事件记录
面试官: Severe, sudden, and sometimes debilitating face pain is a symptom of a disease called 三叉神经痛 and some people suffer with the condition and don't even realize that's what they have. Or maybe it was misdiagnosed as something else so they can't get treatment.
Dr. Shervin Rahimpour是一名 神经外科医生 谁擅长三叉神经痛的手术治疗, 他将大发娱乐大发娱乐理解如何做出诊断. 首先，你告诉我这是一种诊断不佳的疾病. 你这话到底是什么意思?
Dr. Rahimpour: 这种疼痛通常分布在脸颊和下巴周围. And so it's natural for patients to think that this is likely a result of their dental health. 所以他们经常通过牙医寻求治疗, 通常, 你知道, 做拔牙之类的手术, 这种痛苦持续存在. So that's often why this is poorly diagnosed is because it overlaps with other common issues like having tooth pain.
面试官: 是的. And I think a lot of us think well, the pain is here, this must be the source of the pain. 它在我的嘴里或脸颊上，它一定是源头. 但这种疾病的情况并非如此. 疼痛是从哪里来的?
Dr. Rahimpour: 三叉神经, 哪条是大发娱乐拥有的12条脑神经中的一条, 供应, 除此之外, 大发娱乐在脸上感受到的感觉. 大发娱乐有两根神经，两边各有一根. 每一根神经都向那半张脸大发娱乐提供感觉. 神经有三个分支与之相关. 有一种覆盖在额头和眼睛周围. The other division is around the cheek area, and then a third division encompasses the jaw. 所以最常见的是, 这种痛苦可能会影响到排名靠后的两个部门, 哪个在脸颊和下巴周围, and that's where this overlap comes with potentially pain coming from your teeth.
面试官: And somebody goes to the dentist, they have an extraction done and that doesn't solve anything. Do they try to get a diagnosis beyond that, or do most people just give up or do 你知道?
Dr. Rahimpour: 是啊，我得补充一句，有时候可能是你的牙齿. 所以让你的牙医做这个评估是值得的. But eventually, this pain syndrome is referred either to a pain specialist or even a neurologist. Those are the folks that typically end up diagnosing this as 三叉神经痛-type pain.
面试官: 解释一下人们可能会遇到的一些常见症状.
Dr. Rahimpour: 是的,绝对. 所以，这种疼痛曾经是 . . . this disease used to be known as suicide disease because it was such a horrible pain for patients to experience. And it's often a severe electric type jolt or stabbing pain involving one or more of the divisions of the trigeminal nerve of the face. 它通常是由相对无害的刺激引起的. 我的意思是，任何东西都可以像一阵风一样简单, 或者说话，或者刷牙, 或者洗澡的时候被水打到脸. These are kind of the very, very basic and innocuous things that can trigger that type of pain.
面试官: 以及引起疼痛的神经是怎么回事?
Dr. Rahimpour: The vast majority of cases are thought to be caused by a vessel sitting on the nerve root as it enters into the brainstem. And so what this vessel causes is damage over a period of time that ends up injuring the insulation around the nerve known as myelin. 这就会导致神经异常放电.
面试官: So it's rubbing 再一次。st there, damaging the insulation every time your heart beats.
Dr. Rahimpour: 完全正确.
面试官: 它破坏了 . . . 好吧.
Dr. Rahimpour: So the thought is that if we can remove or transpose this vessel from the nerve root . . .
面试官: 对，把它拿开.
Dr. Rahimpour: 把它从那里拿开, that could potentially allow the nerve to heal and prevent some of this aberrant firing.
面试官: And if a patient has this type of pain, they would go to their primary care physician first likely. 检查结果是什么样的?
