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三叉神經(jīng)痛和微血管減壓三叉神經(jīng)痛和微血管減壓11.DefinitionofTrigeminalNeuralgia

Trigeminalneuralgia

(TN,or

TGN),alsoknownas

prosopalgia,

suicidedisease,or

Fothergill'sdisease,

isa

neuropathic

disordercharacterizedbyepisodesofintense

painintheface,originatingfromthe

trigeminalnerve.

1.DefinitionofTrigeminalNe22.PrevalenceandIncidence2.1150,000peoplearediagnosedwithTNeveryyear（annualoccurrenceis3-5/100,000)2.2Overtheageof50(52-69).

2.3Morecommoninwomenthaninmen（F/M，1.74/1).

2.PrevalenceandIncidence2.133.EtiologyofTNTN(EtiologicPoint)IdiopathicTN(MVC80%,AT,et)SymptomaticTN(MS1.7-5%,Tumors0.8-11.6%)3.EtiologyofTNTNIdiopathicT44.PathologyofTN4.1TNisakindofnon-nociceptivepain,whichiscausedbycompressionordamagetonervesinsteadofstimulationtoalgesiroreceptor.4.2PeripheralandcentraltheoryofTN:MVC,demyelination,ectopicimpulseintrigeminalnerve,sensoryreflexepilepsy,etc.

4.PathologyofTN4.1TNisa55.ClinicalcharactersofTN5.1DermatomeofTNTheophthalmicbranch(V1)isresponsibleforsensationfromthescalp,forehead,uppereyelidandtipofthenose.Themaxillarybranch(V2)sensationcoversthelowereyelid,thesideofthenose,theupperlipandcheek,andtheupperteethandgums.Themandibularbranch(V3)isresponsibleforsensationofthelowerteethandgums,lowerlip,chin,jaw,andpartoftheear.Itisalsoresponsibleforsupplyingthemusclesinvolvedwithchewing(mastication),thosemusclesinvolvedwithchewing.5.ClinicalcharactersofTN5.65.2MajorclinicalfeaturesofTN5.2Majorclinicalfeaturesof7TN(SymptomaticViewpoint)TypicalTN(ParoxysmalPain)AtypicalTN(ParoxysmalandConstantPain)TNTypicalTNAtypicalTN85.3DiagnosticcriteriaofTN(FromHIS):5.3DiagnosticcriteriaofTN95.4DifferentDiagnosisofFacialPain5.4DifferentDiagnosisofFac10GeneralcausesoforofacialpainGeneralcausesoforofacialpa11Generalprinciplesinthemedicalmanagementoffacialpain.TCAs,tricyclicantidepressants.Generalprinciplesinthemedi126.TreatmentforTN6.1MedicalTreatment：6.1.1Carbamazapineisthegoldstandardforinitialtreatment.6.TreatmentforTN6.1Medical13三叉神經(jīng)痛和微血管減壓課件146.3OperationforTN:6.3.1Percutaneousprocedures:Radiofrequencythermal;Glycerolinjection;Microcompression;6.3OperationforTN:6.3.1Per156.3.2OpenSurgery(MVD):6.3.2.1TheoreticalBasis:6.3.2.2Preoperativeevaluation:3DMRI:3Dtimeofflight(3D-TOF),3Dconstructiveinterferenceinsteady–state(3D-CISS),fastimagingemployingsteady-stateacquisition(FIESTA).6.3.2OpenSurgery(MVD):16In3D-TOF,signalofvenousisisointensive.In3D-TOF,signalofvenousis17TheimageofnerveinFIESTAstageissuperiortoitin3D-TOFstage.TheimageofnerveinFIESTAs18三叉神經(jīng)痛和微血管減壓課件196.3.2.3Operativetechnique：6.3.2.3Operativetechnique：20三叉神經(jīng)痛和微血管減壓課件21三叉神經(jīng)痛和微血管減壓課件22三叉神經(jīng)痛和微血管減壓課件23三叉神經(jīng)痛和微血管減壓課件24三叉神經(jīng)痛和微血管減壓課件25三叉神經(jīng)痛和微血管減壓課件266.3.3Radiotherapy:6.3.3Radiotherapy:27TheEndTheEnd28三叉神經(jīng)痛和微血管減壓三叉神經(jīng)痛和微血管減壓291.DefinitionofTrigeminalNeuralgia

Trigeminalneuralgia

(TN,or

TGN),alsoknownas

prosopalgia,

suicidedisease,or

Fothergill'sdisease,

isa

neuropathic

disordercharacterizedbyepisodesofintense

painintheface,originatingfromthe

trigeminalnerve.

1.DefinitionofTrigeminalNe302.PrevalenceandIncidence2.1150,000peoplearediagnosedwithTNeveryyear（annualoccurrenceis3-5/100,000)2.2Overtheageof50(52-69).

2.3Morecommoninwomenthaninmen（F/M，1.74/1).

2.PrevalenceandIncidence2.1313.EtiologyofTNTN(EtiologicPoint)IdiopathicTN(MVC80%,AT,et)SymptomaticTN(MS1.7-5%,Tumors0.8-11.6%)3.EtiologyofTNTNIdiopathicT324.PathologyofTN4.1TNisakindofnon-nociceptivepain,whichiscausedbycompressionordamagetonervesinsteadofstimulationtoalgesiroreceptor.4.2PeripheralandcentraltheoryofTN:MVC,demyelination,ectopicimpulseintrigeminalnerve,sensoryreflexepilepsy,etc.

4.PathologyofTN4.1TNisa335.ClinicalcharactersofTN5.1DermatomeofTNTheophthalmicbranch(V1)isresponsibleforsensationfromthescalp,forehead,uppereyelidandtipofthenose.Themaxillarybranch(V2)sensationcoversthelowereyelid,thesideofthenose,theupperlipandcheek,andtheupperteethandgums.Themandibularbranch(V3)isresponsibleforsensationofthelowerteethandgums,lowerlip,chin,jaw,andpartoftheear.Itisalsoresponsibleforsupplyingthemusclesinvolvedwithchewing(mastication),thosemusclesinvolvedwithchewing.5.ClinicalcharactersofTN5.345.2MajorclinicalfeaturesofTN5.2Majorclinicalfeaturesof35TN(SymptomaticViewpoint)TypicalTN(ParoxysmalPain)AtypicalTN(ParoxysmalandConstantPain)TNTypicalTNAtypicalTN365.3DiagnosticcriteriaofTN(FromHIS):5.3DiagnosticcriteriaofTN375.4DifferentDiagnosisofFacialPain5.4DifferentDiagnosisofFac38GeneralcausesoforofacialpainGeneralcausesoforofacialpa39Generalprinciplesinthemedicalmanagementoffacialpain.TCAs,tricyclicantidepressants.Generalprinciplesinthemedi406.TreatmentforTN6.1MedicalTreatment：6.1.1Carbamazapineisthegoldstandardforinitialtreatment.6.TreatmentforTN6.1Medical41三叉神經(jīng)痛和微血管減壓課件426.3OperationforTN:6.3.1Percutaneousprocedures:Radiofrequencythermal;Glycerolinjection;Microcompression;6.3OperationforTN:6.3.1Per436.3.2OpenSurgery(MVD):6.3.2.1TheoreticalBasis:6.3.2.2Preo

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