A型肉毒毒素与微血管减压术治疗原发性三叉神经痛的临床疗效分析
|
摘要
目的：探讨A型肉毒毒素（botulinum toxin type A，BTX-A）与微血管减压术（microvascular decompression，MVD)治疗原发性三叉神经痛（idiopathic trigeminalneuralgia，ITN）的疗效。
方法：收集44例原发性三叉神经痛患者，其中24例三叉神经痛患者行A型肉毒毒素治疗（肉毒毒素治疗组)，20例三叉神经痛患者行微血管减压术治疗(微血管减压术组)。对这两种方法的治疗效果进行分析。用视觉模拟评分（Visual AnalogScores,VAS）进行疼痛测评。
结果：1、BTX-A组治疗前VAS评分为9.00±0.88，注射后1周为5.33±3.38，注射后2周为3.08±2.24，注射后1月为2.00±2.21，注射后3月为3.42±2.76，注射后6月为5.88±2.95，治疗前后比较，差异有统计学意义（P＜0.001）。MVD组术前VAS评分为8.95±0.83，术后1周为2.30±2.23，术后2周为0.85±1.09，术后1月为0.30±0.73，术后3月为0.10±0.45，术后6月为0.1±0.45，治疗前后比较，差异有统计学意义（P＜0.001）。两组间比较差异有显著统计学意义。
2、并发症：肉毒毒素组主要为一过性口角歪斜、眼睑闭合不全3例，4～6周后自行恢复。微血管减压术组主要有：头晕3例，听力丧失1例；局部面部麻木1例；术后出现小脑出血、第四脑室受压等严重并发症1例，需再次开颅行血肿清除术，出院前痊愈，遗留有面部麻木。两组均无死亡病例。
3、对微血管减压术20例患者进行术后随访，随访时间6月～3年，其中3例复发，复发率为15.0％。肉毒毒素组治疗6个月后疗效明显减退，甚至疼痛反复需要再次进行注射治疗，并且显示再次注射治疗有效。
结论：1、A型肉毒毒素治疗原发性三叉神经痛安全、有效，但疗效持续时间相对于微血管减压术较短。
2、微血管减压术治疗原发性三叉神经痛治愈率高，疼痛缓解率优于肉毒毒素治疗，复发率低，但有一定的严重并发症。
3、对于常规药物治疗效果差、术后复发患者、存在手术禁忌症或是害怕手术的原发性三叉神经痛患者，尤其是年龄高、手术风险大的患者，注射A型肉毒毒素治疗是一种可供选择的治疗方法。
Objective：To compare the effects of botulinum toxin type A and microvasculardecompression in the treatment of idiopathic trigeminal neuralgia.
Methods：Forty-four patients with idiopathic trigeminal neuralgia were involved in thestudy，Twenty-four patients were treated by botulinum toxin type A while twenty patientsreceived the surgery of microvascular decompression. Visual analog scores (VAS) wasused to evaluate the effects of these two treatment by measuring the degree of pain.
Results：1、The VAS was9.00±0.88before the BTX-A treatment. The scoresdecreased to5.33±3.38,3.08±2.24，2.00±2.21,3.42±2.76and5.88±2.95at one week,two weeks, one month, three months and six months after the treatment. The effects ofVAS in the treatment of idiopathic trigeminal neuralgia was considered as statisticallysignificant (p<0.001). The VAS was8.95±0.83before the surgery of MVD. The scoreswere2.30±2.23,0.85±1.09，0.30±0.73，0.10±0.45and0.10±0.45at one week, twoweeks, one month, three months and six months after the surgery, respectively. The surgeryof MVD showed significant effects to alleviate the pain from the patients with idiopathictrigeminal neuralgia (p<0.001). The scores of two groups were significant differencesafter the treatments．
2、Complications of the treatment with botulinum toxin: three patients had transientnumbness of the mouth askew and incomplete eyelid closure. They got spontaneousrecovery after4to6weeks. Complications of microvascular decompression:3cases ofdizziness, one case of permanent hearing loss; one cases of partial facial numbness;1patient had compression cerebellar hemorrhage of the fourth ventricle due to the cerebellar hemorrhage. The patient received the second surgery for hematoma dissection and gotrecovery with facial numbness. No patients died during the treatment.
