Trigeminal neuralgia!

 One of the difficult cases. 40 years of age at the onset of the majority of trigeminal neuralgia, occurs in the elderly, women in particular more than the right side of the left side of its incidence. The disease is characterized by the trigeminal nerve distribution in the head and face area, the occurrence of convulsive, arrest, lightning-like, knife-like, burning kind, stubborn, severe intolerable pain. Talking, brushing teeth or when the wind was blowing can lead to pain, patients with trigeminal neuralgia often so afraid to wipe her face, eating, and even did not dare to swallow saliva, thus affecting the normal life and work. Some people call this pain the

Category

trigeminal neuralgia can be divided into primary (symptomatic) and secondary trigeminal neuralgia two categories, one of the more common trigeminal neuralgia.

primary trigeminal neuralgia: is the exact cause of trigeminal neuralgia can not find. May be due to hardening of the supply of blood vessels and nerve caused due to meningeal thickening may also be nerve caused by compression of bone pain caused by the narrow hole.

secondary trigeminal neuralgia: is due to tumor compression, inflammation, vascular malformations caused by trigeminal neuralgia. Different from the primary characteristics of this type of pain often has sustained, and can detect lesions of the trigeminal nerve signs adjacent structures. Etiology and clinical diagnosis



primary cause and pathogenesis of trigeminal neuralgia is not known, but most believe that the lesions in the peripheral part of the trigeminal nerve, which in the sensory root of trigeminal nerve section in half. According to microsurgery and electron microscopy, may be a small vascular malformation, deformity of bone petrous part of other factors, which cause pain attack.

clinical features: sudden onset, without warning, mostly for one side. Attack, severe pain, such as a knife, electric shock, like a few seconds to 1 - 2 minutes, often accompanied by facial muscle twitching, tearing, salivation, facial flushing, conjunctival congestion and other symptoms, as the disease worsens, the interim period Yulai shorter, more frequent attacks, after a strong pain stimulation, patients with mental disorders to stress, never forget, causing great pain.

the etiology and pathology of trigeminal neuralgia still unclear, therefore, treatment should aim at long-term analgesia. Method of analgesia is still diverse. Can be broadly divided into non-invasive and invasive treatment. Non-invasive treatments include drug therapy, Chinese medicine acupuncture, physiotherapy and head gamma knife treatment. For short duration, less pain patients. Also be used as supplementary treatment of invasive treatment. Invasive treatments, including surgical therapy, injection therapy, radiofrequency therapy, gamma knife treatment.

[Edit this section] treatment

[Edit this section] a general treatment

(a) drug therapy

1. Carbamazepine (carbamazepine) started 2 times a day, after a daily 3 times. Daily 0.2 ~ 0.6g, points 2 to 3 times daily, the daily maximum dose 1.2g. 24 ~ 48h after medication with analgesic effect.

2. Phenytoin (sodium phenytoin) alias Big Lunding (dilantin), a white powder, odorless, taste bitter. Soluble in water, almost insoluble in ether or chloroform in the air, easy to deliquescence.

(b) traditional Chinese medicine

in medicine, trigeminal neuralgia is a Old medical books in the Wind On to stop or reduce episodes of pain. Some clinicians treating trigeminal neuralgia with internal medicine, and achieved certain results. TCM Differential Treatment for the disease claims, according to different types, to give specific treatment.

famous traditional Chinese medicine on the beach Dr. Li, the original Thirty years of treatment Legend exclusive patented formula of Chinese medicine, so that more than 35,450

type attack for pathogenic wind outside, the main Zhang Zhiyi blood circulation, expelling wind pain. The anger on the inflammation model, the use of Yin and Yang, pathogenic fire extinguishing wind. susceptible patients. Since opening in 1990 in Shanghai features of trigeminal neuralgia specialist out-patient, to September 2006, a total of 35,450 patients seek treatment for trigeminal neuralgia who, in addition trigeminal neuralgia patients from Shanghai, Zhejiang, Jiangsu, Heilongjiang, Liaoning, Jilin, Inner Mongolia, Gansu, Beijing, Tianjin, Hunan, Hubei, Sichuan, Guangdong, Hainan and other parts of the country, as well as Hong Kong, Macao, Japan, the United States, Canada, Singapore and other overseas patients screen name from. The method and effect of treatment in Shanghai, Oriental medicine treatment of headache powder trick magic method. Let the majority of patients with the king of pain, say goodbye to a hundred!

