1. First, the distribution of etiology.
The etiology is not clear, and it is impossible to achieve targeted and effective treatment. The etiology of trigeminal neuralgia, 80-90% of the pain is caused by vascular compression damage to the trigeminal nerve, the remaining 5-10% of patients are secondary to tumors, others such as neuroinflammatory injury (viral and immune), abnormal structures stuck on the nerve (meninges, neuromembranes), multiple sclerosis, degeneration of the trigeminal nerve can also be caused.
2, then the corresponding treatment.
Vascular compression type — trigeminal nerve decompression (Microvascular decompression, MVD) to release vascular compression; tumor secondary type — tumor resection + nerve decompression; inflammatory injury type — Chinese medicine conditioning, neurotrophy, balloon compression (Percutaneous micro-balloon compression (PBC) or thermal coagulation destruction; abnormal compression type – nerve decompression.
3.Early Chinese medicine adjustment.
When a typical episode of trigeminal neuralgia first starts, the cause can be any one of them, and is the result of an imbalance in the scales of causative damage factors and self-repair resistance factors. Traditional Chinese medicine is characterized by overall personal conditioning, which can both weaken the causative damage factors and strengthen the self-repair resistance, and theoretically has the possibility of healing. In particular, the inflammatory type of trigeminal neuralgia has a chance of self-healing within the first year through TCM conditioning and neurotrophic assistance. However, all types of trigeminal neuralgia over one year basically lose the possibility of self-healing.
4.Temporary carbamate.
Carbamazepine is an effective drug for trigeminal neuralgia, but it can only stop the pain, not cure it. It is effective for more than 93% of patients. Domestically produced 100mg a piece and imported Deltamethrin 200mg a piece. However, patients who are allergic to carbamazepine cannot take it, and carbamazepine is toxic to liver, kidney and hematopoietic system, so you should go to hospital for blood test regularly every two to three months after taking it. And carbamazepine has drug resistance phenomenon, to achieve the same pain relief effect, the amount of medicine must be increased continuously with time, so the side effects of drug dizziness and sleepiness will gradually increase until it is not tolerated.
5.Radical decompression surgery.
Nerve decompression is suitable for the radical treatment of trigeminal neuralgia caused by various physical stuck pressure factors, and the biggest advantage is the root cause of the disease, preservation of nerve function and less likely to recur. The risk of complications with minimally invasive locked-hole surgery should be less than 2% under surgeons with more than 600 cases of experience with this procedure. The indications for surgery are mainly limited by the risk of general anesthesia. The total cost is $16,000 to $17,000 and the hospital stay is 8 days.
6.No re-destruction.
Patients who cannot or do not want to accept decompression can choose the nerve branch/stem/ganglion destruction procedure, specifically peripheral nerve avulsion; gamma focused cautery of nerve root; trigeminal nerve hemimelia destruction including balloon compression, radiofrequency thermal cautery, chemical agent destruction by alcohol, glycerin, etc. The advantage is the high safety compared to surgery, the disadvantage is the ease of recurrence and the legacy of permanent facial, oral and tongue numbness, chewing function impact.
Is open microvascular decompression surgery scary?
Many patients are in severe pain due to trigeminal neuralgia, glossopharyngeal neuralgia, or due to facial muscle spasm that seriously affects their daily work and life, and they are eager to cure the disease, but they are always worried and afraid when it comes to surgery, and they always think that the surgery has to open up the skull – “to make an incision in the brain “, and eventually often do not dare to accept surgical treatment, especially for patients with relatively mild symptoms. Yu Wenhua, Department of Neurosurgery, Hangzhou First People’s Hospital
In fact, this is a misconception, microvascular decompression surgery is a very mature surgical technique for the treatment of trigeminal neuralgia, glossopharyngeal neuralgia, facial spasm and other cranial nerve diseases, and has been used in clinical application for nearly 60 years, and the surgery is not operated inside the brain, but using the interstices of human tissue, in the subarachnoid space between the brain tissue and the skull, microvascular decompression is to compress the nerve root Microvascular decompression is a treatment method that separates the blood vessel (the cause of the disease) from the nerve root, relocates and fixes it at a site far away from the nerve root, and achieves complete decompression of the nerve root.
Therefore, in theory, the risk of surgery is not high for an experienced neurosurgeon. Especially in recent years, the progress of microsurgery technology, the application of minimally invasive surgical techniques and the update of surgical equipment have not only significantly improved the surgical efficacy, but also greatly reduced the surgical risk. Microvascular decompression surgery is currently the international first choice for the radical treatment of trigeminal neuralgia and facial spasm, and its biggest advantages are the treatment for the cause, high rate of complete cure and efficiency of pain, low recurrence rate, few complications, and the ability to The normal function of the nerve can be preserved after surgery.
