A qualitative study of the psychological processes in patients with post-herpetic neuralgia

Objective:To understand the psychological process of patients with post-herpetic neuralgia(PHN)and provide references for the psychological management of PHN.Methods:The objective sampling method was used to conduct semi-structural in-depth interviews on 10 PHN patients,and Colaizzi’s phenomenological analysis method was used for data analysis.Results:According to the different pain durations of PHN patients,the patients were divided into three stages and five themes were extracted:the need for strong pain relief,the helpless tolerance of pain,the self-feeling burden,the need for health education,and the positive response to pain.Conclusions:PHN has complex psychological activities,so it is necessary to pay attention to the psychological process of patients and take effective psychological measures to intervene negative psychology so that patients can actively cope with the pain.

Transcranial direct current stimulation efficacy in trigeminal neuralgia

Trigeminal neuralgia is a severe,disabling pain and its deafferentation remains a challenge for health providers.Transcranial direct current stimulation is a non-invasive stimulation technique which finds new utility in managing pain.There-fore,the introduction of alternative,non-invasive,safe,and effective methods should be considered in treating patients with trigeminal neuralgia unresponsive to conventional treatment.

Meta-analysis and sequential analysis of acupuncture compared to carbamazepine in the treatment of trigeminal neuralgia

BACKGROUND In this randomized controlled trial(RCT)comparing current acupuncture with carbamazepine for trigeminal neuralgia,meta-and sequential analyses were utilized.AIM To guide clinical decision making regarding the treatment of trigeminal neuralgia with carbamazepine.METHODS The RCT literature on needle comparison was searched in various Chinese biomedical databases including Chinese Biomedical Literature Database,Wanfang Data,VIP Database,as well as international databases such as Excerpt Medica Database,Cochrane Library,PubMed,and Web of Science,along with related clinical registration platforms such as World Health Organization International Clinical Trial Registry Platform,ChiCTR,and Clinical Trials up to 1 April 2020.Risk of bias was evaluated using the Cochrane Collaborative Risk Bias tool,primary outcome measures(pain reduction)were analyzed using STATA metaanalysis,outcome measures were analyzed using trial sequential analysis 0.9.5.10 Beta sequential analysis,GRADE was used to assess the evidence,and adverse reactions were documented.RESULTS This study analyzed 16 RCTs with a total of 1231 participants.The meta-analysis revealed a statistically significant difference in pain reduction between acupuncture and carbamazepine[standardized mean difference(SMD)=1.47;95%confidence interval(CI):0.99-1.95],although the quality of evidence was deemed to be of extremely low quality.Cumulative meta-analysis based on the year of publication indicated that carbamazepine treatment first demonstrated a statistically significant difference in pain reduction in 2014 and remained relatively stable over time[SMD=1.84;95%CI:0.22-3.47].Additionally,the number of adverse events associated with acupuncture was significantly lower compared to carbamazepine.CONCLUSION Acupuncture for trigeminal neuralgia is better than analgesia and safer than carbamazepine;however,firm conclusions still require a high-quality,multicenter,large-sample RCT to confirm these findings.

Laser speckle contrast imaging to predict the effect of temporary spinal cord stimulation in postherpetic neuralgia patients: A prospective observational study

Temporary spinal cord stimulation(tSCS)can effectively reduce the pain and severity of postherpetic neuralgia(PHN).However,there are no effective and objective methods for predicting the effects of tSCS on PHN.Laser speckle contrast imaging(LSCI)is frequently used in neurology to evaluate the effectiveness of treatment.To assess the accuracy of LSCI in predicting the impact of tSCS on PHN,14 adult patients receiving tSCS treatments for spinal nerve-innervated(C6-T2)PHN participated in this observational study.Visual analog scale(VAS)assessments and LSCI bloodflow images of the-ngers were recorded after the tSCS procedure.The results showed that the VAS scores of all patients decreased signi-cantly.Moreover,the bloodflow index(BFI)values were signi-cantly higher than they were before the procedure.Increased bloodflow and pain alleviation were positively correlated.The-ndings indicated that spinal nerve PHN(C6-T2)was signi-cantly reduced by tSCS.Pain alleviation by tSCS was positively correlated with increased bloodflow in the hand.The effect of tSCS on PHN may thus be predicted using an independent and consistent indicator such as LSCI.

