TRIGEMINAL NEVRALJİ TEDAVİSİNDE KRİYOTERAPİNİN YERİ-THE ROLE OF CRYOTHERAPY IN THE TREATMENT OF TRIGEMINAL NEURALGIA

Abstract

ÖZET

Trigeminal nevralji, 5. kafa çifti nervus trigeminusun dağıldığı alanlarda lokalize olan, 3 dalından herhangi birini ya da en çok 2. veya 3. dalını aynı anda tutabilen, batıcı, delici, şimşek çakar tarzda, birkaç saniyeden birkaç dakikaya kadar süren genelde tek taraflı ağrı krizleri ile karakterizedir. Meydana geliş nedeni henüz net olarak açıklanamadığı için trigeminal nevraljinin tedavisinde kesinleşmiş bir protokol yoktur. Bu nedenle trigeminal nevralji tedavisi hekimler açısından da sorun oluşturmaktadır. Trigeminal nevralji tedavisinde uygulanabilecek seçenekler, medikal tedavi, alkol, fenol veya gliserol ile sinir blokajı, mikrovasküler dekompresyon, kriyoterapi, periferik nörektomi rizotomi, radyocerrahi yöntemleri ve son yıllarda lazer uygulamalarıdır. Trigeminal nevralji tanısı konulduktan sonra genellikle ilk olarak medikal tedavi tercih edilmektedir. Fakat zamanla ilaçlara karşı direnç geliştiğinden cerrahi yöntemlerin kullanılması yaygın hale gelmiştir. Cerrahi yöntemlerin kornplikasyona daha açık olması, nevralji hastalarının çoğunlukla ileri yaşta hastalar olması sebebiyle sistemik durumlarının cerrahi müdahaleler için elverişli olmaması nedeniyle daha az invazif yöntemlerin kullanımı gündeme gelmiştir. Kriyoterapi yöntemi, uygulama kolaylığı, komplikasyonunun az olması, tekrarlanabilmesi ve ağrı gidermede oldukça iyi sonuçlar göstermesi nedeniyle hekimler için olduğu kadar, ağrısız ve rahat uygulanabilirliği nedeniyle hastalar için de rahat kabul edilebilen bir yöntemdir. Tedavide, bölgesel olarak soğuk uygulaması yapılarak periferik sinirlerin iletim özellikleri değiştirilir. Böylece sinir iletiminde blok meydana getirilir. Bu derlemede, trigeminal nevralji tedavisinde kriyoterapinin ne kadar etkili olduğu ve diğer tedavi yöntemlerine göre avantaj ve dezavantajları literatür bilgileri ışığında irdelenmiştir.

Anahtar Kelimeler:Trigeminal nevralji, kriyoterapi.

SUMMARY

Trigeminal neuralgia is a sudden brief, usually uni-lateral, severe, recurrent pain in the distribution of mostly 2nd or 3rd branches of the fifth cranial nerve. There isn't a definite treatment protocol for trigeminal neuralgia because its etiology is still unclear. Hence its treatment is a challenging problem for the clinicians. Treatment modalities for trigeminal neuralgia are, medical therapy, alcohol, phenol or glycerol injections, microvascular decompression, cryotherapy, peripheric neurectomy, rhizotomy, radiosurgery techniques and in recent years laser application. When the patient is diagnosed as trigeminal neuralgia, medical therapy is preferred primarily but surgical procedures has become widespread because by ihe time of progress a resistance develops against medicines. But surgical procedures can be dangerous because of complications and the patients' systemic conditions may not be suitable for surgery. For this reason less invasive techniques becomes common in use. Cryotherapy technique is a desirable technique both for patient and doctor because of its positive properties. !t can be applied easily and repeatedly, its complication rate is low and its results are obviously good. In this technique, cold is applied locally in this way, peripheric nerve's conduction features are altered and nerve conduction is blocked. In this review, the pros and cons of cryotherapy procedure and its effectiveness is reviewed in the light of the recent studies.

Key Words: Trigeminal neuralgia, cryotherapy.

 

Keywords

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