to diagnosis and treatment of consumers in the yuan, and some nearly million, spent a few years, are no good effect, or no effect.

using the re-referral, with the effect of no pain, no side effects, drug use is simple and safe for patients.

to 660 cases for analysis:

1. 660 cases, 10 cases were hospitalized, the youngest 26 years old, maximum 85 years old, 72.3% aged over 51. The shortest duration of two months, the longest 34 years, an average of 6.5 years, 660 patients, some with primary hypertension, coronary heart disease, arrhythmia, hyperlipidemia, chronic bronchitis, diabetes, benign tumors,UGG boots cheap, etc. . 660 cases of patients who have been following treatment with acupuncture, closed embedding, nerve root resection, radio frequency, taking carbamazepine, large warehouses Ding, phenytoin, has been introduced craniotomy individual, but can not achieve the desired effect only alleviate the symptoms of a short-lived effect.

2. The simple drug therapy, if treatment with traditional Chinese medicine recipe, the second day, fasting or after a meal, can take one hour warm month, a course of treatment. Reduce or disable the second week of medicine carbamazepine, patients should adhere to the medication usually 1-3 treatments, some patients medication more than 3 courses.

3. therapeutic efficacy:

markedly: All the more, the pain disappeared completely, or significantly eased.

effective: pain reduced significantly reduced seizure frequency, pain duration,UGG boots clearance, pain and narrowed down.

valid: ongoing medication for 6 months, pain-free relief.

patient medication by the third week of this method, the pain began to ease, characterized by pain is reduced, reducing the number of episodes, duration, pain intensity reduced, so that the original could not bear the pain and slow down as you can endure, and gradually recovery can brush your teeth, wash your face, speech, normal eating, more importantly, can disable or reduce the use of carbamazepine.

markedly: 271 cases, markedly effective rate was 41%

effective: 330 cases, 50% efficiency

ineffective: 59 patients, 9%

inefficiency can be prompted from the statistics, San

original Chinese recipe for four decades With more than a dozen kinds of expensive medicine to cure The medical profession continue to write for a legendary life.

The disease mostly occurs in older, average age 59.3 years, and patients with physical weakness, wasting blood, blood the wind, blood deficiency and qi stagnation, hardship and disease resistance meridian. Unique Chinese rattan and other compatibility cleverly precision drew much essence of Chinese medicine on patients with trigeminal neuralgia acts as a skull base arterial compression of the trigeminal nerve, to get through the meridians. The total effective rate of 92% or more! The internationally recognized for the difficult cases is not easy. Made careful study of Practice has proved that traditional Chinese medicine for several decades a significant effect of trigeminal neuralgia, which indicated the need to improve the microcirculation of the nerve, to achieve analgesia. World-famous home and abroad, to 35 450 headache patients regain a happy and healthy life.

(c) of the acupuncture treatment

1. Ordinary acupuncture therapy in the clinical application of acupuncture easy, efficient and safe, side effects. Main points: the wind pool, Yifeng, Shimonoseki, hand three years, Hegu. Distribution Point: the first a pain plus the sun, Yang Bai, fishing bamboo, the first dimension. Article 2,3 supported pain plus the sun, four white,UGGs, Shimonoseki, hearings, to warehouse, bearing slurry, Ying Hong. Line re-stimulation, and needle retention, but also for electrical stimulation of acupuncture therapy treatment machine.

2. Acupuncture needle sticks around the trigeminal nerve supraorbital foramen, infraorbital foramen, posterior alveolar and mental foramen hole, direct needle around the trigeminal nerve branches appeared to be a branch of the distribution area of ipsilateral pain and swelling response to Ma, but were quickly analgesic effect. Held by the acupuncture technique, the Department of Plug Twist strong stimulation mention, regardless of yin and yang complement diarrhea, patients were lying on the first needle, methods should be light in order to avoid fainting, or have fear of emotions.

3. use of acupuncture bee: bee sting bee acupuncture needles contain liquid, significant effect on the nervous system. Principle of acupoints treatment with acupuncture, often received good results.