3、Patients who were subjected to the surgery of microvascular decompression werefollowed up for6months to3years during which3patients had recurrence and therecurrence rate was15.0%. The alleviation of pain by botulinum toxin only persisted for6months after which re-injection of botulinum toxin was required to alleviate pain.
Conclusions：1、BTX-A is safe and effective in the treatment of idiopathic trigeminalneuralgia. However, the effects of BTX sustained for shorter time compared with that ofMVD.
2、Microvascular decompression (MVD) is more effective in the treatment ofidiopathic trigeminal neuralgia by comparison with Botulinum toxin type A (BTX-A),especially for the relief of pain. However, the MVD has more complications and higherrecurrence rate than BTX-A.
3、 For the patients with idiopathic trigeminal neuralgia who are resistant toconventional drug therapy, have surgical contraindications or recurrence after surgery orare afraid of surgery, especially high age, surgical risk big patients,injection of botulinumtoxin type A is an alternative treatment.
方法：收集44例原发性三叉神经痛患者，其中24例三叉神经痛患者行A型肉毒毒素治疗（肉毒毒素治疗组)，20例三叉神经痛患者行微血管减压术治疗(微血管减压术组)。对这两种方法的治疗效果进行分析。用视觉模拟评分（Visual AnalogScores,VAS）进行疼痛测评。
结果：1、BTX-A组治疗前VAS评分为9.00±0.88，注射后1周为5.33±3.38，注射后2周为3.08±2.24，注射后1月为2.00±2.21，注射后3月为3.42±2.76，注射后6月为5.88±2.95，治疗前后比较，差异有统计学意义（P＜0.001）。MVD组术前VAS评分为8.95±0.83，术后1周为2.30±2.23，术后2周为0.85±1.09，术后1月为0.30±0.73，术后3月为0.10±0.45，术后6月为0.1±0.45，治疗前后比较，差异有统计学意义（P＜0.001）。两组间比较差异有显著统计学意义。
2、并发症：肉毒毒素组主要为一过性口角歪斜、眼睑闭合不全3例，4～6周后自行恢复。微血管减压术组主要有：头晕3例，听力丧失1例；局部面部麻木1例；术后出现小脑出血、第四脑室受压等严重并发症1例，需再次开颅行血肿清除术，出院前痊愈，遗留有面部麻木。两组均无死亡病例。
3、对微血管减压术20例患者进行术后随访，随访时间6月～3年，其中3例复发，复发率为15.0％。肉毒毒素组治疗6个月后疗效明显减退，甚至疼痛反复需要再次进行注射治疗，并且显示再次注射治疗有效。
结论：1、A型肉毒毒素治疗原发性三叉神经痛安全、有效，但疗效持续时间相对于微血管减压术较短。
2、微血管减压术治疗原发性三叉神经痛治愈率高，疼痛缓解率优于肉毒毒素治疗，复发率低，但有一定的严重并发症。
3、对于常规药物治疗效果差、术后复发患者、存在手术禁忌症或是害怕手术的原发性三叉神经痛患者，尤其是年龄高、手术风险大的患者，注射A型肉毒毒素治疗是一种可供选择的治疗方法。
Objective：To compare the effects of botulinum toxin type A and microvasculardecompression in the treatment of idiopathic trigeminal neuralgia.
Methods：Forty-four patients with idiopathic trigeminal neuralgia were involved in thestudy，Twenty-four patients were treated by botulinum toxin type A while twenty patientsreceived the surgery of microvascular decompression. Visual analog scores (VAS) wasused to evaluate the effects of these two treatment by measuring the degree of pain.
