三叉神经痛的临床治疗进展

三叉神经痛是一种常见的面部疼痛性疾病,目前对其病因的认识并不明确。普遍认为压迫可导致三叉神经痛,致病原因包括血管因素和非血管因素,其次创伤也可导致三叉神经痛,常见于口腔外科手术后。三叉神经痛的治疗方法较多,首选药物治疗,包括全身用药和局部用药,药物治疗初期效果明显,但很难治愈三叉神经痛,而且需要长期服药,副作用较大,当药物治疗无效或者患者难以耐受其副作用时,可采用外科疗法进行辅助治疗。三叉神经痛的外科疗法主要包括无创的微血管减压术及有创的射频热凝术、球囊压迫术和甘油毁损术。近年来采用放射外科对三叉神经痛进行治疗,取得了确切效果。此外,还有一些关于其他治疗方法的文献报道,均有一定效果。本文对三叉神经痛病因的认识及临床治疗进展作一回顾性综述。     

咀嚼肌痉挛

咀嚼肌痉挛是一种临床罕见疾病,表现为单侧嚼肌突发阵发性、不自主地抽搐发作。伴或不伴有单侧面萎缩或局部硬皮病,其发病机制至今尚不明确,国内外报道极少,目前为止,仅26例具有肌电图支持的病例报道。文章复习了相关文献,对其病因、发病机制、诊断原则、治疗方法等作了系统综述。     

咀嚼肌痉挛

咀嚼肌痉挛是一种临床罕见疾病,表现为单侧嚼肌突发阵发性、不自主地抽搐发作。伴或不伴有单侧面萎缩或局部硬皮病,其发病机制至今尚不明确,国内外报道极少,目前为止,仅26例具有肌电图支持的病例报道。文章复习了相关文献,对其病因、发病机制、诊断原则、治疗方法等作了系统综述。     

成年兄妹全身多毛症观察

毛人,又称先天性全身性多毛症,是少见的与遗传有关的综合征。以往文献报道以散发个例为多,家族累代发病者极少。1980年11月初,笔者在广东省英德县和清远县交界的两个毗邻公社发现一对成年毛人兄妹,并对其家族及其亲属进行了初步调查,共3代,32人。发现在同一家族中,二代共5例患者。其中妹     

精神分裂症遗传因素与遗传方式的探讨

木文对200例精神分裂症患者的遗传因素与遗传方式作了研究。分析了索引病例的家族遗传史、 家族成员的精神疾患分类、各级亲族的患病率及各种环境因素的作用。认为遗传因素在精神分裂症IyIJ 病因中具有重要意义,而环境因素对精神分裂症的发病亦起着不可忽视的作用。同时,通过统计分析, 指出精神分裂症的遗传方式为多基因遗传,其加权平均遗传率为60.46%.     

对称性肢端角化病临床研究-附9例报道

目的:报道一组以肢端出现对称性、棕褐色、角化过度性斑片病例,探讨发病原因和治疗方法。方法:系统收集自2012年10月至2016年6月期间诊疗的以对称性肢端角化性皮损为表现的9例患者的临床资料,包括年龄、性别、职业、家族成员情况、临床表现、皮损组织病理学改变、治疗、治疗转归等。结果:9例患者中男8例,女1例,平均年龄27.4岁(13~43岁),病程2个月至15年,平均(4.5±4.3)年。有1例男性患者有一同胞姐姐有类似病史。临床主要表现为红褐色角化性斑片,每年7、8月开始发病,10月左右开始缓解并渐完全消退。部分手部有轻度瘙痒不适。皮肤组织病理学检查表现为明显的网篮状角化过度,轻度乳头瘤样增生,真皮浅层血管周围稀疏淋巴细胞浸润。1例用异维A酸治疗短期有效。结论:对称性肢端角化病主要以肢端出现对称性角化斑为主,常伴随寻常型鱼鳞病;遗传因素和环境因素在发病中的作用有待阐述;异维A酸可作为一种治疗选择。     