Mechanism of Huanglian Detoxification Soup Relieving Postherpetic Neuralgia by Enhancing IL-2 Levels in Rats

[Objectives]To explore the mechanism of Huanglian detoxification soup improving pain behavior by affecting serum IL-2 levels in postherpetic neuralgia(post herpes neuralgia,PHN)model rats.[Methods]20 PHN rats were randomly divided into model group(PHN group)and detoxification decoction group(n=10).In the group,10%Huanglian detoxification soup(0.4 mL/0.1 kg)was given once in the morning and evening for 14 d.The PHN group was filled with an equal volume of 0.9%sodium chloride solution.Tail vein serum inflammatory factor interleukin-2(IL-2),IL-βand IL-6 levels were measured using ELISA kits at 7 and 21 d.[Results]IL-2 increased at 14 and 21 d in IL group,while IL-βand IL-6 decreased compared with the PHN group(P<0.05).[Conclusions]Huanglian detoxification soup may raise IL-2 levels after VZV infection to promote the differentiation of cells of the immune system,so as to relieve the pain caused by IL-βand IL-6 inflammatory factors.

Transcranial Direct Current Stimulation Is Safe and Relieves Post-Herpetic Neuralgia in Patient with Dermatomyositis: A Case Report

To the best of our knowledge, this is the first report in the literature showing the efficacy of transcranial direct current stimulation (tDCS) in treating refractory post-herpetic neuralgia in a patient with dermatomyositis. In addition, our results showed that tDCS sessions are safe and do not lead to disease relapse. Therefore, despite the limitations of being a case report, this study provides encouraging results that need to be widely explored in studies with a representative number of patients and with an appropriate design for patients with this systemic rheumatic autoimmune disease.

Correlation of p38MAPK,ERK1/2 and JNK expression in peripheral blood with the cytokines and pain mediators in patients with post-herpetic neuralgia

Objective: To study the correlation of p38MAPK, ERK1/2 and JNK expression in peripheral blood with the cytokines and pain mediators in patients with post-herpetic neuralgia (PHN). Methods: Patients who were diagnosed with herpes zoster for the first time in the Second Hospital of Hanbin District Ankang City between March 2015 and April 2016 were selected and divided into the PHN group who were combined with post-herpetic neuralgia and the pure HZ group who were without neuralgia, and the healthy volunteers who received physical examination in the Second Hospital of Hanbin District Ankang City during the same period were selected as control group. The peripheral blood was collected to determine the expression of MAPK signaling molecules, and serum was collected to determine the contents of cytokines and pain mediators. Results: p38MAPK, ERK1/2 and JNK mRNA expression in peripheral blood as well as 5-HT, CGRP, SP, NSE, S100B, IFN-γ, TNF-α and IL-17 levels in serum of PHN group and HZ group were significantly higher than those of control group while β-EP levels were significantly lower than that of control group;p38MAPK, ERK1/2 and JNK mRNA expression in peripheral blood as well as 5-HT, CGRP, SP, NSE, S100B, IFN-γ, TNF-α and IL-17 levels in serum of PHN group were significantly higher than those of HZ group while β-EP level was significantly lower than that of HZ group. p38MAPK, ERK1/2 and JNK expression in peripheral blood of PHN patients were positively correlated with CGRP, 5-HT, SP, NSE, S100B, IFN-γ, TNF-α and IL-17 levels in serum, and negatively correlated with β-EP level in serum. Conclusion: The high expression of p38MAPK, ERK1/2 and JNK in peripheral blood of PHN patients can increase the secretion of cytokines and algogenic mediators and decrease the secretion of analgesic mediators.