Results：1、The VAS was9.00±0.88before the BTX-A treatment. The scoresdecreased to5.33±3.38,3.08±2.24，2.00±2.21,3.42±2.76and5.88±2.95at one week,two weeks, one month, three months and six months after the treatment. The effects ofVAS in the treatment of idiopathic trigeminal neuralgia was considered as statisticallysignificant (p<0.001). The VAS was8.95±0.83before the surgery of MVD. The scoreswere2.30±2.23,0.85±1.09，0.30±0.73，0.10±0.45and0.10±0.45at one week, twoweeks, one month, three months and six months after the surgery, respectively. The surgeryof MVD showed significant effects to alleviate the pain from the patients with idiopathictrigeminal neuralgia (p<0.001). The scores of two groups were significant differencesafter the treatments．
2、Complications of the treatment with botulinum toxin: three patients had transientnumbness of the mouth askew and incomplete eyelid closure. They got spontaneousrecovery after4to6weeks. Complications of microvascular decompression:3cases ofdizziness, one case of permanent hearing loss; one cases of partial facial numbness;1patient had compression cerebellar hemorrhage of the fourth ventricle due to the cerebellar hemorrhage. The patient received the second surgery for hematoma dissection and gotrecovery with facial numbness. No patients died during the treatment.
3、Patients who were subjected to the surgery of microvascular decompression werefollowed up for6months to3years during which3patients had recurrence and therecurrence rate was15.0%. The alleviation of pain by botulinum toxin only persisted for6months after which re-injection of botulinum toxin was required to alleviate pain.
Conclusions：1、BTX-A is safe and effective in the treatment of idiopathic trigeminalneuralgia. However, the effects of BTX sustained for shorter time compared with that ofMVD.
2、Microvascular decompression (MVD) is more effective in the treatment ofidiopathic trigeminal neuralgia by comparison with Botulinum toxin type A (BTX-A),especially for the relief of pain. However, the MVD has more complications and higherrecurrence rate than BTX-A.
3、 For the patients with idiopathic trigeminal neuralgia who are resistant toconventional drug therapy, have surgical contraindications or recurrence after surgery orare afraid of surgery, especially high age, surgical risk big patients,injection of botulinumtoxin type A is an alternative treatment.
引文
1.黄宇光,徐建国.神经病理性疼痛临床诊疗学.人民卫生出版社,2010;324-333.
2. Tash RT, Sze G, Leslie DR. Trigeminal neuralgia: MR imaging features. Radiology,1989;172:767-770.
3. Dandy WE. Concerning the cause of trigeminal neuralgia. Am J surg,1934;24:447-455.
4. Jannetta PJ. Aterial compression of the trigeminal nerve at the pons in patients withtrigeminal neuralgia. Neurosurg,1967;26:159—162.
5. Sindrup SH, Jensen TS. Pharmacotherapy of trigeminal neuralgia. Clin J Pain2002;18:22–27.
6. Jorns TP, Zakrzewska JM. Evidence-based approach to the medical management oftrigeminal neuralgia. Br J Neurosurg,2007;21（3）:253-261.
7.卢红霞,谢向东,李文涛.卡马西平联合甲钴胺治疗原发性三叉神经痛46例对照研究.中国实用神经疾病杂志,2008;11（9）:57-59.
8. Katusic S, Beard CM, Bergstralh E, Kurland LT. Incidence and clinical features oftrigeminal neuralgia, Rochster, Minnesota,1945-1984.Ann Neurol1990;27:89-95.
9. Ahn KS, Lee MK, Hwang SH, Lee JE, Cho CW, Kim DJ. Percutaneous BalloonCompression of Trigeminal Ganglion for the treatment of idiopathic TrigeminalNeuralgia. Korean Neurosurg Soc,2004;36:213-217.
10.朱晋,仲骏,李世亭.微血管减压术治疗三叉神经痛临床回顾.中华神经外科疾病研究杂志,2009;8（3）:206-209.
11. Broggi G, Ferroli P. Microvascular decompression for trigeminal neuralgia: commentson a series of250cases, including10patients with multiple sclerosis. NeurolNeurosurg Psychiatry,2000Jan;68(1):59-64.