降钙素基因相关肽与偏头痛关系的研究

偏头痛是临床上常见的多发性疾病,主要表现为一侧或双侧头部反复发作的搏动性疼痛,可伴有恶心、呕吐、视物异常等神经症状。关于偏头痛的发病机制研究尚无定论。偏头痛的发病机理一直受到人们的关注,近年来一些研究表明,偏头痛的发作与头颅血管周围组织产生的血管活性物质,特别是与三叉神经血管系统的降钙素基因相关肽(calcitonin gene-relatedpeptide,CGRP)的含量变化关系密切。     

家族性不宁腿综合征候选基因的连锁分析

不宁腿综合征（restless legs syndrome,RLS)是以下肢部出现蚁行样及酸、麻、胀等不适感而使肢体不得休息为特征的一组病症。由于症状常在晚间发作并导致运动不安,患者长期入睡困难,经受严重的继发性失眠。作为一种常见的神经系统疾病,RLS发病率高达5％,其中原发性RLS多呈阳性家族史,表现为单基因决定的常染色体显性遗传。现在,人们普遍认为RLS的发生很可能与神经系统内多巴胺能功能异常和脑内铁缺乏有关,并初步建立了脑铁－多巴胺能系统的致病模型。为了探求脑铁－多巴胺能系统在RLS中的作用,选择了与脑铁－多巴胺能系统相关的16个疾病侯选基因,在每个候选基因附近染色体区域内选取若干个微卫星多态标记,应用微卫星引物荧光标记－基因扫描技术,对一个汉族家族性不宁腿综合征家系进行了基因分型和常染色体显性遗传模式下的连锁分析,试图从分子遗传学层面上确认或排除一些可能与RLS相关的重要侯选基因。结果显示,当重组系数θ=0.00时,LOD值均小于－2.00,所选位点与家族性不宁腿综合征不连锁。由此得出结论,在本家系中,所有候选基因均与家族性不宁腿综合征的发病无关,家族性不宁腿综合征可能是由其他多巴胺传导和脑铁代谢相关基因所致,或是存在全新的致病机制参与RLS的发生。     

血管迷走性晕厥的治疗进展

血管迷走性晕厥(Vasovagal syncope,VVS)是一种常见的反射性晕厥。其病理生理学机制非常复杂,病因仍存在争议,可能涉及到的原因是多方面的。目前所采用的治疗方法较多,疗效不一,而血管迷走性晕厥所带来的二次伤害及心理变化直接影响患者的生活质量,造成病情的迁延反复。对于血管迷走性晕厥防治重点应是避免诱发,此外还可进行非药物治疗、药物治疗及起搏器治疗,这些治疗方案可降低患者发作频率,提高其生活质量。本文对血管迷走性晕厥的研究进展作简要综述。     

血管生成素样蛋白3表达调控及生物学功能

血管生成素样蛋白3（angiopoietin-like protein3,ANGPTL3）是血管生成素和血管生成素样蛋白家族成员,主要表达于肝脏。其具有调节脂质代谢和促进血管生成的作用,其中尤以调节脂质代谢的作用显著。探讨ANGPTL3表达调控及功能的分子机制,对于了解代谢性疾病发病机制及寻找新的治疗途径有积极意义。     

微球囊压迫介入治疗三叉神经痛

目的：三叉神经痛是口腔科常见疾病之一,病因不清。令患者难于忍受。多年来人们探索出很多的治疗手段,这些方法均不同程度伴有疗效、副损伤及并发症上的各种缺点。经研究经介入方法利用微球囊能改变了三叉神经半月节的解剖位置从而缓解其周围压力,进而治疗了三叉神经痛且疗效很好。结论：微球囊加压介入治疗三叉神经痛是目前有效治疗三叉神经痛的方法。     

Effectiveness of radiofrequency thermocoagulation in recurrent trigeminal neuralgia after previous retrogasserian rhizotomy