Correlation of serum inflammatory cytokine and immunoglobulin content with post-herpetic neuralgia in patients with acute herpes zoster

Objective:To study the correlation of serum inflammatory cytokine and immunoglobulin content with post-herpetic neuralgia in patients with acute herpes zoster.Methods:Patients diagnosed with herpes zoster in our hospital between May 2012 and October 2015 were selected and divided into herpes zoster-post-herpetic neuralgia group (VZV-PHN group) and herpes zoster-control group (VZV-Con group) according to the incidence of post-herpetic neuralgia (PHN);healthy volunteers receiving physical examination in our hospital during the same period were selected as normal control group (Con group).Results: Serumβ-EP, NT, IFN-γ and IL-2 levels of VZV-PHN group and VZV-Con group were significantly lower than those of Con group (P<0.05), while SP, VGF, CGRP, IL-4, IL-6, IL-17, IL-21, TNF-α, IL-10, TGF-β1, IgG, IgM and IgA levels were significantly higher than those of Con group (P<0.05);serumβ-EP, NT, IFN-γ, IL-2, IgG, IgM and IgA levels of VZV-PHN group were significantly lower than those of VZV-Con group (P<0.05) while SP, VGF, CGRP, IL-4, IL-6, IL-17, IL-21, TNF-α, IL-10 and TGF-β1 levels were significantly higher than those of VZV-Con group (P<0.05);β-EP and NT were positively correlated with IFN-γ, IL-2, IgG, IgM and IgA, and negatively correlated with IL-4, IL-6, IL-17, IL-21, TNF-α, IL-10 and TGF-β1;SP, VGF and CGRP were negatively correlated with IFN-γ, IL-2, IgG, IgM and IgA, and positively correlated with IL-4, IL-6, IL-17, IL-21, TNF-α, IL-10 and TGF-β1.Conclusions:Abnormal secretion of inflammatory cytokines and immunoglobulin caused by humoral immune and cellular immune response disorder is associated with the occurrence of post-herpetic neuralgia in patients with acute herpes zoster.

Analysis of the Degree of Psychological Distress of Elderly Patients with Recurrent Trigeminal Neuralgia and Its Influencing Factors

Objective:To analyze the degree of psychological distress among elderly patients with recurrent trigeminal neuralgia and its influencing factors.Methods:A single-center cross-sectional study was conducted on 126 elderly patients with recurrent trigeminal neuralgia who visited the Pain Department of our hospital from March 2022 to April 2024.Logistic regression analysis was employed to evaluate the factors influencing psychological distress,based on general patient data,the Distress Thermometer(DT),the Perceived Social Support from Family Scale(PSS-Fa),and the Pitsburgh Sleep Quality Index(PSQI).Results:Among the 126 elderly patients with recurrent trigeminal neuralgia,those with a DT score≥4(72 patients,57.14%)were more prevalent than those with a DT score<4(54 patients,42.86%).The average DT score for all patients was 4.35±1.72.Patients in the DT score≥4 group were older than those in the DT score<4 group(t=4.207,P=0.000),had lower PSS-Fa scores(t=5.925,P=0.000),and had higher PSQI scores(t=17.858,P=0.000).There were no statistically significant differences in gender,marital status,residence area,education level,disease type,or pain location(all P>0.05).Older age and poor sleep quality were identified as independent risk factors for psychological distress in elderly patients with recurrent trigeminal neuralgia(OR=1.258,OR=1.713,both P<0.05),while higher levels of family support were identified as a protective factor(OR=0.581,P=0.025).Conclusion:Elderly patients with recurrent trigeminal neuralgia experience psychological distress,and the degree of severity depends on age,quality of sleep,and level of family support.

Interpeduncular cistern intrathecal targeted drug delivery for intractable postherpetic neuralgia: A case report

BACKGROUND Intractable postherpetic neuralgia(PHN)can be difficult to manage even with aggressive multimodal therapies.Patients who experience uncontrolled refractory cranial PHN despite conservative treatment may benefit from an intrathecal drug delivery system(IDDS).For craniofacial neuropathic pain,the traditional approach has been to place the intrathecal catheter tip below the level of the cranial nerve root entry zones,which may lead to insufficient analgesia.CASE SUMMARY We describe a 69-year-old man with a 1-year history of PHN after developing a vesicular rash in the ophthalmic division of cranial nerve V(trigeminal nerve)distribution.The pain was rated 7-8 at rest and 9-10 at breakthrough pain(BTP)on a numeric rating scale.Despite receiving aggressive multimodal therapies including large doses of oral analgesics(gabapentin 150 mg q12 h,oxycodone 5 mg/acetaminophen 325 mg q6 h,and lidocaine 5%patch 700 mg q12 h)and sphenopalatine ganglion block,there was no relief of pain.Subsequently,the patient elected to have an implantable IDDS with the catheter tip placed at the interpeduncular cistern.The frequency of BTP episodes decreased.The patient’s continuous daily dose was adjusted to 0.032 mg/d after 3 mo of follow-up and stopped 5 mo later.He did not report pain or other discomfort at outpatient follow-up 6 mo and 1 year after stopping intracisternal hydromorphone.CONCLUSION The use of interpeduncular cistern intrathecal infusion with low-dose hydromorphone by IDDS may be effective for severe craniofacial PHN.

