三叉神經痛的射頻神經燒融治療
三叉神經痛，常被認為是人類已知的最劇烈的痛楚之一。該疼痛通常呈現為間歇性且劇烈，像是在面部、下顎、牙齒或牙齦中射出的銳利射擊感或電擊。簡單的活動，例如進食、說話或觸碰臉部都可能觸發這種使人無法忍受的疼痛。
對三叉神經痛的治療包括藥物治療、介入治療和開放手術，本文集中介紹介入治療。
射頻神經燒融治療是一種微創的介入治療方法。當藥物治療效果不佳或副作用難以忍受時，這方法便大派用場。除此之外，當患者不能接受開通手術之風險，也會選擇使用射頻神經燒融治療。
射頻熱凝治療過程需要在X光導引下小心進行。醫生在臉頰插入導引針到達頭骨基底的神經的出口處。然後，將電極精確放置於賈塞氏節（Gasserian ganglion）的相關位置上。這神經節是一個關鍵神經結構，負責傳遞疼痛感覺。
醫生會為患者進行輕度麻醉。手術期間醫生會議輕微電流刺激神經節，並要求患者清晰地表達，受刺激的位置。這確保電極精準地定位於痛楚信號傳遞的路徑。一旦確認位置正確，醫生便會施加射頻電流在神經上精准燒融，這便可有效地中斷痛楚信號的傳導。
該手術通過麻木神經來緩解痛楚，該效果通常可以持續數年。然而，射頻神經燒融治療並非沒有風險。潛在的併發症包括過度的臉部麻木、咀嚼肌肉的無力，以及角膜感覺減退。這些併發症通常是暫時性的。
射頻神經燒融治療為三叉神經痛的患者提供了一個希望。它平衡了患者對成效和安全的要求，他為那些試盡了所有方法的患者提供了一個有效的治療方案。
Reference:
Altamirano JM, Jimenez-Olvera M, Moreno-Jimenez S, Gutierrez-Aceves GA, Velasco-Campos F, Navarro-Olvera JL, et al. Comparison of microvascular decompression, percutaneous radiofrequency rhizotomy, and stereotactic radiosurgery in the treatment of trigeminal neuralgia: A long term quasi-experimental study. Pain Pract. 2024;24:514-24. doi: 10.1111/papr.13327.
Understanding Radiofrequency thermocoagulation for Trigeminal Neuralgia
Trigeminal neuralgia, often termed "suicidal pain," is recognized as one of the most excruciating conditions known to humanity. The pain, typically episodic and severe, is likened to a sharp, shooting sensation or an electric shock in the face, jaw, teeth, or gums. Simple activities such as eating, speaking, or touching the face can trigger this debilitating pain.
The treatment for trigeminal neuralgia encompasses medications, interventions, and open surgery, with this article focusing specifically on interventions. Radiofrequency thermocoagulation presents a minimally invasive interventional option for trigeminal neuralgia, particularly when medications prove ineffective or cause intolerable side effects. It is also considered when microvascular decompression (MVD), a more invasive surgical procedure, is deemed unsuitable for the patient.
The radiofrequency thermocoagulation procedure is conducted with meticulous care under fluoroscopic guidance. A needle is inserted through the cheek to access the base of the skull, where the nerve exits. An electrode is then precisely positioned at the Gasserian ganglion, a critical nerve structure that relays pain sensations.
Patients are kept awake, under mild sedation, to provide real-time feedback to guide the location of the electrode. This ensures the electrode is accurately placed to target the pathway of the pain signals. Once the correct position is confirmed, a radiofrequency current is applied to create a lesion on the nerve, effectively disrupting the transmission of pain signals.
The procedure offers immediate pain relief by numbing the nerve, with the effects typically lasting several years.
However, radiofrequency thermocoagulation is not without its risks. Potential complications include excessive facial numbness, weakness in the masticatory muscles, and corneal hypoesthesia. These complications are generally temporary and not permanent.
In conclusion, radiofrequency thermocoagulation offers a promising option for those struggling with trigeminal neuralgia. It strikes a balance between efficacy and safety, providing a viable option for patients who have exhausted other treatment avenues.
Reference:
Altamirano JM, Jimenez-Olvera M, Moreno-Jimenez S, Gutierrez-Aceves GA, Velasco-Campos F, Navarro-Olvera JL, et al. Comparison of microvascular decompression, percutaneous radiofrequency rhizotomy, and stereotactic radiosurgery in the treatment of trigeminal neuralgia: A long term quasi-experimental study. Pain Pract. 2024;24:514-24. doi: 10.1111/papr.13327.