神经电刺激治疗慢性头面部疼痛：综述（十二）

 英语晨读 ·

山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。

本次文献选自Antony AB,  Mazzola AJ,  Dhaliwal GS, et al. Neurostimulation for the Treatment of Chronic Head and Facial Pain: A Literature Review[J]. Pain Physician, 2019, 22(5):447-477. 本次学习由陈阳住院医师主讲。

Intravenous Transfusion

Intravenous lidocaine has been thoroughly studied in patients with chronic pain. Retrospective cases have demonstrated promise using intravenous lidocaine in chronic daily headache. In patients with PHN, intravenous lidocaine has displayed significant improvements in pain scores. Further studies are indicated for intravenous therapy including lidocaine, ketamine, and phentolamine.

静脉输液

静脉注射利多卡因已经在患有慢性疼痛的患者中进行了深入研究。回顾性研究表明静脉注射利多卡因治疗慢性天天头痛可能有效。在PHN患者中，静脉注射利多卡因已显示出疼痛评分的显著改善。包括利多卡因、氯胺酮和酚妥拉明在内的静脉疗法有待进一步研究。

Surgery

Surgery can successfully relieve irritation of a nerve or can provide relief through nerve resection. Microvascular decompression has shown success in patients with TN when a neighboring vessel, usually the superior cerebellar artery, is responsible for compression of the nerve root. If no compressing vessel is identified, internal neurolysis may be performed that divides the nerve into 8 to 10 bundles from the pons to the petrous bone. Pain relief can also be achieved through intentional direct injury to or disruption of the offending nerve. In addition to the inherent risk of invasive surgery itself, destruction of a nerve may increase the risk of developing difficult to treat pain conditions such as causalgia or neuroma formation.

外科手术

手术可以缓解神经激惹，也可以通过神经切除术缓解疼痛。当周围血管（通常是小脑上动脉）引起神经根受压时，微血管减压术在TN患者中证明有效。如果未发现压迫血管，可行神经破坏，将从脑桥到颞骨岩部的神经分成8到10束。可以通过意直接损伤或破坏神经而缓解疼痛。除了有创手术本身的风险外，神经破坏还可能增加发展成难以治疗的疼痛状况（如灼痛或神经瘤形成）的风险。

Another procedure, nucleus caudalis dorsal root entry zone ablation has reported good outcomes in treating refractory TN, atypical headache, and complex craniofacial pain. The trigeminal nucleus caudalis has been described to receive and integrate nociceptive sensation. This procedure is performed under open surgery as the substantia gelatinosa at the nucleus caudalis level is lesioned. Because of the risks of damage to the brainstem during surgical manipulation, this procedure is often a last resort. Another technique, trigeminal tractotomy and nucleotomy involves lesioning the descending spinal trigeminal tracts in the medulla along with the nucleus caudalis. Surgical procedures are reserved for intractable severe cases.

另一种方法是尾状核背根区消融治疗难治性TN、非典型头痛和复杂的颅面痛，效果良好。有报道称三叉神经尾状核可接收并整合伤害感受。该手术开放进行，因为需要破坏尾核中的胶质区。由于在手术过程中会有损坏脑干的风险，因此该手术通常是不得已的方法。另外一种技术，三叉神经神经束切断术和核团切断术，涉及破坏延髓中的下行三叉神经脊束核与尾状核。手术多作为难治性严重病例的一种选择。

Gamma Knife Radiosurgery

Gamma Knife radiosurgery has been developed for the treatment of nerve pain such as TN. This technique involves radiation of the trigeminal nerve usually 2 to 4 mm anterior to the brainstem. Studies have shown this technique to have excellent efficacy after a lag period of a few months. This technique is hopeful to provide relief with limited complications.

伽玛刀放射手术

伽玛刀放射手术已用来治疗诸如TN之类的神经痛。该技术通常在脑干前2至4毫米的三叉神经照射。研究表明，这种技术在几个月后具有出色的疗效。该技术有望在缓解疼痛的同时减少并发症的发生。