Zur Wertigkeit destruktiver Eingriffe am Trigeminus bei atypischen Gesichtsschmerzen

Zusammenfassung

Primär atypische Gesichtsschmerzen sind, im Gegenteil zur echten Trigeminusneuralgie, operativ schwer zu beeinflussen. Dies gilt insbesondere für jene Schmerzzustände, welche nach Operationen im Gesichtsoder Kieferbereich auftreten oder gar unklarer Genese sind. Anhand eines Krankengutes von 48 Patienten und einer Literaturanalyse wird dargestellt, daß destruktive Eingriffe am Trigeminus nur in wenigen Fällen erfolgreich, zumeist jedoch erfolglos sind und in einem hohen Prozentsatz zu einer Verschlechterung der initialen Schmerzsymptomatik führen. Da die Erfolgsaussichten offensichtlich geringer sind als das Risiko einer postoperativen Verschlechterung, wird von destruktiven Eingriffen im Trigeminusbereich bei solchen Schmerzsyndromen abgeraten.

Abstract

Interruption of trigeminal pathways still is a common treatment in trigeminal neuralgia and has also been suggested for atypical facial pain.

The published results in the latter group are rather poor since only 17 to 24% of these patients were free from pain after surgery. There is no information on the outcome of those patients classified as “poor results”. We had the opportunity of seeing 48 patients who had been treated without success elsewhere. Pain occurred in most cases after ETN or dental operations. 36 patients underwent, despite poor results after a first neurosurgical intervention, further (up to five) operations. In 58% a postoperative deterioration occurred mainly consisting of anaesthesia dolorosa. Suicidal attempts were four times more frequent than in the group of those patients who had merely not benefited from surgery.

In conclusion, the poor results of trigeminal surgery reported in literature and the considerably high risk of postoperative deterioration, as shown in our series, prompt us to warn against destructive trigeminal surgery in atypical facial pain.

Key-Words

Facial pain - Trigeminal surgery