Of course, microvascular decompression is not without any risk. The degree of risk depends on whether there are abnormalities in the development of the local anatomy, the number and thickness of the compressed vessels, and the relationship between the vessels and the nerve roots. Therefore, the greater the number of compressed vessels, the thicker the vessels, and the heavier the adhesions between the vessels and the nerve roots, especially in a few patients with anatomical variations, are the main factors that increase the risk of surgery. Therefore, detailed pre-numerical evaluation and skillful surgical technique are the keys to improve the surgical efficacy and reduce the surgical risk. Overall, this surgery is quite safe, but after all, it is an operation on the head, and the common risks of the surgery are as follows.
1. Facial numbness, which rarely occurs after this surgery, and even if it does, it is temporary and will gradually recover after surgery. If the nerve is partially cut, there will definitely be numbness after surgery, but this is a different kind of surgery.
2. Tinnitus and hearing loss: Because the auditory nerve and trigeminal nerve are close to each other, the microvessels on the auditory nerve may be stretched during surgery, and sometimes this strain may lead to hearing loss and tinnitus. More than 90% of this tinnitus and hearing loss can be recovered after surgery. Only very few have long-term complications.
3. Wound and intracranial infections, with low incidence.
4.Intracranial hemorrhage: including intracerebral hematoma and subdural hematoma, the former has many causes, and the latter may be related to the collapse of intracranial brain tissue causing small vein avulsion.
5, subcutaneous fluid: mostly caused by poorly closed dural sutures, which is generally not very relevant.
6, cerebrospinal fluid nasal leakage: there must be two conditions, one is that the patient has obvious cranial pneumatization behind the ear (well-developed mastoid air space), and the mastoid air space is opened and not closed tightly during the operation, and the second is that the dural suture is not completely closed. After the occurrence of some patients need to open the wound to re-open the mastoid air chamber.
7.Other things are fever, diplopia, etc.
8, life threatening, mainly because the patient originally had heart disease or cerebral vascular sclerosis, or intracranial and aneurysm of the large arteries, as well as the original patient has potential more serious diseases, etc., due to the surgery itself is extremely rare.
Therefore, it is important to choose a regular hospital for treatment.
Precautions after microvascular decompression surgery
1.Absolutely lie in bed for 24 hours after surgery (sitting up or standing is strictly prohibited within 24 hours, do not put pillows within 6 hours, and turn over), and the limbs should be moved frequently (to prevent venous thrombosis of the lower limbs).
2. After 24 hours, gradually shake the head of the bed higher, if dizziness and other discomfort occurs, immediately lie flat, this process is repeated until the patient sits up independently without discomfort and can move down. Yu Wenhua, Department of Neurosurgery, Hangzhou First People’s Hospital
3, 6 hours after surgery can drink water, 12 hours can eat food (no strict restrictions on the type, appropriate increase salt and fiber intake) (especially when the appetite is poor and the amount of food is small, to increase the intake of salt); bedside period less food such as fresh milk, soy products and other foods that are easy to produce gas.
4, 24 hours after surgery to cardiac monitoring, oxygen, close monitoring and observation of vital signs (heart rate, blood pressure, oxygen saturation), mostly within 48 hours after surgery can sit up after removal of catheter.
5, the night after surgery need to head CT examination to exclude early postoperative bleeding, so that timely treatment.
6.The early complication is mainly postoperative bleeding, most of which is within 24 hours after surgery, so our department routinely needs CT examination after surgery to facilitate early detection and treatment. 2-5 days after surgery, we mainly observe the function of cranial nerves such as tinnitus, hearing loss, facial nerve palsy, hoarseness, etc. 5-7 days after surgery, we should pay attention to body temperature (infection occurs), and if fever does not subside, lumbar puncture examination should be performed if necessary (decided by the doctor). (decided according to the specific situation).
7. If the fever disappears for more than 2 days after surgery and there is no other discomfort, the patient will be discharged on the 8th-9th day.
Facial muscle spasm 3-8% of postoperative patients may have delayed facial palsy (most of them appear 1~2 weeks after surgery), mostly related to viral activation, the prognosis is good, please contact our hospital (0571-87065701 ext. 21481), regular treatment according to facial palsy, most of them can return to normal within 1 month.