12.吕学明,吕福林,袁绍纪,张荣伟,陈援朝等.微血管减压术治疗脑神经疾病的并发症分析.中国神经精神疾病杂志,2010;36（1）:53-54.
13.李莉,刘庆森.肉毒毒素在疼痛治疗中的应用.中国临床康复杂志,2006;10（40）:130-132.
14. Micheli F, Scorticati MC, Raina G. Beneficial effects of botulinum toxin type a forpatients with painful tic convulsif. Clin Neuropharmacol2002;25:260-262.
15. Merskey H, Bogduk N. Classification of chronic pain. Description of Chronic Pain.Syndromes and Definitions of Pain Terms. Seattle:IASP Press,1994:59-71.
16. Anonymous.Classification and diagnostic eriteria for headache disorders, cranianeuralgias and facial pain.Headache Classification Committee of the InternationalHeadache Society. Cephalalgia1988;8(Suppl7):1-96.
17. Revil SI, Robinson JO, Rosen M, et al. The reliability of a linear analogue forevaluating pain. Anaesthesia,1976;31:1191-1198.
18.杨岸超,张建国,张凯,孟凡刚,葛明等.原发性典型与不典型三叉神经痛微血管减压术的疗效分析.中华神经外科疾病研究杂志,2011;10（2）:109-112.
19. Pamir MN, Peker S. Microvascular Decompression for Trigeminal Neuralgia:ALong-Term Follom-Up Study. Minim Invas Neurosurg,2006;49:342-346.
20. Devor M, Amir R, Rappaport ZH. Pathopysiology of trigeminal neuralgia: the ignitionhypothesis. Clin J Pain,2002;18（1）:4-13.
21. Marinkovic S, Todorovic V, Gibo H, et al. The trigeminal vasculature pathology inpatients with neuralgia. Headache,2007;47（9）:1334-1339.
22. Cho DY, Chang CG, Wang YC, Wang FH, Shen CC, Yang DY. Repeat operations infailed microvascular decompression for trigeminal neuralgia. Neurosurgery.1994;35:665-669.
23. Schulte-Mattler WJ, Wieser T, Zierz S. Treatment of tension-type headache withbotulinum toxin: a pilot study. Eur J Med Res,1999;4（5）:183-6.
24. Zú iga C, Díaz S, Piedimonte F, Micheli F. Beneficial effects of Botulinum toxin typeA in trigeminal neuralgia. Arq Neuropsiquiatr2008;66(3-A):500-503.
25. Ngeow WC, Nair R. Injection of botulinum toxin type A (BOTOX) into trigger zone oftrigeminal neuralgia as a means to control pain. Oral Surg Oral Med Oral Pathol OralRadiol Endod2010;109(3):e47-e50.
26.申继红,连亚军,郑亚珂,张海峰,谢媛媛,魏红玲.A型肉毒毒素治疗原发性三叉神经痛的疗效观察.中国康复医学杂志,2011;26（5）:483-484.
27.朱婷鸽,张琪林,罗蔚锋,毛成洁,胡伟东,刘春风. A型肉毒毒素治疗难治性三叉神经痛临床观察.中国临床神经科学,2011;19(1):32-35.
28. Aoki KR. Evidence for antiociceptive activity of botulinum toxin type A in painmanagement. Headache,2003;43（suppl1）: S9-S15.
29. Mense S. Neurobiological basis for the use of botulinum toxin in pain therapy. J Neurol,2004;251（Supp l1）:I1-I7.
30. Guyer BM. Mechanism of Botulinum toxin in the relief of chronic pain. Curr Rev Pain,1999;3(6):427-431.
1.王忠诚.神经外科学.武汉:湖北科学技术出版社,2005:1029-1031.
