Trigeminal Neuropathic Pain

N. Field, J. Pilitsis
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Abstract

Motor cortex stimulation is a surgical treatment for medically refractory trigeminal neuropathic pain, a syndrome often caused by nerve injury due to trauma, dental work, or previous surgery for trigeminal neuralgia. Preoperative planning includes pain assessment scales, psychological clearance, and functional magnetic resonance imaging (fMRI) to map the motor cortex. The patient undergoes a craniotomy with trial placement of an epidural electrode array, assisted by neuronavigation, phase reversal monitoring, and somatosensory evoked potential recordings. Less commonly, the electrodes are placed in the subdural space. Postoperative seizure is the most common complication, additionally there are risks for infection and hemorrhage. Programming of the device is performed and the patient undergoes permanent implantation of the system if they achieve a greater than 50% reduction in their pain. Further research is necessary to determine which patients will have the best response to therapy.
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三叉神经性疼痛
运动皮质刺激是医学上难治性三叉神经痛的一种外科治疗方法,三叉神经痛是一种通常由外伤、牙科手术或先前三叉神经痛手术引起的神经损伤引起的综合征。术前计划包括疼痛评估量表、心理清除和功能磁共振成像(fMRI)来绘制运动皮层。患者接受开颅手术,尝试放置硬膜外电极阵列,辅以神经导航、相位逆转监测和体感诱发电位记录。不太常见的是,电极被放置在硬膜下空间。术后癫痫是最常见的并发症,此外还有感染和出血的危险。对设备进行编程,如果患者的疼痛减轻了50%以上,则进行系统的永久植入。需要进一步的研究来确定哪些患者对治疗有最好的反应。
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