jimmyabijahh的部落格

簡介：

三叉神經（Trigeminal nerve）是人體的第五對腦神經，它掌管了臉部的感覺及臉部下方的運動訊息，一旦因為某些原因發生異常，就會造成面部疼痛的相關問題。三叉神經總共有三個分支，神經痛最常發生在第二及第三分支。

三叉神經痛較常發生於五十歲以上的老年人身上，女性多於男性，若是對此病置之不理的話，病況可是會逐漸惡化的。

成因：

造成三叉神經發生問題的原因很多，最常見的就是被神經旁邊伴行的血管壓迫導致神經不正常放電而有異常疼痛感。除此之外，腦部腫瘤亦有可能壓迫到三叉神經，其他像是多發性硬化症這種自體免疫疾病，也可能因為髓鞘的破壞而引發三叉神經病變。

症狀：

面部的陣發性疼痛是三叉神經痛的主要症狀，這種疼痛呈現抽痛或宛如電擊，如上所述因為常發生在第二及第三分支，所以解剖位置上就會經常發生在臉頰、下巴、嘴唇、牙齒和牙齦等處，臨床上很容易使患者誤以為是牙齒發生問題而先於牙科就診。

三叉神經痛可能由咀嚼、刷牙、微笑或化妝等等動作所觸發，但也可能沒有先兆就發生。值得注意的是，三叉神經痛往往是突發性的，而且通常只影響臉部的單側，隨著病況的惡化，疼痛的頻率和強度可能會逐漸加強，嚴重時甚至連臉部吹到風都有可能引發劇痛。

如此將對患者的日常行為產生影響，例如不敢洗臉或刷牙甚至影響睡眠及工作品質等，對疼痛的預期心理也可能使患者長期處在低落的情緒之中。

治療：

治療三叉神經痛的方法包括藥物以及手術治療，藥物治療的目標通常是減輕患者的疼痛，最常見的是抗癲癇藥物中的癲通（Tegretol），這種藥物對大部分的患者都有療效，但是藥物本身的副作用稍大，嚴重的話可能會有全身性過敏的情況。除了Tegretol之外也可搭配止痛藥、肌肉鬆弛劑等輔助治療。

手術治療雖然較能解決根本上的問題，但由於考慮到伴隨而來的風險，通常用作藥物治療無效的二線療法。

若要考慮手術則必須先釐清是何種病灶導致症狀，這樣手術治療才會有效。例如可安排腦部磁振造影排除腦部腫瘤壓迫，若是腫瘤壓迫且腫瘤已有一定大小(>2.5cm or 3cm)，則應考慮手術；若還未達到此一大小則可考慮立體定位放射手術如加馬刀（Gamma knife）或是直線加速器（Linear accelerator），兩者皆為放射手術，只是廠牌與原理稍微不同。

方才提到導致三叉神經痛的常見原因是血管壓迫，微血管減壓手術便能解決此一問題，透過手術隔開壓迫三叉神經的血管，並且在血管與神經之間置入軟墊阻隔，通常會有不錯的效果。除此之外，若未發現腫瘤也沒有血管壓迫神經，可考慮三叉神經阻斷術，藉由電燒、注射藥物或氣球擴張的方法阻斷三叉神經節達到治療效果。

Introduction:

The Trigeminal nerve is the fifth pair of cranial nerves in the human body. It controls the facial sensation and the movement information under the face. Once an abnormality occurs for some reason, it will cause facial pain. The trigeminal nerve has a total of three branches, and neuralgia most often occurs in the second and third branches.

Trigeminal neuralgia occurs more frequently in older people over the age of 50. More women than men, if the disease is ignored, the condition will gradually deteriorate.

Causes:

There are many causes of trigeminal neurogenesis problems. The most common is that the vascular compression accompanied by the nerve causes abnormal nerve discharge and abnormal pain. In addition, brain tumors may also be compressed to the trigeminal nerve, other autoimmune diseases such as multiple sclerosis, may also cause trigeminal neuropathy due to destruction of myelin.

symptom:

Paroxysmal pain on the face is the main symptom of trigeminal neuralgia. This pain presents with pain or like an electric shock. As mentioned above, because it often occurs in the second and third branches, the anatomical position often occurs on the cheeks and chin. , lips, teeth and gums, etc., clinically easy to make patients mistakenly think that it is a tooth problem and precede the dentist.

Trigeminal neuralgia can be triggered by chewing, brushing, smiling, or makeup, but it can happen without warning. It is worth noting that trigeminal neuralgia is often sudden and usually affects only one side of the face. As the condition deteriorates, the frequency and intensity of pain may gradually increase. In severe cases, even the face blows into the wind. It can cause severe pain.

This will have an impact on the patient's daily behavior, such as not being able to wash your face or brush your teeth or even affect your sleep and work quality. The expectation of pain may also cause the patient to be in a low mood for a long time.

treatment:

laennecMethods for treating trigeminal neuralgia include medications and surgical treatments. The goal of medications is usually to alleviate pain in patients. The most common is epilemic in antiepileptic drugs, which is effective in most patients. However, the side effects of the drug itself are slightly larger, and if it is serious, there may be a systemic allergy. In addition to Tegretol, it can be combined with analgesics, muscle relaxants and other ancillary treatments.

Although surgical treatment can solve the fundamental problem, it is usually used as a second-line therapy for drug treatment because of the accompanying risks.

In order to consider surgery, it is necessary to first determine what kind of lesions cause symptoms, so that surgical treatment will be effective. For example, brain magnetic resonance imaging can be arranged to exclude brain tumor compression. If the tumor is compressed and the tumor has a certain size (>2.5cm or 3cm), surgery should be considered; if this size has not been reached, stereotactic radiosurgery can be considered. Such as Gamma knife or Linear accelerator, both are radiosurgery, but the label is slightly different from the principle.

It is only mentioned that the common cause of trigeminal neuralgia is vascular compression. Microvascular decompression surgery can solve this problem by separating the blood vessels that compress the trigeminal nerve through surgery and placing a cushion between the blood vessels and the nerves. Have a good effect. In addition, if no tumor is found and no vascular compression nerves, trigeminal nerve blockade can be considered to block the trigeminal ganglion by electrocautery, injection of drugs or balloon expansion.

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