2. Sindrup SH, Jensen TS.Pharmacotherapy of trigeminal neuralgia. Clin J Pain2002;18:22–27.
3. Liu JK, Apfelbaum RI.Treatment of trigeminal neuralgia. Neurosurg Clin N Am,2004;15:319—334.
4. Cole CD, Liu JK, Apfelbaum RI. Historical perspectives on the diagnosis and treatmentof trigeminal neuralgia. Neurosurg Focus,2005;18:E4.
5. Hussain AM, Afshan G. Use of anticonvulsants drugs for neuropathic painful conditions.J Pak Med Assoc,2008;58(12):690-696.
6. Carrazana E, Mikoshiba I. Rationale and evidence for the use of oxcarbazepine inneuropathic pain. J Pain Symptom Manage,2003;25:31—35.
7. Nasreddine W, Beydoun A. Oxcarbazepine in neuropathic pain. Expert Opin InvestigDrugs,2007;16(10):1615-1625.
8.黄宇光,徐建国.神经病理性疼痛临床诊疗学.人民卫生出版社,2010;144-146.
9. Marziniak M, Breyer R, Evers S.SUNCT syndrome successfully treated with thecombination of oxcarbazepine and gabapentin. Pain Med,2009;10(8):1497-500.
10. Rozen TD. Antiepileptic drugs in the management of cluster headache and trigeminalneuralgia. Headache,2001;41Suppl1:S25.
11. Ito M, Yoshida K, Kimura H, et a1. Successful treatment of trigeminal neuralgia withmilnacipran. Clin Neuropharmacoi,2007;30:183-185.
12. Vick PG, Lamer TJ. Treatment of central poststroke painwithoral ketamine.Pain,2001;92(1/2):311-313.
13. Des B, Saha SP. Trigeminal neuralgia: current concepts and management. J Indian MedAssoc,2001;99:704.
14. Micheli F, Scorticati MC, Raina G. Beneficial effects of botulinum toxin type a forpatients with painful tic convulsif. Clin Neuropharmacol2002;25:260-262.
15. Bohluli B, Motamedi MH, Bagheri SC, et al. Use of botulinum toxin A fordrug-refractory trigeminal neuralgia: preliminary report. Oral Surg Oral Med OralPathol Oral Radiol Endod,2011;111(1):47-50.
16.朱婷鸽,张琪林,罗蔚锋,毛成洁,胡伟东,刘春风. A型肉毒毒素治疗难治性三叉神经痛临床观察.中国临床神经科学,2011;19(1):32-35.
17. Aoki KR. Evidence for antiociceptive activity of botulinum toxin type A in painmanagement. Headache,2003;43（suppl1）: S9-S15.
18. Kanai A, Suzuki A, Kobayashi M. Intranasal lidocaine8%spray for second-divisiontrigeminal neuralgia. Br J Anaesth,2006;97(4):559-563.
19. Rudolph M, Krafft MD. Trigeminal Neuralgia. AM Fam Physician,2008;77(9):1291-1296.
20. Jorns TP, Zakrzewska JM. Evidence-based approach to the medical management oftrigeminal neuralgia. Br J Neurosurg,2007;2l:253-26l.
21.吴承远,孟凡刚,王宏伟,刘玉光,徐淑军,孙召花.选择性射频热凝治疗三叉神经痛1860例临床研究.中华神经外科杂志,2004;20（1）:55-58.
22. Dandy WE.Concerning the cause of trigeminal neuralgia. Am J Surg,1934;24:447-455.
23. Jannetta PJ. Aterial compression of the trigeminal nerve at the pons in patients withtrigeminal neuralgia. Neurosurg,1967;26:159—162.
24. Pamir MN, Peker S. Microvascular Decompression for Trigeminal Neuralgia: ALong-Term Follom-Up Study. Minim Invas Neurosurg,2006;49:342-346.
25. Leksell L. Stereotaxic Radiosugery in Trigiminal Neuralgia. Acta Chir Scamd,1971;173:311-314.
26. Rand RW, Jacques DB, Melbe RW, et a1. Leksell Gamma Knife Treatment of TICDouloureux. Stereotact Furst Neurosurg,1993;61Suppl1:93-102.
