Pathophysiology and Management of Refractory Trigeminal Neuralgia.

IF 4.8 2区医学 Q1 CLINICAL NEUROLOGY Current Neurology and Neuroscience Reports Pub Date : 2024-12-12 DOI:10.1007/s11910-024-01387-2

Jennifer I Stern, Rushna Ali, Chia-Chun Chiang, Carrie E Robertson

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引用次数: 0

Abstract

Purpose of review: Discuss the current understanding of the pathophysiology and management of refractory trigeminal neuralgia (TN). This includes a discussion on why TN can recur after microvascular decompression and a discussion on "outside of the box" options when both first- and second-line management strategies have been exhausted.

Recent findings: This review discusses second- and third-line oral medication options, botulinum toxin A, repeat microvascular decompression, repeat ablative procedures, internal neurolysis, trigeminal branch blockade, and neuromodulation using TMS or peripheral stimulation. Additional management for chronic neuropathic facial pain such as deep brain stimulation, motor cortex stimulation, and focused ultrasound thalamotomy are also discussed, though evidence in trigeminal neuralgia is limited. Treatment of recurrent TN despite multiple surgeries can be challenging, and multiple minimally invasive and more invasive management options have been reported in small studies and case reports. Further studies are needed to determine an optimal stepwise approach.

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难治性三叉神经痛的病理生理学和治疗。

综述目的：讨论目前对难治性三叉神经痛（TN）的病理生理学和治疗的认识。这包括讨论为什么在微血管减压后TN会复发，以及当一线和二线治疗策略都已用尽时“跳出框框”的选择。最近的发现：这篇综述讨论了二线和三线口服药物选择，肉毒杆菌毒素A，重复微血管减压，重复消融手术，内神经松解术，三叉分支阻断，以及使用TMS或外周刺激进行神经调节。对于慢性神经性面部疼痛的其他治疗方法，如深部脑刺激、运动皮层刺激和聚焦超声丘脑切开术也进行了讨论，尽管三叉神经痛的证据有限。尽管多次手术治疗复发性TN可能具有挑战性，在小型研究和病例报告中已经报道了多种微创和更具侵入性的管理选择。需要进一步的研究来确定最佳的逐步方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Neurology and Neuroscience Reports 医学-临床神经学

CiteScore

9.20

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Current Neurology and Neuroscience Reports provides in-depth review articles contributed by international experts on the most significant developments in the field. By presenting clear, insightful, balanced reviews that emphasize recently published papers of major importance, the journal elucidates current and emerging approaches to the diagnosis, treatment, management, and prevention of neurological disease and disorders. Presents the views of experts on current advances in neurology and neuroscience Gathers and synthesizes important recent papers on the topic Includes reviews of recently published clinical trials, valuable web sites, and commentaries from well-known figures in the field.