• Journal of Oral Medicine and Pain
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• 제32권4호
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• pp.449-453
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• 2007

삼차신경통은 삼차신경의 하나 이상 분지에서 나타나는 안면 편측 통증 질환으로 짧은 찌르는 듯한 통증이다. 삼차 신경통의 가장 흔한 원인은 인접 삼차신경이나 삼차신경근 부위를 압박하는 혈관에 의하거나 특발성으로 나타나는 특발성 삼차신경통과 구조적 병소에 의해 나타나는 증후성 삼차신경통으로 분류된다. 증후성 삼차신경통은 수막종, 청신경종, 표피양암종 등이 주된 원인이며, 감각 결함, 운동 결함, 운동실조, 안구진탕 등과 같은 신경계 증상이 동반된다. 삼차 신경통의 치료는 크게 약물 치료와 외과적 치료가 있다. 이 중 가장 효과적으로 사용되는 약물은 Carbamazepine이며, 졸음, 현기증, 불안, 오심, 식욕부진 등의 다양한 부작용을 나타낼 수 있다. 특히 간독성, 골수 기능 억제 등의 위험한 부작용이 나타날 수 있으므로 주기적으로 혈액검사, 간 및 신장 기능 검사가 필요하다. 이에 삼차신경통의 임상 증례를 통해 증후성 삼차신경통과 특발성 삼차신경통의 예를 들어 진단과 치료를 시행함에 있어 여러 고려 사항들 중 특히 우리가 소홀히 하거나 간과하기 쉬운 중요 고려사항을 되짚어 보고자 한다.

• Korean Journal of Radiology
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• 제23권8호
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• pp.821-827
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• 2022

Objective: To determine the anatomical characteristics of the petrous ridge and trigeminal nerve in trigeminal neuralgia (TN) without neurovascular compression (NVC). Materials and Methods: From May 2017 to March 2021, 66 patients (49 female and 17 male; mean age ± standard deviation [SD], 56.8 ± 13.3 years) with TN without NVC and 57 controls (46 female and 11 male; 52.0 ± 15.6 years) were enrolled. The angle of the petrous ridge (APR) and angle of the trigeminal nerve (ATN) were measured using magnetic resonance imaging with a high-resolution three-dimensional T2 sequence. Data on the symptomatic side were compared with those on the asymptomatic side in patients and with the mean measurements of the bilateral sides in controls. Receiver operating characteristic (ROC) analysis was conducted to evaluate the performance of APR and ATN in distinguishing TN patients from controls. Results: In TN patients without NVC, the mean ± standard deviation (SD) of APR on the symptomatic side (98.40° ± 19.75°) was significantly smaller than that of the asymptomatic side (105.59° ± 22.45°, p = 0.019) and controls (108.44° ± 15.98°, p = 0.003). The mean ATN ± SD on the symptomatic side (144.41° ± 8.92°) was significantly smaller than that of the asymptomatic side (149.67° ± 8.09°, p = 0.003) and controls (150.45° ± 8.48°, p = 0.001). The area under the ROC curve for distinguishing TN patients from controls was 0.673 (95% confidence interval [CI]: 0.579-0.758) for APR and 0.700 (CI: 0.607-0.782) for ATN. The sensitivity and specificity using the diagnostic cutoff yielding the highest Youden index were 81.8% (54/66) and 49.1% (28/57), respectively, for APR (with a cutoff score of 94.30°) and 65.2% (43/66) and 66.7% (38/57), respectively, for ATN (cutoff score, 148.25°). Conclusion: In patients with TN without NVC, APR and ATN were smaller than those in controls, which may explain the potential cause of TN and provide additional information for diagnosis.

• Journal of Korean Neurosurgical Society
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• 제41권6호
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• pp.359-366
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• 2007

Trigeminal neuralgia is a condition associated with severe episodic lancinating facial pain subject to remissions and relapses. Trigeminal neuralgia is often associated with blood vessel cross compression of the root entry zone or more rarely with demyelinating diseases and occasionally with direct compression by neoplasms of the posterior fossa. If initial medical management fails to control pain or is associated with unacceptable side effects, a variety of surgical procedures offer the hope for long-lasting pain relief or even cure. For patients who are healthy without significant medical co-morbidities, direct microsurgical vascular decompression [MVD] offers treatment that is often definitive. Other surgical options are effective for elderly patients not suitable for MVD. Percutaneous retrogasserian glycerol rhizotomy is a minimally invasive technique that is based on anatomic definition of the trigeminal cistern followed by injection of anhydrous glycerol to produce a weak neurolytic effect on the post-ganglionic fibers. Other percutaneous management strategies include radiofrequency rhizotomy and balloon compression. More recently, stereotactic radiosurgery has been used as a truly minimally invasive strategy. It also is anatomically based using high resolution MRI to define the retrogasserian target. Radiosurgery provides effective symptomatic relief in the vast majority of patients, especially those who have never had prior surgical procedures. For younger patients, we recommend microvascular decompression. For patients with severe exacerbations of their pain and who need rapid response to treatment, we suggest glycerol rhizotomy. For other patients, gamma knife radiosurgery represents an effective management strategy with excellent preservation of existing facial sensation.