27. Régis J．Metellus P, Hayashi M, et a1. Prospective controlled trial of gamma knifesurgery for essential trigeminal neuralgia. J Neurosurg,2006;104:913-924.
28. Slavin KV, Colpan ME. Munawar N, et a1.Trigeminal and occipital nerve stimulationfor craniofacial pain: a single-institution experience and review of the literature.Neurosurg Focus,2006;2l(6):E5.
29. Brown JA, Pilitsis JG. Percutaneous balloon compression for the treatment oftrigeminal neuralgia: results in56patients based on balloon compression pressuremonitoring. Neurosurg Focus,2005;18(5):E10.
30.徐翔,李平.针灸治疗原发性三叉神经痛50例临床观察.世界中西医结合杂志,2008;3（10）:596-597.
31.张志远,冉鹏飞.芎附全蜈干姜汤治疗顽固性三叉神经痛39例.光明中医,2011;26（3）:511-512.
32.孟敏,吕斌,杨棕嘉,李俊斌.中医药治疗老年人三叉神经痛的临床分析.中华老年口腔医学杂志,2011;9（3）:172-173.
2. Tash RT, Sze G, Leslie DR. Trigeminal neuralgia: MR imaging features. Radiology,1989;172:767-770.
3. Dandy WE. Concerning the cause of trigeminal neuralgia. Am J surg,1934;24:447-455.
4. Jannetta PJ. Aterial compression of the trigeminal nerve at the pons in patients withtrigeminal neuralgia. Neurosurg,1967;26:159—162.
5. Sindrup SH, Jensen TS. Pharmacotherapy of trigeminal neuralgia. Clin J Pain2002;18:22–27.
6. Jorns TP, Zakrzewska JM. Evidence-based approach to the medical management oftrigeminal neuralgia. Br J Neurosurg,2007;21（3）:253-261.
7.卢红霞,谢向东,李文涛.卡马西平联合甲钴胺治疗原发性三叉神经痛46例对照研究.中国实用神经疾病杂志,2008;11（9）:57-59.
8. Katusic S, Beard CM, Bergstralh E, Kurland LT. Incidence and clinical features oftrigeminal neuralgia, Rochster, Minnesota,1945-1984.Ann Neurol1990;27:89-95.
9. Ahn KS, Lee MK, Hwang SH, Lee JE, Cho CW, Kim DJ. Percutaneous BalloonCompression of Trigeminal Ganglion for the treatment of idiopathic TrigeminalNeuralgia. Korean Neurosurg Soc,2004;36:213-217.
10.朱晋,仲骏,李世亭.微血管减压术治疗三叉神经痛临床回顾.中华神经外科疾病研究杂志,2009;8（3）:206-209.
11. Broggi G, Ferroli P. Microvascular decompression for trigeminal neuralgia: commentson a series of250cases, including10patients with multiple sclerosis. NeurolNeurosurg Psychiatry,2000Jan;68(1):59-64.
12.吕学明,吕福林,袁绍纪,张荣伟,陈援朝等.微血管减压术治疗脑神经疾病的并发症分析.中国神经精神疾病杂志,2010;36（1）:53-54.
13.李莉,刘庆森.肉毒毒素在疼痛治疗中的应用.中国临床康复杂志,2006;10（40）:130-132.
14. Micheli F, Scorticati MC, Raina G. Beneficial effects of botulinum toxin type a forpatients with painful tic convulsif. Clin Neuropharmacol2002;25:260-262.
15. Merskey H, Bogduk N. Classification of chronic pain. Description of Chronic Pain.Syndromes and Definitions of Pain Terms. Seattle:IASP Press,1994:59-71.
16. Anonymous.Classification and diagnostic eriteria for headache disorders, cranianeuralgias and facial pain.Headache Classification Committee of the InternationalHeadache Society. Cephalalgia1988;8(Suppl7):1-96.
17. Revil SI, Robinson JO, Rosen M, et al. The reliability of a linear analogue forevaluating pain. Anaesthesia,1976;31:1191-1198.
