What is trigeminal neuralgia: Trigeminal neuralgia is a paroxysmal overdrive-like stabbing pain lasting several seconds, often sensationally excited by stimulation, confined to one or more areas of the distribution of the trigeminal nerve on one side of the face, without nerve deficits. Trigeminal neuralgia rarely presents as a persistent pain.
How to differentiate trigeminal neuralgia from herpes zoster: trigeminal neuralgia is not related to herpes simplex virus infection and is characterized by a remission period of several weeks to several months. The pain of shingles is persistent. There is usually pain followed by characteristic vesicles and crusting.
What is the mechanism of trigeminal neuralgia: Most of it is due to vascular compression and a few to tumor compression in the posterior cranial recess.
How is trigeminal neuralgia treated: commonly used drugs include: carbamazepine, which provides complete or satisfactory relief in most patients. Baclofen, which is also moderately effective, may be more effective when combined with carbamazepine. However, in cases where medication is not effective, or when the side effects of medication outweigh the risks of surgery, surgery should be considered.
Two common surgical methods and indications are described below.
I. Percutaneous percutaneous radiofrequency destruction: surgical indications.
1.Patients whose medication is ineffective or who cannot tolerate the side effects of medication
2.Patients of advanced age or poor general condition who cannot tolerate craniotomy
3, combined with multiple sclerosis cases Efficacy and complications: remission rate of 98%, relapse rate of 23%, complication rate of 0.2%, mainly facial numbness, corneal ulcers, and mastication difficulties.
Second, microvascular decompression: surgical indications.
1, history of failure of drug or percutaneous puncture.
2, cases of facial numbness after surgery that cannot be treated by other methods.
3, cases with pain in the first branch of the trigeminal nerve
4, the patient’s general condition is good, no organic lesions, and can tolerate surgery
5, exclude multiple sclerosis and lesions in the pontocerebellar horn region.
Efficacy and complications: remission rate: 90%, medium-term (5 years) recurrence rate: 15%, long-term (15 years) recurrence rate: 30%, with less facial numbness.
Complications.
1, meningitis
2, deafness, dizziness
3, diplopia
4, seizures