三叉神经痛的发病机制及立体定向放射外科治疗进展

摘要

Trigeminal neuralgia (TN) is a debilitating pain syndrome within the trigeminal nerve distribution, that is characterized by agonizing, paroxysmal and lancinating pain. The pathophysiology of trigeminal neuralgia is not clear and no satisfactory animal model so far. But with the rapid development of pathophysiology and neuroimaging, there are some evidences showed that the central nervous and peripheral nerve factors may cause trigeminal neuralgia attacks. The recommended ifrst-line treatment for TN is medical therapy, but this often fails to provide pain relief. Thus, secondline treatment modalities are given to patients whose symptoms are intractable or who cannot tolerate medication. These treatment modalities include invasive procedures such as microvascular decompression (MVD), and ablative procedures such as radiosurgery, percutaneous balloon microcompression, radiofrequency rhizotomy and glycerol rhizolysis. Among them, gamma knife and CyberKnife radiosurgery have becoming an important method in the treatment of TN because of its’ minimally invasive and signiifcant efifciency.%三叉神经痛是指在三叉神经分布区内反复发作的阵发性剧烈疼痛。其发病机制是一个非常复杂的病理过程，至今没有满意的动物模型，制约了其病因学的研究，随着病理生理及神经影像学的发展，有越来越多的证据表明：中枢神经因素及外周神经因素均可导致三叉神经痛的发作。三叉神经痛的一线治疗方案是药物治疗，如卡马西平或奥卡西平等；但对于不耐受药物副作用或是药物难治性TN可选择二线治疗，如微血管减压术，立体定向放射外科，经皮穿刺微球囊压迫术，射频或甘油注射三叉神经阻断术。其中，以伽玛刀和射波刀为代表的立体定向放射外科因创伤性极小，且疗效显著成为TN患者治疗的重要方法。