事件记录
面试官: 严重，突然，有时使人虚弱的面部疼痛是一种疾病的症状 三叉神经痛 有些人患有这种疾病，甚至没有意识到他们患有这种疾病. 或者可能被误诊为其他疾病，所以他们无法得到治疗.
Dr. Shervin Rahimpour是一名 神经外科医生 who specializes in the surgical treatment of 三叉神经痛, and he's going to help us understand how to come to that diagnosis. So first of all, you tell me it's a poorly diagnosed disease. What exactly do you mean by that?
Dr. Rahimpour: Often this pain is distributed around the cheek and jaw area. 因此，患者很自然地认为这可能是他们牙齿健康的结果. And so they often seek treatment through a dentist, 通常, 你知道, undergo a tooth extraction or something like that, 这种痛苦持续存在. 所以这就是为什么这个诊断很差的原因，因为它和其他常见的问题重叠，比如牙痛.
面试官: 是的. 我想大发娱乐很多人都认为，痛苦就在大发娱乐，这一定是痛苦的根源. It's in my mouth or my cheek, it must be the source. But that's not the case with this disease. Where does the pain originate from?
Dr. Rahimpour: 三叉神经, which is one of the 12 cranial nerves that we have, 供应, 除此之外, the sensation that we feel over our face. So there are two nerves, one for each side. Each nerve 供应 the sensation to that half of the face. And the nerve has three divisions associated with it. There's one that kind of overlays the forehead and around the eye. 另一部分在脸颊周围，第三部分在下巴周围. 所以最常见的是, the pain is likely to affect those bottom two divisions, which is around the cheek and the jaw area, 这就是牙齿潜在疼痛的重叠之处.
面试官: 有人去看牙医，他们拔了牙，但这并不能解决任何问题. 他们会试图得到更明确的诊断吗，还是大多数人都放弃了，你知道吗?
Dr. Rahimpour: 是的, I should add that sometimes it can be your teeth. So it is worth having that evaluation done by your dentist. 但最终，这种疼痛综合症会被转介给疼痛专家甚至神经科医生. 这些人通常最终诊断为三叉神经痛类型的疼痛.
面试官: Explain some of the common symptoms that people might experience.
Dr. Rahimpour: 是的,绝对. So 再一次。, this pain used to be . . . 这种疾病过去被称为自杀病，因为它对病人来说是一种可怕的痛苦. 它通常是一种严重的电击或刺痛，涉及面部三叉神经的一个或多个分支. It's often set off by very relatively innocuous stimuli. What 我的意思是 by that is anything as simple as just a gust of 风, or 会说话的 or brushing your teeth, or having water hit your face when you're taking a shower. 这些都是非常基本的无害的东西可以引发那种疼痛.
面试官: And what's going on with the nerves that is causing this pain?
Dr. Rahimpour: 绝大多数病例被认为是由神经根上的血管进入脑干引起的. 这条血管在一段时间内造成了损伤，最终损伤了神经周围的绝缘层，也就是髓鞘. And then this can result in sort of aberrant firing of the nerve.
面试官: 所以它会摩擦那里，每次你的心跳都会破坏绝缘层.
Dr. Rahimpour: 完全正确.
面试官: 它破坏了 . . . 好吧.
Dr. Rahimpour: 所以大发娱乐的想法是如果大发娱乐能从神经根移除或转置这条血管 . . .
面试官: 是的, get it away from there.
Dr. Rahimpour: 把它从那里拿开, 这可能会让神经愈合，并防止这种异常的放电.
面试官: 如果病人有这种类型的疼痛，他们可能会首先去看他们的初级保健医生. What would that workup look like?
Dr. Rahimpour: 通常, 病人有这些典型的症状或者说是面部的刺痛感, 再一次。, involving either one or more divisions of the trigeminal nerve. And we often ask patients, 你知道, "How is this pain brought about?“如果有什么, 再一次。, 风, 咀嚼, 会说话的, 诸如此类的, that's pretty consistent with 三叉神经痛. The pain also 再一次。 persists to seconds to potentially minutes, and so that's another signature or hallmark of the disease. And we often look for patients that, 你知道, 通常大发娱乐发现这种疾病在老年人中更常见. So the incidence kind of climbs as age goes up. But this can also be a result of some other secondary processes. 当然, 它可以包括面部创伤和其他继发原因，如多发性硬化症.
面试官: 在什么情况下，一个人应该考虑咨询专门研究三叉神经痛的医生?
Dr. Rahimpour: I think early on it's best to have the medical therapy be optimized. 所以很多治疗这种疼痛的药物实际上都是抗惊厥药 癫痫. 原因是，与癫痫类似，神经可以自行行动并开火. 所以大发娱乐的想法是大发娱乐能不能稳定这条神经从而阻止它放电, the same way that we try for 癫痫. Those types of medications are started, 它们被增加到治疗水平，然后对病人进行评估，看看这是否能治疗他们的疼痛. 再一次。, the vast majority of patients respond to these medications, 90%以上, but half of those patients end up having unwanted drug side effects. 当然，还有10%的人对药物完全没有反应.
面试官: 是的. 这种药物, is it kind of a dialing-in process, you've kind of got to figure out the sweet spot for everybody?
Dr. Rahimpour: 是的，我想说大多数抗惊厥药都是以低剂量开始的然后逐渐增加剂量.
面试官: And for the individual that is not responding to medication, 或者副作用非常严重，影响了生活质量, 这就是 microvascular decompression procedure 进来. That's what you're doing there.
Dr. Rahimpour: 完全正确. So for patients that aren't responding to the medication, 如果他们做过核磁共振扫描，显示那里可能有一条血管在压迫神经, that's where microvascular decompression can play a role.
面试官: 对于那些有这种情况的病人来说，它不会压迫到神经? 这是可能的，对吧?
Dr. Rahimpour: 大发娱乐不一定会看到血管压迫神经, or they might not necessarily be a good operative candidate, we can offer other minimally invasive approaches. 这些方法包括 经皮神经根切断术. The premise there is that we with a needle go to the base of this nerve, known as the trigeminal ganglion, and we try to damage that nerve to sort of disrupt the pain signal. 另一种选择是使用放射疗法，就像人们用放射疗法治疗肿瘤一样，试图集中放射疗法，试图再次损伤神经, to stop this pain signaling.
面试官: Are these other last two procedures, 它们能代替微血管减压吗?
Dr. Rahimpour: 它们是替代品，但我要补充一点，它们没有那么有效. 所以当大发娱乐找到适合进行微血管减压的病人时, 大发娱乐努力提倡这样做，因为这给了大发娱乐最好的摆脱痛苦的机会.
面试官: After somebody has the microvascular decompression, what is the success rate that that actually takes care of the pain?
Dr. Rahimpour: We expect that patients often have immediate pain relief after surgery, especially if we do find a blood vessel that's compressing the nerve. Historically, 70% to 80% of patients are still pain-free at five years.
面试官: 剩下的20%?
Dr. Rahimpour: 疼痛会再次发生. 如果是这样的话, we can always revisit other possible interventions, 包括我提到的一些经皮和放射手术技术.
面试官: For the patients who get the microvascular decompression, what's the satisfaction rate among those patients? I hear this could be life-changing for some people.
Dr. Rahimpour: 绝对. So 再一次。, this is a very debilitating disease. 我的意思是, you can imagine if it's affecting the way you eat, 以及你在预期突然疼痛发作时的日常行为, being pain-free means everything. And so when patients are pain-free 再一次。, where we expect that to be the case in the vast, vast majority of times after microvascular decompression, this is absolutely life-changing.