1、TrigeminalNeuralgiaandMicrovascularDecompressionLiuZhan,Departmentofneurosurgery，2ndAffiliatedHospital11.Definition of Trigeminal Neuralgia Trigeminal neuralgia(TN,or TGN),also known as prosopalgia,suicide disease,or Fothergills disease,is a neuropathic disorder characterized by episodes of intense
2、pain in the face,originating from the trigeminal nerve.22.Prevalence and Incidence2.1 150,000 people are diagnosed with TN every year（annual occurrence is 3-5/100,000)2.2 Over the age of 50(52-69).2.3 More common in women than in men（F/M，1.74/1).33.Etiology of TNTN(Etiologic Point)Idiopathic TN(MVC
3、80%,AT,et)Symptomatic TN(MS 1.7-5%,Tumors 0.8-11.6%)44.Pathology of TN4.1 TN is a kind of non-nociceptive pain,which is caused by compression or damage to nerves instead of stimulation to algesiroreceptor.4.2 Peripheral and central theory of TN:MVC,demyelination,ectopic impulse in trigeminal nerve,s
4、ensory reflex epilepsy,etc.55.Clinical characters of TN5.1 Dermatome of TN The ophthalmic branch(V1)is responsible for sensation from the scalp,forehead,upper eyelid and tip of the nose.The maxillary branch(V2)sensation covers the lower eyelid,the side of the nose,the upper lip and cheek,and the upp
5、er teeth and gums.The mandibular branch(V3)is responsible for sensation of the lower teeth and gums,lower lip,chin,jaw,and part of the ear.It is also responsible for supplying the muscles involved with chewing(mastication),those muscles involved with chewing.65.2 Major clinical features of TN7TN(Sym
6、ptomatic Viewpoint)Typical TN(Paroxysmal Pain)Atypical TN(Paroxysmal and Constant Pain)85.3 Diagnostic criteria of TN(From HIS):95.4 Different Diagnosis of Facial Pain10General causes of orofacial pain11General principles in the medical management of facial pain.TCAs,tricyclic antidepressants.126.Tr
7、eatment for TN6.1 Medical Treatment：6.1.1 Carbamazapine is the gold standard for initial treatment.13146.3 Operation for TN:6.3.1 Percutaneous procedures:Radiofrequency thermal;Glycerol injection;Microcompression;156.3.2 Open Surgery(MVD):6.3.2.1 Theoretical Basis:6.3.2.2 Preoperative evaluation:3D
8、MRI:3D time of flight(3D-TOF),3D constructive interference in steady state(3D-CISS),fast imaging employing steady-state acquisition(FIESTA).16In 3D-TOF,signal of venous is isointensive.17The image of nerve in FIESTA stage is superior to it in 3D-TOF stage.18196.3.2.3 Operative technique：202122232425266.3.3 Radiotherapy:NoImage27The End28
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