三叉神経痛Trigeminal Neuralgia

三叉神経痛は血管が三叉神経を圧迫することによって痛みが生じます。
まれに、脳腫瘍による圧迫や、血管の圧迫がない場合もありますので、よい治療結果を得るためには正確な診断が欠かせません。
特殊な撮影方法を用いてMRIを撮影、画像をコンピューターで解析し、圧迫している血管を立体表示して診断します。
このことにより、正確な診断を得ることができ、適切な治療方法の検討が可能となります。
Trigeminal neuralgia is caused by vascular compression on the nerve. The compression may be caused by veins, arachnoid adhesion, and tumors. To obtain good operative result, it is crucial to establish a solid diagnosis for the neuralgia. 3D reconstruction from MRI and CT images precisely depict the relation between the nerve and adjacent vessels, resulting in safe and effective microvascular decompression surgery.

治療方法
Treatment Choice

治療は手術、ガンマナイフの2種類があります。
手術は顕微鏡を用いて行います。原因となる血管を数mm移動させて三叉神経への圧迫を取り除きます。痛みの根本原因を取り除くため、理想的な治療方法です。
ガンマナイフ治療は、三叉神経を圧迫している血管はそのままにしておき、三叉神経に放射線を照射することによって、痛みに対する感じ方を変える治療です。手術が困難な患者さんには適した方法です。
The two treatment modalities for trigeminal neuralgia are microvascular decompression and Gamma Knife surgery. Microvascular decompression is the ideal treatment as it removes the responsible vessel(s) away from the nerve. The procedure can be done through a small key hole, so the patient recovers quickly after the surgery. For patients with general anesthesia difficulty, Gamma Knife is used for treatment.

特殊な三叉神経痛
Rare cases of trigeminal neuralgia

典型的な動脈の接触以外の特殊な三叉神経痛の治療も行っています。
特殊な三叉神経痛には下記のものがあります。
I have had rare causes of trigeminal neuralgia among a large number of treated cases as follows.

  1. 太い動脈 (椎骨動脈・脳底動脈) による圧迫
    Large arteries such as the vertebral and basilar artery
  2. 静脈の接触による三叉神経痛
    Veins
  3. くも膜の癒着による三叉神経痛
    Adhesion by the arachnoid membrane
  4. 腫瘍の圧迫による三叉神経痛
    Tumor compression such as Schwannoma, Meningioma, and Epidermoid Cyst
  5. 再発
    Recurrent cases
  6. 先天奇形・異常に伴う三叉神経痛
    Developmental anomaly

case01.Trigeminal Neuralgia : Typical arterial case

67 F
Severe facial pain lasting over 5 years on the right side of her face.
Microvascular decompression with precise preoperative diagnosis relieved her pain without any complication.

Pre OP MRI

Intraoperative findings


case02.Trigeminal Neuralgia : vein

Compression by vein may cause trigeminal neuralgia. Small veins are often not seen on normal MRI sequence.
Enhanced MRI with precise analysis is required.
Trigeminal neuralgia for more than 20 years.
No definite diagnosis was made in other hospital.
Our precise diagnosis revealed the implication of vein upon the trigeminal nerve. The culprit vein was coagulated and divided, resulting in complete pain relief.

52 F
Trigeminal neuralgia for more than 20 years.
No definite diagnosis has not been made in other hospital.
Our precise diagnosis revealed the implication of vein upon the trigeminal nerve. The culprlit vein was coagulated and divided, resulting in complete pain relief.


case03.Trigeminal Neuralgia : vertebrobasilar artery

78 F
Severe facial pain on the left side.
Dolichoectasic basilar artery compressed the trigeminal nerve. Microvascular decompression successfully relieved her pain.


case04.Trigeminal Neuralgia : developmental malformation

38 M
Trigeminal neuralgia on the right side.
He was rejected operation by some hospitals because of high risk.
We performed microvascular decompression after careful observation using 3D imaging, which lead to successful microvascular decompression.


case05.Trigeminal Neuralgia : varix

56 F
Trigeminal neuralgia on the right side.
MRI revealed a mass lesion on the root of the right trigeminal nerve.
Successful microvascular decompression relieved her pain immediately after the operation.


case06.Trigeminal Neuralgia : bone anomaly

49 M
Very rare trigeminal neuralgia caused by bony compression on the nerve.
Severe facial pain on the right forced him to resign his job. Simulation using 3D skull base model was consistent with surgical findings.
The pain completely resolved and he was able to return to work.


case07.Trigeminal Schwannoma : Neuralgia caused by tumor

52 F
She underwent operation 10 years ago.
Her tumor recurred rapidly in these 3 months.
Sensory disturbance was present on the right side of her face. After complete removal, no neurological deterioration noted.


case08.Nervus Intermedius Neuralgia

A 36-year-old woman suffered from paroxysmal stabbing deep ear pain for more than 10 years. Preoperative MR imaging demonstrated a vascular loop coursing close to the brain stem between the seventh and eighth nerves. Microvascular decompression of the nerve relieved her neurological symptom immediately after the surgery.


case09.Glossopharyngeal Neuralgia

Glossopharyngeal neuralgia is similar electric-shock like pain like trigeminal neuralgia, which affects the deep throat area when swallowing. The glossopharyngeal nerve is compressed by arteries.


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