18.杨岸超,张建国,张凯,孟凡刚,葛明等.原发性典型与不典型三叉神经痛微血管减压术的疗效分析.中华神经外科疾病研究杂志,2011;10（2）:109-112.
19. Pamir MN, Peker S. Microvascular Decompression for Trigeminal Neuralgia:ALong-Term Follom-Up Study. Minim Invas Neurosurg,2006;49:342-346.
20. Devor M, Amir R, Rappaport ZH. Pathopysiology of trigeminal neuralgia: the ignitionhypothesis. Clin J Pain,2002;18（1）:4-13.
21. Marinkovic S, Todorovic V, Gibo H, et al. The trigeminal vasculature pathology inpatients with neuralgia. Headache,2007;47（9）:1334-1339.
22. Cho DY, Chang CG, Wang YC, Wang FH, Shen CC, Yang DY. Repeat operations infailed microvascular decompression for trigeminal neuralgia. Neurosurgery.1994;35:665-669.
23. Schulte-Mattler WJ, Wieser T, Zierz S. Treatment of tension-type headache withbotulinum toxin: a pilot study. Eur J Med Res,1999;4（5）:183-6.
24. Zú iga C, Díaz S, Piedimonte F, Micheli F. Beneficial effects of Botulinum toxin typeA in trigeminal neuralgia. Arq Neuropsiquiatr2008;66(3-A):500-503.
25. Ngeow WC, Nair R. Injection of botulinum toxin type A (BOTOX) into trigger zone oftrigeminal neuralgia as a means to control pain. Oral Surg Oral Med Oral Pathol OralRadiol Endod2010;109(3):e47-e50.
26.申继红,连亚军,郑亚珂,张海峰,谢媛媛,魏红玲.A型肉毒毒素治疗原发性三叉神经痛的疗效观察.中国康复医学杂志,2011;26（5）:483-484.
27.朱婷鸽,张琪林,罗蔚锋,毛成洁,胡伟东,刘春风. A型肉毒毒素治疗难治性三叉神经痛临床观察.中国临床神经科学,2011;19(1):32-35.
28. Aoki KR. Evidence for antiociceptive activity of botulinum toxin type A in painmanagement. Headache,2003;43（suppl1）: S9-S15.
29. Mense S. Neurobiological basis for the use of botulinum toxin in pain therapy. J Neurol,2004;251（Supp l1）:I1-I7.
30. Guyer BM. Mechanism of Botulinum toxin in the relief of chronic pain. Curr Rev Pain,1999;3(6):427-431.
1.王忠诚.神经外科学.武汉:湖北科学技术出版社,2005:1029-1031.
2. Sindrup SH, Jensen TS.Pharmacotherapy of trigeminal neuralgia. Clin J Pain2002;18:22–27.
3. Liu JK, Apfelbaum RI.Treatment of trigeminal neuralgia. Neurosurg Clin N Am,2004;15:319—334.
4. Cole CD, Liu JK, Apfelbaum RI. Historical perspectives on the diagnosis and treatmentof trigeminal neuralgia. Neurosurg Focus,2005;18:E4.
5. Hussain AM, Afshan G. Use of anticonvulsants drugs for neuropathic painful conditions.J Pak Med Assoc,2008;58(12):690-696.
6. Carrazana E, Mikoshiba I. Rationale and evidence for the use of oxcarbazepine inneuropathic pain. J Pain Symptom Manage,2003;25:31—35.
7. Nasreddine W, Beydoun A. Oxcarbazepine in neuropathic pain. Expert Opin InvestigDrugs,2007;16(10):1615-1625.
8.黄宇光,徐建国.神经病理性疼痛临床诊疗学.人民卫生出版社,2010;144-146.
9. Marziniak M, Breyer R, Evers S.SUNCT syndrome successfully treated with thecombination of oxcarbazepine and gabapentin. Pain Med,2009;10(8):1497-500.
