Trigeminal Nevralji
Özet
Trigeminal nevralji (TN), yüzün duyusunu alan trigeminal siniri etkileyen, genellikle tek taraflı, ani ve şiddetli elektrik çarpması benzeri ağrı ataklarıyla seyreden kronik bir sendromdur. Yıllık insidansı 100.000 kişide 4-29 arası olup, kadınlarda ve 50 yaş üstünde daha sık görülür. ICHD-3'e göre klasik, sekonder ve idiyopatik olarak üçe ayrılır. Klasik tip çoğunlukla superior serebellar arterin mikrovasküler basısından ve buna bağlı demiyelinizasyondan kaynaklanır. Sekonder tip ise tümör veya multipl skleroz gibi altta yatan hastalıklara bağlıdır. Tanıda sekonder nedenleri dışlamak için altın standart beyin MR'ıdır. Tedavide birinci basamak farmakolojik ajanlar karbamazepin ve okskarbazepindir; dirençli vakalarda lamotrijin, gabapentin veya baklofen eklenebilir. Akut alevlenmelerde intravenöz fosfenitoin veya lidokain infüzyonları etkilidir. İlaç tedavisine yanıt vermeyen klasik TN'li hastalarda en etkili uzun süreli cerrahi yöntem invaziv olan mikrovasküler dekompresyondur. Cerrahiye uygun olmayan veya vasküler basısı bulunmayan hastalarda ise perkütan nöroablatif yöntemler (balon kompresyon, radyofrekans termokoagülasyon, gliserol rizoliz) veya stereotaktik radyocerrahi gibi daha az invaziv ablatif seçenekler tercih edilir. Nüksler ve remisyonlarla seyreden bu hastalıkta tedavi seçimi hastanın yaşına ve genel sağlık durumuna göre özelleştirilmelidir.
Trigeminal neuralgia (TN) is a chronic painful syndrome characterized by recurrent, brief, and very severe electric shock-like pain attacks that usually affect one side of the face by impacting the trigeminal nerve. Its annual incidence is 4-29 per 100,000 people, occurring more frequently in women and individuals over the age of 50. According to ICHD-3, it is classified into three types: classical, secondary, and idiopathic. The classical type is mostly caused by microvascular compression of the superior cerebellar artery and subsequent nerve demyelination, while the secondary type is related to underlying diseases such as tumors or multiple sclerosis. Brain MRI is the gold standard for diagnosis to rule out secondary causes. First-line pharmacological treatments are carbamazepine and oxcarbazepine, while lamotrigine, gabapentin, or baclofen can be added in resistant cases. Intravenous infusions of fosphenytoin or lidocaine are effective during acute exacerbations. For classical TN patients unresponsive to medical treatment, invasive microvascular decompression is the most effective long-term surgical method. In patients who are not suitable for this surgery or lack vascular contact, less invasive ablative options like percutaneous neuroablative procedures (balloon compression, radiofrequency thermocoagulation, glycerol rhizolysis) or stereotactic radiosurgery are preferred. Characterized by relapses and remissions, the treatment selection for this disease must be customized according to the patient's age and general health status.
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