[Edit this section] II, around the branch of trigeminal nerve block therapy

branch closed around the trigeminal nerve trigeminal neuralgia is a common method of clinical treatment. The site of injection of the trigeminal nerve branch is mainly through the bone hole, such as the supraorbital foramen, infraorbital foramen, inferior alveolar holes, mental foramen, pterygopalatine hole and so on. The use of drugs, including ethanol, phenol, doxorubicin, streptomycin. Treatment of trigeminal nerve pain around the branch closed confined, the effect of the operator's skill level and degree of patient's condition closely related, therefore, most patients relapse six months to 2 years.

around the trigeminal nerve branch block according to the injection site is divided into: patients supraorbital nerve block, infraorbital nerve block technique, the alveolar nerve block after surgery, maxillary nerve block technique, mental nerve block lag, the next bad teeth and mandibular nerve block nerve block technique.

[Edit this paragraph] three and a half months ganglion block therapy

ganglion block with half the current treatment of trigeminal neuralgia have been widely used at home and abroad, over the years, the injection therapy has been shown to be effective, it does to cure trigeminal neuralgia can be permanent. However, because of injection technique difficult to master, mainly the accuracy of puncture operation is difficult to grasp, therefore, each treatment with the large discrepancy between the different technologies. Piercing through the foramen ovale within the cranial cavity half ganglia, injection of glycerol, ethanol, phenol, doxorubicin, adriamycin, nerve damage and other drugs to block the trigeminal nerve section 2,3 or even all three branch support, get a long block effect. For the treatment of refractory trigeminal neuralgia, cancer pain and maxillofacial postherpetic pain.

treatment indications 1, the injection therapy for severe and stubborn of all patients with trigeminal neuralgia, particularly in the elderly with contraindications craniotomy and chronic patients. 2, while involving the first trigeminal branch 2,3, 1,2 or all 3 sticks and surrounded by the branch block with no response. 3, stubborn facial postherpetic neuralgia.

ganglion block and a half months of complications that may arise from a number of complications, mostly due to the needle (needle-free hand positioning equipment) direction into the needle too deep denial or damage nearby blood vessels, brain and body or ethanol (the drug in our hospital safe medical use of high purity glycerin) and the inflow of large doses of subarachnoid cause damage. The incidence of complications is very low. Ganglion block and a half months through the efforts most of the complications can be avoided.

complications include: loss of sensation within the block or abnormal; vertigo syndrome; chewing difficulties; brain damage;. ipsilateral keratitis, corneal ulcers.

injection therapy and the relationship between craniotomy can complement each other. Surgical treatment of trigeminal neuralgia in recent years has been minimal. For craniotomy patients, should be first injection, all failed to successful craniotomy, or surgical treatment is not good, or relapse after surgery, injection therapy can also be received very good results.

[Edit this section] IV, radiofrequency ablation therapy

radiofrequency ablation therapy is the use of high temperature in the ganglion, neural stem and nerve roots and other parts, to denaturation of protein coagulation, thereby blocking nerve impulse conduction. At present, radiofrequency ablation therapy in clinical more extensive thermal coagulation therapy works well, but more complications, there were no deaths reported. Although the high recurrence rate, due to ease of operation, repeatable, and ultimately achieve the purpose of analgesia.

adverse reactions and complications

1, the operation of pain: This method is required to obtain patient cooperation. Before treatment should be clearly explained in the implementation of this treatment under local anesthesia has some pain, patients must obtain the understanding and cooperation, and attention began to slowly heated from 60 ℃, can reduce the pain caused by a sudden high temperature.

2, intracranial hemorrhage: a half months inside the adjacent ganglion and internal carotid artery cavernous sinus, foramen ovale puncture carelessly or too deep into the easy to damage and bleeding, severe intracranial hematoma can form. (Biopsy instrument can be totally avoided)

3, brain damage: such as facial paresis and so on.

4, intracranial infection: Strict aseptic intracranial prevent secondary infection. Special attention to prevent repeated puncture needle puncture buccal mucosa to oral bacteria into the brain.

5, herpes zoster: a few at sunrise is now suffering from post-operative area, the mechanism is unclear. Violet can be painted or local cortisone ointment, a few days to heal.