Analgesic effects of different acupuncture therapies on postherpetic neuralgia:a Bayes⁃ian network meta-analysis

OBJECTIVE To assess the effi⁃cacy and safety of acupuncture-related treat⁃ments for postherpetic neuralgia(PHN),identify the most effective acupuncture and related treat⁃ments.METHODS PubMed,Cochrane Central Register of Controlled Trials,Embase,Web of Science,and four Chinese databases,a clinical research registration platform,and grey literature were searched.We evaluated the risk of bias and quality in the included studies and per⁃formed a Bayesian multiple network meta-analysis.RESULTS We included 29 randomized controlled trials comprising 1973 patients,of which approximately 17.24%showed a high risk of bias.According to the Jadad scale,2,16,and 11 studies were high,medium,and low quality,respectively.The pairwise meta-analysis results revealed that the efficacy of all acupuncture-related treatments for pain relief related to PHN showed the difference was statistically significant com⁃pared with that of antiepileptics.The network meta-analysis results showed that pricking and cupping plus antiepileptics were the most effective,followed by electroacupuncture(EA)plus antiepileptics for pain relief in patients with PHN.EA plus antiepileptics ranked the best regarding reduced Pittsburgh Sleep Quality Index and Self-Rating Depression Scale scores in patients with PHN.No results were found regarding total response rate or quality of life among this study.Acupuncture-related treatments showed a lower incidence of adverse events than that of antiepi⁃leptics-related treatments.CONCLUSION Acu⁃puncture-related therapies may be potential treat⁃ment options for PHN and are relatively safe.Pricking and cupping plus antiepileptics are the most effective techniques for pain relief.EA plus antiepileptics is the best approach for improving insomnia and depression symptoms of PHN.

Motor cortex transcranial magnetic stimulation to reduce intractable postherpetic neuralgia with poor response to other threapies:Report of two cases

BACKGROUND Postherpetic neuralgia(PHN)is a typical neuropathic pain condition that appears in the lesioned skin regions following the healing of shingles.The pain condition tends to persist,which is often accompanied by negative emotions(e.g.,anxiety and depression)and substantially reduces the quality of life.In addition to analgesia(e.g.,pregabalin and gabapentin),nerve radiofrequency technology is an effective treatment for intractable PHN.However,there is still a significant portion of patients who do not benefit from this treatment.As a non-invasive form of brain stimulation,repetitive transcranial magnetic stimulation(rTMS)targeting the motor cortex is able to reduce neuropathic pain with grade A evidence.CASE SUMMARY Here we report two cases in which motor cortex rTMS was used to treat intractable PHN that did not respond to initial drug and radiofrequency therapies.Moreover,we specifically investigated rTMS efficacy at 3 mo following treatment.CONCLUSION Motor cortex rTMS can treat intractable PHN that did not respond to initial drug and radiofrequency therapies.

H7N9 avian influenza with first manifestation of occipital neuralgia:A case report

BACKGROUND Most of the first symptoms of avian influenza are respiratory symptoms,and cases with occipital neuralgia as the first manifestation are rarely reported.CASE SUMMARY A middle-aged patient complaining of paroxysmal pain behind the ear was admitted to our hospital.The patient’s condition changed rapidly,and high fever,unexpected respiratory failure,and multiple organ failure developed rapidly.The patient was diagnosed with H7N9 avian influenza based on etiology.CONCLUSION We believe that the etiology of occipital neuralgia is complex and could be the earliest manifestation of severe diseases.The possibility of an infectious disease should be considered when occipital neuralgia is accompanied by fever.Avian influenza is one of these causative agents.