Dr. Rahimpour: 通常, the patient has these classic types of symptoms or the stabbing electric type pains of the facial region, 再一次。, 三叉神经的涉及三叉神经的一个或多个分支的. 大发娱乐经常问病人，“这种疼痛是怎么来的？?“如果有什么, 再一次。, 风, 咀嚼, 会说话的, 诸如此类的, 这很符合三叉神经痛的症状. 疼痛也会持续几秒钟甚至几分钟, 这是这种疾病的另一个特征或标志. 大发娱乐经常寻找这样的病人, 你知道, typically we find that this disease occurs more often in the older population. 所以发病率随着年龄的增长而上升. 但这也可能是其他一些次要过程的结果. 当然, it can range anything from facial trauma and include other secondary causes like multiple sclerosis.
面试官: At what point should a person consider consulting with a physician who specializes in 三叉神经痛?
Dr. Rahimpour: 我认为最好在早期优化药物治疗. So a lot of the medications we use for this type of pain are actually anticonvulsants used in 癫痫. The reason why is because, similar to 癫痫, the nerve can act on its own and fire. And so the idea is can we stabilize this nerve so that it prevents it from firing, 就像大发娱乐治疗癫痫一样. 这些类型的药物已经开始了, they're increased to a therapeutic level and then the patient is evaluated to see if this treats their pain. 再一次。, 绝大多数患者对这些药物有反应, 90%以上, 但这些患者中有一半最终出现了不想要的药物副作用. And then, of course, there's a 10% that did not respond to the medication at all.
面试官: 是的. 这种药物, 这是一个拨号的过程吗, 你得找出每个人的最佳位置?
Dr. Rahimpour: 是的, I would say that most anticonvulsants are started at a low dose and gradually titrated up.
面试官: 对于那些对药物没有反应的人, or the side effects are just so terrible that it's really impacting the quality of life, 这就是 微血管减压手术 进来. 这就是你要做的.
Dr. Rahimpour: 完全正确. 所以对于药物没有反应的病人, if they've had an MRI scan that shows that potentially there might be a vessel there pushing on the nerve, 这就是微血管减压可以发挥作用的地方.
面试官: What about for patients where they have the condition, and it's not pressing 再一次。st that nerve? 这是可能的，对吧?
Dr. Rahimpour: 病人 where we don't necessarily see a blood vessel pushing on the nerve, 或者他们不一定是一个好的手术候选人, 大发娱乐可以大发娱乐提供其他微创方法. 这些方法包括 经皮神经根切断术. 前提是大发娱乐用一根针扎到神经的底部, 被称为三叉神经节, 大发娱乐试图破坏神经来破坏疼痛信号. The other option is using radiation in the same way that folks use it for tumors to try to focus the radiation and try to damage the nerve 再一次。, 来阻止这种疼痛信号.
面试官: 这是最后两个程序吗, are they an alternative to somebody getting a microvascular decompression?
Dr. Rahimpour: They are alternatives, but I should add that they're not as efficacious. So when we do find patients are good candidates for microvascular decompression, we try to advocate for that as it gives us the best chance for pain freedom.
面试官: 在有人做了微血管减压手术之后, 治疗疼痛的成功率是多少?
Dr. Rahimpour: 大发娱乐期望患者术后疼痛能立即缓解, 尤其是当大发娱乐发现压迫神经的血管时. 从历史上看，70%到80%的患者在5年后仍然没有疼痛.
面试官: 剩下的20%?
Dr. Rahimpour: 疼痛会再次发生. 如果是这样的话, 大发娱乐总是可以重新考虑其他可能的干预措施, including some of the percutaneous and radiosurgery techniques that I mentioned.
面试官: 对于接受微血管减压的患者, 这些病人的满意率是多少? 我听说这可能会改变一些人的生活.
Dr. Rahimpour: 绝对. 这是一种使人衰弱的疾病. 我的意思是, 你可以想象它会影响你的饮食方式, and the way you conduct yourself throughout your day-to-day in anticipation of a sudden pain strike, 无痛意味着一切. 所以当病人不再疼痛时, 大发娱乐认为在大范围内是这样的吗, 绝大多数时候是在微血管减压后, 这绝对会改变你的生活.