6, keratitis half ganglion thermal coagulation of a more serious complication is corneal reflex, severe cases can cause paralysis keratitis, could eventually lead to blindness. Operation should pay attention to control the heating temperature and time, and keep track of changes in corneal reflex. Corneal reflex where forfeiture has occurred, to Zhu Huanzhe glasses, protection of the cornea using the eye ointment to prevent keratitis. After the corneal reflex, some take a few months gradually restored.

7, facial sensory disturbances after the majority of patients with different degrees of facial sensory impairments. Menzel concluded in 315 cases, approximately 93.1% of patients after treatment with varying degrees of facial numbness or a burning sensation.

Therefore, before treatment, patients and their families have the right to Dr. Xiang Zhuzhi understand the possible side effects of treatment may be.

[Edit this paragraph] V. Peripheral nerve avulsion

Some experts believe that the artery in the dependent hardening of the trigeminal nerve, ischemia, resulting in nutritional and metabolic disorders and nerve fiber degeneration. Distal end of nerve fibers around the vascular tissue of oppression to further reduce the blood supply, increase nerve degeneration, resulting in demyelination of nerve fibers occurred Therefore, the clinical emergence of a peripheral nerve avulsion for the procedure should be as much as possible avulsion of the proximal end to prevent recurrence after surgery of trigeminal neuralgia. Since the method of multi-branch trigeminal neuralgia pain or pain in the treatment of deep stretched, results are poor, so the application is small.

[Edit this section] VI, half ganglion balloon compression method

balloon compression method is international, began eight years the technology for the treatment of trigeminal neuralgia. Were treated with general anesthesia, tracheal intubation and controlled breathing. As the proficiency of the puncture operator is different from anesthesia in 20 minutes to 160 minutes. Terminated at any time requires anesthesia so the patient awake as soon as possible. Under X-ray screen half ganglion puncture. Will have a needle puncture 14 in the core needle biopsy of facial skin. Needle stopped at the oval hole, and pull the needle core, the Fogarty balloon through the needle into the half ganglion. Connected with a syringe outside the balloon catheter connector into the 1 ~ 2ml of the liquid balloon swell, forming about 1 × 1.5cm of pear-shaped capsule (X ray findings under the screen), and maintain a few minutes. After the pressure out of the liquid, swell the balloon recovery. Together with the balloon and pull out the needle, oppression puncture to stop bleeding. The operation were carried out under X-ray screen. Success rate of 90%, but relapse again after six months treatment is effective, long-term effects to be observed.

[Edit this section] VII, microvascular decompression of the trigeminal nerve root Since Dandy 1934

vascular compression was first proposed by the trigeminal nerve root can cause trigeminal neuralgia after the argument, some clinical data also indicate that vascular compression of trigeminal neuralgia trigeminal nerve is one of the reasons. Many scholars have therefore adopted neurovascular decompression for trigeminal neuralgia.

(a) of the common methods used

currently undergoing craniotomy for treatment of trigeminal neuralgia are: The middle cranial fossa trigeminal rhizotomy, spinal trigeminal rhizotomy, trigeminal nerve root posterior fossa decompression surgery and microvascular decompression of trigeminal nerve surgery.

(b) of the operative techniques

routine disinfection, the use of 2% lidocaine for infiltration within the ear tag line after the anesthesia or general anesthesia. Along the tag line for the incision, with the skull drilled close to the posterior margin of the sigmoid sinus and drill a large diameter of about 2cm bone window (the bone debris collected standby). The cerebellum under the operating microscope to gently pull back the top open, with 2 ~ 3mm micro broadband suction tube into the brain plate of the trigeminal nerve root which, since the nerve at the pons to the remote exploration and other lesions of vascular compression situation. Sandwiched between the nerve and blood vessel put a piece of autologous small muscles. Will be subject to vascular compression of the nerves and blood vessels surrounding them separated. Zhu Huanzhe his hand hit the trigger at this time point and usually easy to induce pain to do certain actions, if not the purpose of pain relief is achieved. Sutured wound closure.

