Kirurško liječenje neuralgije trigeminusa

master's thesis

• Title (english): Surgical treatment of trigeminal neuralgia
• Author: Arian Širac
• Mentor: Darko Chudy (mentor)
• Committee member: Goran Mrak (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Darko Chudy (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Neuralgija trigeminusa je bolni sindrom koji se u populaciji javlja relativno rijetko. Zbog jake
prirode boli i pratećih posljedica na fizičko i psihičko zdravlje bolesnika vrlo je bitno
pravodobno prepoznati ovaj sindrom i započeti s liječenjem. U studijama je pokazano da bolji
ishod liječenja imaju bolesnici kojima je prije liječenja bolest kraće trajala. Vrlo često se ova
bolest zamjenjuje sa patološkim stanjima dentalne etiologije stoga su doktori dentalne medicine
često prvi u kontaktu sa ovom bolešću. Bol se javlja na licu u predjelu inervacije živca
trigeminusa, pacijenti ju opisuju kao “udar groma”, unilateralna je i može trajati od 1 sekunde
do 2 minute. Bol je često provocirana brijanjem, smijanjem ili vjetrom na licu. Upravo zbog
takvog niskog praga podražljivosti i nepredvidljivosti kada će se bol pojaviti ovi pacijenti često
boluju i od psihijatrijskih bolesti, mogu biti anksiozni ili depresivni, a njihova percepcija boli
je izmjenjena te je katkada teško u komunikaciji s pacijentom doznati koliko ga stvarno boli i
kako se osjeća nakon, na primjer, kirurškog tretmana.
U liječenju neuralgije trigeminusa počinje se sa farmakološkom terapijom. Najbolje rezultate
pokazali su antiepileptici poput karbamazepina, baklofena, lamotrigina... U slučaju da nakon
farmakoterapije pacijent još ima neizdržive bolove prelazi se na kirurško liječenje.
Glavni princip liječenja NT, ali i najinvazivniji jer zahtijeva otvaranje glave je mikrovaskularna
dekompresija (MVD). Pacijenti koji su u dobroj kondiciji za opću anesteziju i bez teških
komorbiditeta najčešće idu na ovaj zahvat.
Alternativa MVD su perkutane tehnike: 1. radiofrekventna termokoagulacija, 2. rizotomija
glicerolom, 3. kompresija balonom. Stereotaktička radiokirurgija je također dobra opcija.
Prednosti perkutanih tehnika je to što su manje invazivne te je brži i lakši postoperativni
oporavak. Stereotaktička radiokirurgija se među svim navedenim terapijskim metodama ističe
kao najmanje invazivna te se promiče u sve privlačniju terapijsku opciju, iako su moguće i
ozbiljne komplikacije poput radionekroze.

Abstract (english)

Trigeminal neuralgia is pain-related syndrome which occurs relatively rarely in population. Due
to strong character of the pain and following concequences on patients physical and mental
health it is very important to early recognize this syndrome and start treating it early. Studies
showed that patients who had shorter duration of the disease prior to surgical treatment have
better postoperative outcomes. Very often, this disease is misdiagnosed with a dental pathology,
therefore dentists are often first to see this condition in patient. The pain appears on the face,
on the location of inervation of trigeminal nerve, patients describe it as a “thunderstruck”, it is
unilateral and lasts for 1 second to 2 minutes. Pain is usually provoked when shaving a beard,
when smiling or due to the wind touching the face. Due to low treshold and unpredictability of
the pain, patients are often affected by psychiatric diseases such as depression or anxiety, their
pain perception is altered and consequently it’s sometimes hard to get the patient’s feedback on
success of surgical treatment.
Treating trigeminal neuralgia starts with farmacological treatment. Antiepileptics such as:
carbamazepine, baclofen, lamotrigine have shown to be a good farmacological options. In case
of inadequate pain control with medications, we proceede to surgical treatments. Main principle
of surgical treatment, but aswell the most invasive since it’s required to open patients skull and
manouver around the brain - is microvascular decompression. Patients in good physical
condition for general anaesthesia and without high risk comorbidities are good candidates for
this procedure. An alternative for MVD are percutaneous treatments such as: 1. baloon
compresion, 2. glicerol rhyzotomy, 3. radiofrequency thermocoagulation. Stereotactic
radiosurgery is aswell a good option.
Percutaneous treatments are generally less invasive than MVD and have easier postoperative
recovery for the patient. Among all mentioned treatments, stereotactic radiosurgery stands out
as the least invasive procedure and breaks through as a very good treatment option.

• Keywords: neuralgija trigeminusa; kirurško liječenje; bol
• Keywords (english): trigeminal neuralgia; surgical treatment; pain
• Language: croatian
• URN:NBN: urn:nbn:hr:105:787346
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-02-28 10:12:01