Electroacupuncture alleviates orofacial allodynia and anxiety-like behaviors by regulating synaptic plasticity of the CA1 hippocampal region in a mouse model of trigeminal neuralgia

OBJECTIVE To investigate whether electroacupuncture(EA)ameliorates abnormal trigeminal neuralgia(TN)orofacial pain and anxiety-like behavior by altering synaptic plasticity in the hippocampus CA1.METHODS A mouse infraorbital nerve transection model(pTION)of neuropathic pain was established,and EA or sham EA was used to treat ipsilateral acu⁃puncture points(GV20-Baihui and ST7-Xia⁃guan).Golgi-Cox staining and transmission elec⁃tron microscopy(TEM)were administrated to observe the changes of synaptic plasticity in the hippocampus CA1.RESULTS Stable and persistent orofacial allodynia and anxiety-like behav⁃iors induced by pT-ION were related to changes in hippocampal synaptic plasticity.Golgi stain⁃ings showed a decrease in the density of dendritic spines,especially mushroom-type dendritic spines,in hippocampal CA1 neurons of pT-ION mice.TEM results showed that the density of synapses,membrane thickness of the postsynaptic density,and length of the synaptic active zone were decreased,whereas the width of the synaptic cleft was increased in pTION mice.EA attenu⁃ated pT-ION-induced orofacial allodynia and anx⁃iety-like behaviors and effectively reversed the abnormal changes in dendritic spines and syn⁃apse of the hippocampal CA1 region.CONCLU⁃SION EA modulates synaptic plasticity of hippo⁃campal CA1 neurons,and reduces abnormal oro⁃facial pain and anxiety-like behavior,providing evidence for a TN treatment strategy.

Treatment of postherpetic neuralgia by bone marrow aspirate injection:A case report

BACKGROUND Postherpetic neuralgia(PHN)is the most frequent and a difficult-to-treat complication of herpes zoster(HZ).Its symptoms include allodynia,hyperalgesia,burning,and an electric shock-like sensation stemming from the hyperexcitability of damaged neurons and varicella-zoster virus-mediated inflammatory tissue damage.HZ-related PHN has an incidence of 5%–30%,and in some patients,the pain is intolerable and can lead to insomnia or depression.In many cases,the pain is resistant to pain-relieving drugs,necessitating radical therapy.CASE SUMMARY We present the case of a patient with PHN whose pain was not cured by conventional treatments,such as analgesics,block injections,or Chinese medicines,but by bone marrow aspirate concentrate(BMAC)injection containing bone marrow mesenchymal stem cells.BMAC has already been used for joint pains.However,this is the first report on its use for PHN treatment.CONCLUSION This report reveals that bone marrow extract can be a radical therapy for PHN.

