neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2018-20-1-33-48neurosurgery-512Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ЛИЦЕВОЙ БОЛИSURGICAL TREATMENT FOR FACIAL PAINhttps://orcid.org/0000-0002-1209-8960РзаевД. А.RzaevD. A.

630087 Новосибирск, ул. Немировича-Данченко, 132/1

630090 Новосибирск, ул. Пирогова, 2

132/1 Nemirovicha-Danchenko St., Novosibirsk 630087

2 Pirogova St., Novosibirsk 630090

d_rzaev@neuronsk.ruhttps://orcid.org/0000-0002-3885-3004МойсакГ. И.MoisakG. I.

630087 Новосибирск, ул. Немировича-Данченко, 132/1

630090 Новосибирск, ул. Пирогова, 2

132/1 Nemirovicha-Danchenko St., Novosibirsk 630087

2 Pirogova St., Novosibirsk 630090

https://orcid.org/0000-0001-7537-3846АмелинаЕ. В.AmelinaE. V.

630090 Новосибирск, пр. Академика Лаврентьева, 6

6 Akademika Lavrent'eva, Novosibirsk 630090

ФГБУ «Федеральный центр нейрохирургии» Минздрава России; ФГАОУ ВО «Новосибирский национальный исследовательский государственный университет»РоссияFederal Neurosurgical Center, Ministry of Health of Russia; Novosibirsk State UniversityRussian FederationФГБУН Институт вычислительных технологий СО РАНРоссияInstitute of Computational Technologies, Siberian Branch of the Russian Academy of SciencesRussian Federation2018220420182013348Copyright © Рзаев Д.А., Мойсак Г.И., Амелина Е.В., 20182018Рзаев Д.А., Мойсак Г.И., Амелина Е.В.Rzaev D.A., Moisak G.I., Amelina E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/512Введение

Введение. Разные виды лицевой боли (ЛБ) относятся к хроническим и трудно излечимым заболеваниям нервной системы. Для повышения эффективности хирургической помощи больным с ЛБ, уменьшения количества неоправданных инвазивных процедур и увеличения числа благоприятных исходов необходима разработка алгоритма выбора оптимального вида вмешательства.

Целями исследования явились оценка эффективности предложенного алгоритма выбора вида лечения ЛБ на большом числе пациентов, разработка алгоритмов дифференцированного лечения больных с синдромом ЛБ разной этиологии и обзор данных литературы об эффективности разных видов вмешательств.

Материалы и методы

Материалы и методы. У 382 пациентов (128 мужчин и 254 женщины) с ЛБ разных типов был апробирован предложенный алгоритм. Пациенты проходили лечение с 2000 по 2016 г. на базе 4 стационаров.

Результаты

Результаты. При всех видах оперативных вмешательств при использовании алгоритма снижение интенсивности боли более чем на 25 % от исходного уровня отмечено в катамнезе у 78,2 % больных.

Заключение

Заключение. Выбор вида хирургического вмешательства основан прежде всего на уточнении этиопатогенетических механизмов болевого синдрома. Для этого необходимо комплексное обследование пациентов, включающее магнитно-резонансную томографию, использование последовательности Т2 3D-CISS, трактографию корешка тройничного нерва, применение при показаниях контрастирующего вещества, что позволяет выявить причину ЛБ. Для выбора оптимального вида лечения предлагается использовать апробированные алгоритмы.

Introduction

Introduction. Different types of facial pain (FP) are the chronic, intractable diseases of the nervous system. To improve the effectiveness of surgery in patients with FP, to reduce the number of unnecessary invasive procedures and to increase the number of favorable outcomes, it is needed to use algorithms for choosing the most preferable interventions.

Objective is to evaluate the effectiveness of the proposed algorithm in the treatment of the FP in the practice of a neurosurgical hospital on a large number of patients, the development of algorithms for differentiated treatment of patients with the different etiologies of FP syndrome and to review the literature in light of the effectiveness of different types of interventions.

Materials and methods

Materials and methods. The proposed algorithm was tested in 382 patients (128 men and 254 women) with different types of FP. Patients were treated in 4 hospitals from 2000 to 2016.

Results

Results. The pain relief more than 25 % of the initial intensity of pain was detected in 78.2 % of patients in the follow-up period in all types of surgical interventions when using the algorithm.

Conclusion

Conclusion. The choice of the type of surgical intervention is based primarily on clarifying the etiopathogenetic mechanisms of the development of pain syndrome. This requires a comprehensive examination of patients using methods such as magnetic resonance imaging, the use of the T2 3D-CISS, the tractography of the trigeminal nerve root, the use of a contrast to diagnose the cause of FP. To select the optimal type of treatment, it is proposed to use algorithms, which reflect the most preferred methods.

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The authors declare that there are no conflicts of interest present.