超聲治療三叉神經(jīng)痛

上海交通大學(xué)附屬上海第六人民醫(yī)院麻醉科趙達強

超聲引導(dǎo)翼腭窩三叉神經(jīng)阻滯如果患者可以選擇一定會選擇超聲引導(dǎo)內(nèi)容三叉神經(jīng)痛的發(fā)病情況三叉神經(jīng)痛的治療方法超聲引導(dǎo)三叉神經(jīng)上頜支阻滯總結(jié)4123發(fā)病情況說話、吃飯、洗臉、剃須、刷牙以及風(fēng)吹等均可誘發(fā)疼痛發(fā)作，扳機點如刀割、針刺、撕裂、燒灼或電擊樣劇烈難忍的疼痛，甚至痛不欲生多發(fā)于40歲以上患者,女性多于男性多為單側(cè)發(fā)病，右多于左，以第二支、第三支發(fā)病最為常見!！!流行病學(xué)發(fā)病率0.1-0.2/1000每年新發(fā)病率12.6/100,000/year

Epidemiologyoftypicalandatypicalcraniofacialneuralgias.ManzoniGandTorelliP.NeurolSci2005;26(Suppl2):S65–S67.內(nèi)容三叉神經(jīng)痛的發(fā)病情況三叉神經(jīng)痛的治療方法超聲引導(dǎo)三叉神經(jīng)上頜支阻滯總結(jié)4123藥物治療Carbamazepine卡馬西平Baclofen巴氯芬gabapentin加巴噴丁oxcarbazepine奧卡西平lamotrigine拉莫三嗪HaridasA,MathewsonC,EljamelS.ZentralblNeurochir2008;69:170-174.Longtermresultsof405refractorytrigeminalneuralgiasurgeriesin256patients.25%patientswhopresentwithsymptomsoftrigeminalneuralgiacanberefractorytomedicaltreatment

andupto8%thesepatientscanedrugintolerant經(jīng)皮治療3

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Ballooncompression（BC）Paincontrol91%at6mand66%at3yGlycerolrhizotomy(GR)Paincontrol90%at6mand54%at3yRadiofrequencythermocoagulation(RF)

Paincontrol97%initiallyand58%at5yJasonS.Cheng,DanielA.Lim,EdwardF.NeurosurgeryPublishAheadofPrintDOI:10.1227/NEU.0000000000000168AReviewofPercutaneousTreatmentsforTrigeminalNeuralgia手術(shù)治療GammaKniferadiationVascularpressionhighinitialsuccessrate(98%),buttheratedecreasesto64%overthenext10yearsThefirstfiveminutesafteragreateroccipitalnerveblock.YoungW,CookB,MalikS,etal.Headache2008;48:1126-1128.DhopleAA,AdamsJR,MaggioWW,etal.JNeurosurg2009；111:351-358.LongtermesofGammaKniferadiosurgeryforclassictrigeminalneuralgia:Implicationsoftreatmentandcriticalreviewoftheliterature.內(nèi)容三叉神經(jīng)痛的發(fā)病情況三叉神經(jīng)痛的治療方法超聲引導(dǎo)三叉神經(jīng)上頜支阻滯總結(jié)4123病例介紹療效結(jié)論theuseofultrasoundguidanceforinjectatedeliveryinthepterygopalatinefossaisasimple,freeofradiationormagnetization,safe,andeffectivepercutaneousprocedurethatprovidessustainedpainreliefintrigeminalneuralgiaoratypicalfacialpainpatientswhohavefailedpreviousmedicalinterventions.解剖解剖超聲圖像超聲引導(dǎo)翼腭窩三叉神經(jīng)阻滯Withsensorystimulationat50Hz,thepatientreportedpainalongthebackoftheupperteethat0.7V.Motorstimulationat2Hzreproducedasimilarpainpatternat1.0V.Pulsedradiofrequencyablationwasperformedat42℃for90secondswith240ohms.Thepatientreported100%painreliefimmediatelyandcurrentlyongoingsustainedpainreliefformorethan6months內(nèi)容三叉神經(jīng)痛的發(fā)病情況三叉神經(jīng)痛的治療方法超聲引導(dǎo)三叉神經(jīng)上頜支阻滯總