admin 三叉神经痛复发：微血管减压与经皮球囊压迫的比较：一项为期五年的随访研究（二）
英语晨读 ·
山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。
本次文献选自Chaves JPG, DE Oliveira TVHF, Francisco AN, Trintinalha MO, Carvalho NVP. Trigeminal neuralgia recurrence: a comparison of microvascular decompression and percutaneous balloon compression: a five years follow-up study. Arq Neuropsiquiatr. 2021 Jan;79(1):51-55.本次学习由谢珺田副主任医师主讲。
Trigeminal neuralgia can be treated pharmacologically or surgically. The most used drugs for pain control are carbamazepine, an antiepileptic, which has a level of evidence II, as well as botulinum toxin. Other medications as phenytoin, gabapentin and amitriptyline may be used additionally. When medical treatment fails, surgical options such as percutaneous procedures, stereotactic radiosurgery and microvascular decompression (MD) should be considered. Percutaneous techniques include percutaneous rhizotomy by radiofrequency, which consists on a thermal injury of the trigeminal ganglion; balloon compression, characterized by a mechanical lesion of the ganglion; and percutaneous rhizotomy with glycerol, which provokes demyelination and axonal fragmentation of pain fibers through a chemical lesion. Gamma knife surgery, a destructive procedure as well, consists on a focused beam of radiation that is aimed at the trigeminal root in the posterior fossa. MD, diversely, is an invasive procedure that allows direct visualization and treatment of the vascular conflict.
三叉神经痛可以通过药物或手术治疗。最常用的疼痛控制药物是卡马西平，一种抗癫痫药物，具有II级证据，以及肉毒杆菌毒素。其他药物如苯妥英钠、加巴喷丁和阿米替林也可以选择应用。当药物治疗无效时，可考虑选择手术，如经皮手术、立体定向放射手术和微血管减压术（MD）。经皮手术包括通过射频进行的经皮神经毁损术，其包括对三叉神经节的热凝损伤；球囊压迫术，以神经节机械损伤为特征；以及甘油经皮神经毁损术，通过化学损伤引起疼痛纤维脱髓鞘和轴突断裂。伽玛刀手术也是一种破坏性的手术，它是通过聚焦的辐射束照射后颅窝的三叉神经根。MD是一种侵入性手术，可以直接观察和治疗血管神经冲突。
Among all surgical procedures, MD is considered the most effective and the first-line surgical treatment option for these patients, because, although more invasive than others, it is considered safe as primary line of surgery, but not for subsequent interventions, due to adhesion in arachnoid and distortion of the normal anatomy of the region.
在所有外科手术中，尽管比其它手术创伤更大，MD仍被认为是这些患者最有效的一线手术治疗方案，但术中不宜做进一步的后续操作，以免引起蛛网膜粘连和该区域正常解剖结构的扭曲。
This study aimed at comparing the outcomes of two of the most used surgical techniques in the treatment of trigeminal neuralgia (percutaneous balloon compression [PBC] and MD), with focus on pain recurrence rates.
本研究旨在比较治疗三叉神经痛最常用的两种手术技术（经皮球囊压迫术[PBC]和MD）的治疗结果，重点关注疼痛复发率。
METHODS
Patient selection
This study is a retrospective analysis of 37 patients with pain recurrence after surgical treatment of trigeminal neuralgia at our institution. The data was collected through chart review of all patients who underwent MD, percutaneous balloon compression or both procedures in the last 5 years (from 2013 to 2018). All patients treated surgically were refractory to medical treatment with gabapentin, carbamazepine, amitriptyline and phenytoin, and all procedures were performed by two neurosurgeons (TO or AF) using the same technique. The type of pain was characterized as type 1 or 2. TN type 1 is characterized by attacks of intense, stabbing pain affecting the mouth, cheek, nose, and/or other areas on one side of the face, while TN type 2 is characterized by less intense pain, but a constant dull aching or burning pain. The selection criteria for PBC or MD was based in the patient choice; usually the elderly patients opted for a minimally invasive method. Recurrence was defined by an increase of pain level that required reinitiation of medication or reoperation after an initial improvement.
资料与方法
病例选择
本研究对37例三叉神经痛患者接受手术治疗后疼痛复发情况进行了回顾性分析。通过对过去5年（2013年至2018年）接受MD、经皮球囊压迫或两种手术的所有患者进行图表回顾，收集数据。所有接受手术治疗的患者均对加巴喷丁、卡马西平、阿米替林和苯妥英的药物治疗无效，所有手术均由两名神经外科医生（TO或AF）使用相同的技术进行。疼痛类型分为1型或2型。1型TN的特征是剧烈的刺痛发作，累及口腔、脸颊、鼻子和/或面部一侧的其它区域，而2型TN则表现为不太强烈的疼痛发作，但伴有持续隐痛或灼痛。PBC或MD的选择标准基于患者的选择；通常老年患者倾向于选择PBC。复发的定义是疼痛程度加重，需要重新开始用药或在经历最初好转后再次手术。
在所有外科手术中，尽管比其它手术创伤更大，MD仍被认为是这些患者最有效的一线手术治疗方案，但术中不宜做进一步的后续操作，以免引起蛛网膜粘连和该区域正常解剖结构的扭曲。
This study aimed at comparing the outcomes of two of the most used surgical techniques in the treatment of trigeminal neuralgia (percutaneous balloon compression [PBC] and MD), with focus on pain recurrence rates.
本研究旨在比较治疗三叉神经痛最常用的两种手术技术（经皮球囊压迫术[PBC]和MD）的治疗结果，重点关注疼痛复发率。
METHODS
Patient selection
This study is a retrospective analysis of 37 patients with pain recurrence after surgical treatment of trigeminal neuralgia at our institution. The data was collected through chart review of all patients who underwent MD, percutaneous balloon compression or both procedures in the last 5 years (from 2013 to 2018). All patients treated surgically were refractory to medical treatment with gabapentin, carbamazepine, amitriptyline and phenytoin, and all procedures were performed by two neurosurgeons (TO or AF) using the same technique. The type of pain was characterized as type 1 or 2. TN type 1 is characterized by attacks of intense, stabbing pain affecting the mouth, cheek, nose, and/or other areas on one side of the face, while TN type 2 is characterized by less intense pain, but a constant dull aching or burning pain. The selection criteria for PBC or MD was based in the patient choice; usually the elderly patients opted for a minimally invasive method. Recurrence was defined by an increase of pain level that required reinitiation of medication or reoperation after an initial improvement.
资料与方法
病例选择
本研究对37例三叉神经痛患者接受手术治疗后疼痛复发情况进行了回顾性分析。通过对过去5年（2013年至2018年）接受MD、经皮球囊压迫或两种手术的所有患者进行图表回顾，收集数据。所有接受手术治疗的患者均对加巴喷丁、卡马西平、阿米替林和苯妥英的药物治疗无效，所有手术均由两名神经外科医生（TO或AF）使用相同的技术进行。疼痛类型分为1型或2型。1型TN的特征是剧烈的刺痛发作，累及口腔、脸颊、鼻子和/或面部一侧的其它区域，而2型TN则表现为不太强烈的疼痛发作，但伴有持续隐痛或灼痛。PBC或MD的选择标准基于患者的选择；通常老年患者倾向于选择PBC。复发的定义是疼痛程度加重，需要重新开始用药或在经历最初好转后再次手术。
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