New insights into the trigeminal nerve somatotopy: Lessons from partial sensory rhizotomy - 28/11/17
Résumé |
Background |
Trigeminal neuralgia (TN) is a severe unilateral facial pain involving one or more branches of the trigeminal nerve (V). Microvascular decompression is a standard curative treatment of pharmacoresistant TN. Alternative procedures used for secondary or idiopathic TN usually lead to a high rate of pain recurrence and sensitive deficits.
Objective |
To study a retrospective cohort of patients treated by partial sensory rhizotomy (PSR) and to precise a somatotopy of the V.
Methods |
Consecutive cases of adult patients treated in our institution between March 2000 and June 2015 for pharmacoresistant TN without vascular compression by two-thirds pars major rhizotomy of the V were retrospectively collected.
Results |
Among 155 patients treated for TN in our institution, 22 patients that had undergone PSR were included. Fourteen patients had idiopathic TN without compression of the nerve root, 6 had TN due to multiple sclerosis and 2 had trigeminal conflict by Meckel's cave inoperable tumor. Complete pain relief was achieved in 86.4%. Partial and focalized postoperative hypoesthesia was present in 22.7%. TN recurrence rate at 5 years was 31.5% (SD 10.9%). The variability of sensory loss and pain relief after PSR are discussed in the light of somatotopy of the V.
Conclusions |
Based on our results, we conclude that a rhizotomy of the ventrolateral two-thirds of pars major of the V is a safe and effective alternative to other destructive procedures to treat pharmacoresistant TN without vascular compression, and we clarify the functional somatotopy of the V at the juxtapontine region.
Le texte complet de cet article est disponible en PDF.Keywords : Somatotopie du nerf trijumeau, Anatomie du nerf trijumeau, Névralgie du trijumeau
Plan
Vol 101 - N° 335
P. 195 - décembre 2017 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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