10. Rozen TD. Antiepileptic drugs in the management of cluster headache and trigeminalneuralgia. Headache,2001;41Suppl1:S25.
11. Ito M, Yoshida K, Kimura H, et a1. Successful treatment of trigeminal neuralgia withmilnacipran. Clin Neuropharmacoi,2007;30:183-185.
12. Vick PG, Lamer TJ. Treatment of central poststroke painwithoral ketamine.Pain,2001;92(1/2):311-313.
13. Des B, Saha SP. Trigeminal neuralgia: current concepts and management. J Indian MedAssoc,2001;99:704.
14. Micheli F, Scorticati MC, Raina G. Beneficial effects of botulinum toxin type a forpatients with painful tic convulsif. Clin Neuropharmacol2002;25:260-262.
15. Bohluli B, Motamedi MH, Bagheri SC, et al. Use of botulinum toxin A fordrug-refractory trigeminal neuralgia: preliminary report. Oral Surg Oral Med OralPathol Oral Radiol Endod,2011;111(1):47-50.
16.朱婷鸽,张琪林,罗蔚锋,毛成洁,胡伟东,刘春风. A型肉毒毒素治疗难治性三叉神经痛临床观察.中国临床神经科学,2011;19(1):32-35.
17. Aoki KR. Evidence for antiociceptive activity of botulinum toxin type A in painmanagement. Headache,2003;43（suppl1）: S9-S15.
18. Kanai A, Suzuki A, Kobayashi M. Intranasal lidocaine8%spray for second-divisiontrigeminal neuralgia. Br J Anaesth,2006;97(4):559-563.
19. Rudolph M, Krafft MD. Trigeminal Neuralgia. AM Fam Physician,2008;77(9):1291-1296.
20. Jorns TP, Zakrzewska JM. Evidence-based approach to the medical management oftrigeminal neuralgia. Br J Neurosurg,2007;2l:253-26l.
21.吴承远,孟凡刚,王宏伟,刘玉光,徐淑军,孙召花.选择性射频热凝治疗三叉神经痛1860例临床研究.中华神经外科杂志,2004;20（1）:55-58.
22. Dandy WE.Concerning the cause of trigeminal neuralgia. Am J Surg,1934;24:447-455.
23. Jannetta PJ. Aterial compression of the trigeminal nerve at the pons in patients withtrigeminal neuralgia. Neurosurg,1967;26:159—162.
24. Pamir MN, Peker S. Microvascular Decompression for Trigeminal Neuralgia: ALong-Term Follom-Up Study. Minim Invas Neurosurg,2006;49:342-346.
25. Leksell L. Stereotaxic Radiosugery in Trigiminal Neuralgia. Acta Chir Scamd,1971;173:311-314.
26. Rand RW, Jacques DB, Melbe RW, et a1. Leksell Gamma Knife Treatment of TICDouloureux. Stereotact Furst Neurosurg,1993;61Suppl1:93-102.
27. Régis J．Metellus P, Hayashi M, et a1. Prospective controlled trial of gamma knifesurgery for essential trigeminal neuralgia. J Neurosurg,2006;104:913-924.
28. Slavin KV, Colpan ME. Munawar N, et a1.Trigeminal and occipital nerve stimulationfor craniofacial pain: a single-institution experience and review of the literature.Neurosurg Focus,2006;2l(6):E5.
29. Brown JA, Pilitsis JG. Percutaneous balloon compression for the treatment oftrigeminal neuralgia: results in56patients based on balloon compression pressuremonitoring. Neurosurg Focus,2005;18(5):E10.
30.徐翔,李平.针灸治疗原发性三叉神经痛50例临床观察.世界中西医结合杂志,2008;3（10）:596-597.
31.张志远,冉鹏飞.芎附全蜈干姜汤治疗顽固性三叉神经痛39例.光明中医,2011;26（3）:511-512.
32.孟敏,吕斌,杨棕嘉,李俊斌.中医药治疗老年人三叉神经痛的临床分析.中华老年口腔医学杂志,2011;9（3）:172-173.