Between 1974 and 1984, 428 trigeminal neuralgia cases were treated by controlled radiofrequency thermocoagulation (RFTC). 29 had recurrent trigeminal neuralgia after intracranial surgery. 26 of the 29 patients were treated by retrogasserian rhizotomy and 3 by posterior fossa exploration. Among the 26 recurrent trigeminal neuralgia following retrogasserian rhizotomy, RFTC was effective in 23 cases (88.5%), and in 3 cases (11.5%) RFTC was effective for a short period. Repeated RFTC was unable to control the pain attacks which were later relieved by posterior fossa exploration and root section. Of the 3 recurrent trigeminal neuralgia following posterior fossa exploration, RFTC was effective in 2 cases (66.6%).     

Microcirculatory changes in experimental trigeminal neuralgia in rats

Biomicroscopic studies of mesentery in trigeminal neuralgia rats caused by creation of a generator of pathologically enhanced excitation in trigeminal nerve caudal nucleus (injection 0.25-1.0 DLM Tetanus toxin) have shown the microcirculatory disorders, venular permeability, mast cells degranulation, and an increase in lymphatic contractile activity. Microcirculatory disorders intensity and adaptation reaction appearance correlated with trigeminal neuralgia clinical picture.     

原发性三叉神经痛和疱疹后三叉神经痛临床特征及射频热凝术后效果分析

摘要 目的：探讨原发性三叉神经痛（PTN）和疱疹后三叉神经痛（PHN）的临床特征,并比较经卵圆孔射频热凝术（RF-TC）治疗PTN和PHN的临床疗效。方法：随机选取2019年1月至2020年8月在我院治疗的三叉神经痛患者123例,其中原发性三叉神经痛90例,带状疱疹后神经痛33例。所有患者均通过RF-TC进行治疗,治疗后通过视觉模拟量表（VAS）、巴罗神经研究所疼痛强度量表对面部疼痛评分进行疼痛评估,通过巴罗神经研究所麻木评分进行麻木评定,通过健康问卷-9对患者抑郁情况进行评估,通过匹斯堡睡眠质量指数测量患者心理状态。结果：PTN患者发病年龄显著低于PHN患者（P<0.05）,而病程显著高于PHN患者（P<0.05）;PHN患者的眼支发生率高于PTN患者（39.39% vs 8.89%, P<0.05）。两组患者经RF-TC治疗前后VAS评分无显著差异（P>0.05）。PHN组从轻度到重度影响睡眠质量的比例显著高于PTN组（30.30% vs 10.00%, P<0.05）。PTN组患者治疗后中重度抑郁患者比例显著高于PHN组患者（21.11% vs 9.09%, P<0.05）。两组患者经RF-TC治疗后,临床治疗有效率、面麻木程度以及巴罗神经研究所疼痛强度量表评定的面部疼痛无显著差异（P>0.05）。结论：经卵圆孔射频热凝术治疗原发性三叉神经痛和带状疱疹后三叉神经痛是安全有效的,但治疗后疱疹后三叉神经痛失眠的发生率较高,而原发性三叉神经痛的抑郁发生率较高。     

Favorable outcome of decompression of the trigeminal nerve in a case of bilateral neuralgia

A case of the bilateral trigeminal neuralgia produced by compression of the V cranial nerve roots by the branch of the anterior lower cerebral artery and post-hemorrhagic aggregates is presented. Complete recovery was obtained in the result of 2-stage, intracranial relief of the right and left trigeminal nerve roots. Neurologists share the opinion that intracranial surgical relief of the V cranial nerve root produces favourable result in case of trigeminal neuralgia resistant to pharmacotherapy.     

