Gamma Knife “cures” trigeminal neuralgia! What is a “radical cure”? 1, gamma knife treatment site in the trigeminal nerve root, whether the pain site is in the eye, maxilla, or mandible, gamma knife treatment site is in the root of the trigeminal nerve, are effective. 2, gamma knife treatment of trigeminal neuralgia has a long-lasting effect, the chance of recurrence is very low, and is almost lifelong effective. Trigeminal neuralgia (trigeminalneuralgia, TN) is characterized by recurrent episodes of electroshock-like transient and severe pain in the face (trigeminal nerve distribution area). The incidence is 1.8%o, 70-80% of cases occur above 40 years old, with a peak age of 50 years old, slightly more women than men, mostly unilateral, more right than left, and less than 5% bilateral. Trigeminal neuralgia can be a clinical manifestation of organic lesions such as tumors and is referred to as secondary trigeminal neuralgia. Primary trigeminal neuralgia, i.e., trigeminal neuralgia without any organic lesion. The pathogenesis of primary, or central nerve nucleus degeneration or peripheral nerve stem lesions. The clinical characteristics of primary trigeminal neuralgia: 1, insidious onset, progressive aggravation, chronic course, with spontaneous intermittent remission periods, but very few self-cured. 2. The site of pain attack is often limited to one side of the facial trigeminal nerve distribution area, mostly starting from one branch and gradually spreading to other branches. The pain of the mandibular branch (branch III) is mostly located in the lower teeth or gingiva, lower lip, ha, as well as the cheek and tongue. The pain of the ophthalmic branch (branch 1) is mainly confined to the arch of the eyebrow and forehead. 3. Nature of pain: Most of the pains are electric shock-like or knife-like or pinprick-like intense throbbing pains. During the attack, the patient often presses the affected side with palm or towel or rubs the face with force in order to reduce the stabbing pain, or keeps making chewing action during the pain attack, which is often accompanied by reflexive twitching of facial muscles in severe cases, with the corners of the mouth drawn to the – measurement, also called “painful twitching”, sometimes accompanied by facial redness, increased skin temperature Sometimes it is accompanied by facial redness, increased skin temperature, conjunctival congestion, increased tearing and salivation, nasal mucosa congestion and runny nose, and sometimes even rolling in bed. 4, pain attacks are often without warning, occurring suddenly, lasting a few seconds, or 1-2 minutes, with a long interval, such as normal people. However, with the development of the disease, the frequency of attacks increases, the degree of pain increases, and the intermittency shortens. There are also periodic attacks of pain, especially at the beginning of the disease, each attack can last for several weeks to months, and then, for unknown reasons, the pain suddenly relieves itself, and then reoccurs after an interval of several weeks, months or years. This self-remission and relapse after remission are often related to the climate, generally easy to occur in spring and autumn, and remission in winter and summer. The pain attacks are more frequent during the day and less frequent at night, but there are also cases where the pain is not sleepable due to changes in sleeping position. At the beginning of the disease, there are fewer attacks and longer intervals, and as the disease progresses, the intervals are gradually shortened. In short, recurrent and transient severe pain is the most important feature of trigeminal neuralgia. 5. Pain trigger point and triggering factors: more than 1/3 of patients are particularly sensitive in a certain area on the affected side, and every slight touch can cause a pain attack. Therefore, this sensitive area is called the “trigger point” or “trigger point”. The trigger is somewhere in the distribution of the bifurcation nerve on the side of the disease, such as the lower lip, nose, corner of the mouth, incisors, canines, root of the teeth, cheek, tongue, etc. The third branch of the trigeminal nerve induces pain attacks, mostly due to jaw movements and hot and cold water stimulation at the lower canine teeth, while direct stimulation of the skin plate trigger point induces pain attacks less often; inducing the second branch pain attacks are mostly due to stimulation of the skin trigger point. 6, complications of pain attacks, the patient generally suddenly shows dullness and keep the original posture and dare not move or frightened-like pain, or moaning, incessant inhalation, chewing, and often use the palm of the hand to press or rub the face. In severe cases, the attack is often accompanied by reflex twitching of facial muscles on the affected side, so the disease is also called “painful twitching”, and can be combined with facial flushing, lacrimation, salivation, runny nose and other autonomic symptoms. The diagnosis of primary trigeminal neuralgia is 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 definitive diagnosis of trigeminal neuralgia should have the following four characteristics: ① there is episodic pain without a pain gap; ② there are no clear positive neurological signs; ③ there is a trigger point; ④ the pain is strictly limited to the trigeminal innervation area. 2, secondary trigeminal neuralgia, the early clinical manifestations of secondary trigeminal neuralgia may be similar to primary, but not necessarily typical. In case of adolescent onset or facial pain from intermittent to continuous or persistent attacks, followed by cranial nerve dysfunction such as trigeminal nerve, cerebellar symptoms and symptoms of increased intracranial pressure, intracranial tumors, vascular malformations and other lesions should be considered as early as possible with the help of cranial CT, MRI or DSA to facilitate early diagnosis and treatment. Trigeminal neuralgia caused by brain tumor Trigeminal neuralgia treatment options: secondary trigeminal neuralgia to treat the cause of the disease, primary trigeminal neuralgia should be preferred to head gamma knife treatment. Gamma knife treatment of trigeminal neuralgia features 1, mature technology: as early as the 1950s gamma knife was used to treat trigeminal neuralgia, for gamma knife treatment methods, sites and doses, have been long-term follow-up, has accumulated a wealth of successful experience. 2, the efficacy of certainty: remission rate of 90%, cure rate of 80%, the treatment of patients who do not work can also repeat the treatment for the second time. 3, the method is simple: less pain, non-invasive, no side effects. Gamma knife will be countless beams of tiny gamma rays space focus on the trigeminal nerve root, the implementation of large doses of radiation irradiation, so that the nerve root gradually atrophy thinning, and finally make the pain disappear. Long-term experience has been accumulated to control the appropriate dose of irradiation, so that the nerve root atrophy is just right, and the pain is controlled without affecting its normal function. Today’s nuclear magnetic imaging technology can clearly show the trigeminal nerve brain pool segment, making the nerve localization simple and accurate, ensuring the efficacy of the treatment. 4, the biggest disadvantage: compared with other methods, the biggest disadvantage of gamma knife treatment of trigeminal neuralgia is the slow onset of effect. Most of them take effect 1 month after treatment, the effect may be repeated within six months, with time pushed back, the more stable the effect, and the recurrence rate is very low, can be said to be effective for life. Other treatment methods for trigeminal neuralgia: 1. Drug therapy: Applicable to those who first suffer from the disease, but the efficacy is not long-lasting, and is often abandoned due to poor efficacy and heavy toxicity. Commonly used drugs are: (1) carbamazepine, is the first choice of treatment drugs, the efficiency of 70 to 80%; (2) phenytoin sodium, easy to produce toxic symptoms; (3) carbamazepine and phenytoin sodium ineffective people can choose baclofen, clonidine. 2.Nerve block and radiofrequency thermal coagulation therapy: through the injection of drugs or radiofrequency thermal coagulation methods, the trigeminal nerve branches or ganglia are destroyed, blocking nerve conduction, and the pain relief effect is obtained. The treatment is simple and safe, but the effect is not long-lasting, and the pain is unbearable and there are numbness and other sequelae during the operation. 3.Craniotomy: called microvascular decompression, it has the risk of craniotomy and is prone to recurrence. The most complex, painful and dangerous treatments, such as craniotomy and radiofrequency thermal coagulation, are not the most effective methods!!!