodes, and the diagnosis can be confirmed by nasopharyngeal examination, biopsy, skull base X-ray, CT and MRI.
9.Glottopharyngeal neuralgia: it is easy to be mixed with trigeminal nerve branch 3 pain, and the sites of glottopharyngeal neuralgia are different, such as soft palate, tonsils, pharyngeal tongue wall, tongue root and external auditory canal. The pain is induced by swallowing action. The pain can disappear after spraying the pharyngeal area with 1% pantocaine or cocaine, etc.
10.Trigeminal nerve hemianopsia tumor: ganglion cell tumor, chordoma, meningioma of the fossa mai, etc. There may be persistent pain, and the patient has obvious trigeminal nerve sensory and motor disorders. There may be bone destruction and other changes on skull base X-ray.
11.Facial neuralgia: Mostly seen in young people, the pain is beyond the trigeminal nerve and can extend to the back of the ear, the top of the head, the occipital neck, and even the shoulder. The pain is persistent, up to several hours, not related to the movement, not afraid to touch, can be bilateral pain, and can be heavier at night.