(c) the effect of surgical factors subjective satisfaction row

microvascular decompression in the treatment of trigeminal neuralgia, although the long-term efficacy of the reports varies, but can still be applied as a viable method . More emphasis on long-term outcome follow-up the past, objective factors, lack of understanding of the effect of treatment in patients with subjective satisfaction, which determine the overall effect of microvascular decompression of trigeminal nerve is also important. Yingxiang subjective satisfaction factors include:

1, trigeminal neuralgia is a tremendous pain to the patient and the therapy is no ideal method and effect of a disease. Thus follow-up found that while post-operative pain in patients with an objective is not completely disappear, leaving mild pain or pain recurrence, but the pain was mild, but also changed the pain before the operation can not be controlled by medication status, or complications associated with mild who were still on the subjective effects of the operation are satisfied. The inconsistency of this objective and subjective, patient self that compared preoperative and postoperative pain unbearable situation, draw the correct choice is understandable, it also uses microvascular decompression for trigeminal neuralgia confidence. Follow-up showed that patients with higher satisfaction, this procedure is still regarded as a better method of treating trigeminal neuralgia.

2, early cure rate after surgery is not reliable. Follow-up found no relief of pain after surgery or complete remission most of the dissatisfied. These patients were carried out early microvascular decompression of cases. In recent years the emphasis on the involved vessels identification, especially those of small unnamed artery and the trigeminal nerve in the brainstem at the phase cross or come into contact, or multiple Qinfan arterial vascular ring concealed the existence or situation, cutting cautery cava also completely cut by thickened arachnoid around the nerve, the trigeminal nerve root by straight method, satisfactory results are obtained.

3, in the microvascular decompression surgery, although pain relief, if you are still left with facial sensory impairment or hearing impairment and other complications, the patient is not satisfied. Line not only for microvascular decompression for pain relief, but also must pay attention to preserve the neurological function, which is different from other surgical methods of trigeminal neuralgia an important point.

[Edit this section] VIII, gamma knife treatment of trigeminal neuralgia

knife come out 30 years ago, has become the field of stereotactic radiosurgery for the most important means. Principles of analgesic Gamma Knife gamma rays is to focus on pre-selected and pain-related brain nuclei or the pain transmission pathway, a large dose of radiation damage of pain pathways, blocking the transmission of pain to achieve analgesia effect. Application of Gamma Knife treatment of trigeminal neuralgia has achieved a certain effect.

first by application of gamma knife treatment is the imaging position, calculate the three-dimensional coordinates of the trigeminal nerve root, and then focus on convergence in the target gamma-ray treatment of physicians by the size of the dose control, resistance breaking the transmission of pain. Treatment is simple, little pain, easy to accept. But once the treatment cost of about 2 million. Head gamma knife treatment of trigeminal neuralgia overall efficiency of 90% or more, including a one-time cure for trigeminal neuralgia (pain in the complete response rate) in 60%, partial response rate (pain relief, seizure frequency reduction) in 30% , the recurrence rate and inefficiency in 1,2% or so. Gamma Knife treatment of trigeminal neuralgia and less demanding on the patient's body, especially for elderly patients as well as systemic diseases is not suitable for surgery. Rarely in the treatment of patients with facial numbness after feeling numbness if the effect will disappear after a period of time.

Based on current experience, Gamma Knife treatment for conditions:

① and primary trigeminal neuralgia refractory to other treatment ineffective
postherpetic neuralgia
② diagnosis of secondary trigeminal neuralgia, the imaging of intracranial tumor or a small vascular malformation, gamma knife treatment can be applied to their primary lesions. General improvement with the primary lesion, the pain will ease.

[Edit this section] preventing

1, eat regularly, should choose soft, easy to chew food, pain induced by chewing of patients will have to eat liquid food, must not eat the fry,cheap UGG boots, spicy food, seafood products, and heat food, etc.; diet rich in nutrition, usually should eat vitamin-rich and have a clear fire detoxification of food; eat fresh fruits, vegetables and soy category, Eat less fat and more fresh meat, the food is appropriate to light.

2, mouth to eat, talk, brush your teeth, wash your face action should be gentle, not eat spicy food, so as not to induce trigeminal neuralgia caused by trigger point.

3, pay attention to head and face warm and avoid local cold, damp, not too cold, too hot washing face; shall be maintained in emotional stability, not excitement, often heard soft music, the mood is calm, keep adequate sleep.

4, to maintain a happy, avoid mental stimulation; try to avoid touching the Appropriate to participate in sports, exercise, enhance physical fitness.