Electrical stimulation of the trigeminal tract in chronic, intractable facial neuralgia

In this paper the treatment of patients with chronic, intractable trigeminal neuralgia by invasive electrical stimulation of the Gasserion ganglion is reviewed. Two different surgical techniques are employed in this treatment. Most frequently, a method similar to the traditional technique for percutaneous glycerol and radiofrequency trigeminal rhizolysis is used: a small percutaneous stimulation electrode is advanced under fluoroscopic control through a thin needle via the foramen ovale to the Gasserian cistern. Some neurosurgeons use an open surgical technique by which the Gasserian ganglion is approached subtemporally and extradurally, and the bipolar pad electrode is sutured to the dura. When percutaneous test stimulation is successful (at least 50% pain relief) the electrode is internalized and connected to a subcutaneous pulse generator or RF-receiver. Data from 8 clinical studies, including 267 patients have been reviewed. Of all 233 patients with medication-resistant atypical trigeminal neuralgia 48% had at least 50% long term pain relief. The result of test stimulation is a good predictor of the long term effect, because 83% of all patients with successful test stimulation had at least 50% long term relief, and 70% had at least 75% long term relief. Patients generally preferred this invasive method over TENS. The success rate in patients with postherpetic trigeminal neuralgia was very low (less than 10%). It is suggested that the likelihood of pain relief by electrical stimulation is inversely related to the degree of sensory loss. It is concluded that invasive stimulation of the Gasserian ganglion is a promising treatment modality for patients with chronic, intractable, atypical trigeminal neuralgia.     

Microsurgical Vascular Decompression for Trigeminal Neuralgia and Hemifacial Spasm

Vascular cross-compression of cranial nerves has been proposed as the cause of cranial neuropathies, including trigeminal neuralgia and hemifacial spasm. Over the last decade we have used microsurgical vascular decompression to treat these two disorders. Results in 50 patients treated for trigeminal neuralgia have been excellent in 42, good in 5 and poor in 2; and 1 patient was cured after a second operation. Results in 22 patients treated for hemifacial spasm have been excellent in 18, good in 2 and fair in 1. One patient died. There were no late recurrences of symptoms.The pathophysiological mechanisms of trigeminal neuralgia and hemifacial spasm remain unknown.     

A few remarks regarding 421 cases of trigeminal neuralgia]

Referring to the treatment of 421 patients with trigeminal neuralgia, the authors indicate an early alcoholization or exheyresis in case of therapeutical failure of systemic conservative treatment. Such a management prevents transformation of the peripheral into central neuralgia. Emphasis is on more frequent treatment of neuralgia by dental surgeons.     

改良微血管减压术治疗复发性三叉神经痛的疗效及安全性分析

目的:探讨改良微血管减压术(MVD)治疗复发性三叉神经痛的疗效及安全性。方法:回顾性分析2010年至2015年收治的50例复发性三叉神经痛患者,2012年前采取常规MVD手术方法(MVD组,n=22),2012年后采取改良MVD的手术方法(改良MVD组,n=28)。MVD组采用传统MVD对三叉神经根进行全程减压,即沿首次切口入路,依次切开皮下、肌筋膜,充分分离骨窗边缘的瘢痕组织,适当扩大骨窗直至硬脑膜充分暴露。切开硬膜,锐性分离蛛网膜后探查Meckel腔至神经出脑区(REZ),仔细探查三叉神经全段,分离压迫神经的责任血管以及首次手术置入的Teflon垫棉,对三叉神经进行全程减压。改良MVD组在此基础上,探查三叉神经颅内段及其周围结构,解剖三叉神经脑干延伸段,垫开小脑上动脉对三叉神经脑干延伸段的压迫。比较两组术后缓解率、并发症、复发情况。结果:改良MVD组术后缓解率为100.0%,显著高于MVD组72.7%(P0.05);两组术后并发症的发生率比较差异无统计学意义(P0.05);改良MVD组术后1年复发率为0%,显著低于MVD组22.7%(P0.05)。结论:MVD术中三叉神经根全程减压联合脑干延伸段减压治疗复发性三叉神经痛患者可有效缓解疼痛,降低术后复发风险,且不增加术后并发症。