槲皮素通过抑制MIP-1α/CCR1/CCR5信号通路减轻大鼠带状疱疹后神经痛的机制

目的 探讨槲皮素(Que)对大鼠带状疱疹后神经痛(PHN)及趋化因子配体3(CCL3,即MIP-1α)/C-C趋化因子受体(CCR)1/CCR5信号通路的影响。方法 将60只大鼠分为对照组(Con组)、PHN组、L-Que组(30 mg/kg)、M-Que组(60 mg/kg)、H-Que组(120 mg/kg)以及H-Que+MIP-1α组(120 mg/kg Que+0.4μg/kg重组MIP-1α)。检测各组大鼠机械痛阈值(PWT)、热痛阈值(TWL);试剂盒检测外周组织液腺苷、腺嘌呤核糖核苷酸(AMP)、腺苷二磷酸(ADP)以及脊髓背角样本肿瘤坏死因子-α(TNF-α)和白细胞介素-1β(IL-1β)水平;通过HE染色观察脊髓背角病理切片;免疫荧光染色检测脊髓背角小胶质细胞活化情况;Western blot检测MIP-1α/CCR1/CCR5信号通路蛋白表达。结果 PHN组脊髓背角组织出现破裂现象,神经束排列混乱,炎性细胞浸润、水肿,神经元轻微萎缩现象。与Con组相比,PHN组PWT值、腺苷、AMP、ADP水平降低(P<0.05),TWL值、TNF-α、IL-1β水平、Iba1阳性小胶质细胞数量以及MIP-1α、CCR1、CCR5蛋白水平均升高(P<0.05);Que治疗后,大鼠神经束排列杂乱现象有所改善,炎性细胞浸润减少,神经元萎缩现象减轻;与PHN组相比,L-Que组、M-Que组、H-Que组的PWT值、腺苷、AMP、ADP水平升高(P<0.05),TWL值、TNF-α、IL-1β水平、Iba1阳性小胶质细胞数量以及MIP-1α、CCR1、CCR5蛋白水平均降低(P<0.05),且Que作用效果呈剂量依赖性;与H-Que组相比,H-Que+MIP-1α组的PWT值、腺苷、AMP、ADP水平降低(P<0.05),TWL值、TNF-α、IL-1β水平、Iba1阳性小胶质细胞数量以及MIP-1α、CCR1、CCR5蛋白水平均升高(P<0.05)。结论 Que可能通过抑制MIP-1α/CCR1/CCR5信号通路减轻大鼠炎症反应,进而减轻PHN。

止痛如神汤在腰骶部带状疱疹后神经痛(脾虚湿蕴)患者中的应用及对疼痛程度的影响

目的:观察止痛如神汤在腰骶部带状疱疹后神经痛(脾虚湿蕴)患者中的应用及对疼痛程度的影响。方法:本研究纳入2020年1月—2023年1月于彭州市人民医院就诊的60例腰骶部带状疱疹后神经痛(脾虚湿蕴)患者作为研究对象,根据随机数表法将患者分为观察组和对照组,各30例。对照组给予基础治疗,观察组给予基础治疗联合口服止痛如神汤。比较两组临床疗效、疼痛程度[视觉模拟评分法(visual analogue scale,VAS)]、睡眠质量[匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)]及不良反应发生情况。结果:观察组总有效率高于对照组,差异有统计学意义(χ^(2)=8.822,P=0.003)。治疗前,两组VAS评分比较,差异无统计学意义(P>0.05);治疗后3周、4周、12周,两组VAS评分低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗前,两组PSQI评分比较,差异无统计学意义(P>0.05);治疗后3周、4周、12周两组PSQI评分低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。两组整个研究过程中均治疗顺利,治疗期间无过敏、皮肤感染等不良反应发生。结论:腰骶部带状疱疹后神经痛(脾虚湿蕴)患者在基础治疗基础上加用止痛如神汤,具有镇痛效果好,安全性高,对睡眠质量改善作用明显。

放血疗法联合神经阻滞及臭氧注射治疗老年带状疱疹后遗神经痛患者的临床观察

目的探讨放血疗法联合神经阻滞及臭氧注射对老年带状疱疹后遗神经痛患者疼痛症状、睡眠质量的影响及安全性分析。方法选取2023年6月—2023年12月上海市浦东新区人民医院疼痛门诊收治的80例老年带状疱疹后遗神经痛患者,按照随机数字表法分为2组:观察组(n=40)和对照组(n=40)。对照组接受神经阻滞联合臭氧注射治疗,观察组则在与对照组相同治疗的基础之上加用行放血疗法,2组均连续治疗4周。分别于治疗前及治疗4周后对2组患者进行疼痛VAS评分、匹兹堡睡眠质量指数(PSQI)评分,观察2组临床疗效、治疗不良反应发生情况,对2组上述评估值进行分析与比较。结果治疗后,2组VAS评分、PSQI评分均较同组治疗前显著降低(P<0.05),且观察组VAS评分、PSQI评分显著低于对照组(P<0.05);观察组总有效率高于对照组(P<0.05);2组治疗期间不良反应总发生率差异无统计学意义(P>0.05)。结论放血疗法联合神经阻滞及臭氧注射可能显著改善老年带状疱疹后遗神经痛患者疼痛症状,提高患者的睡眠质量和临床疗效。

带状疱疹后神经痛病人疼痛部位评估图谱研究进展

对带状疱疹的发生部位、皮损面积、带状疱疹后神经痛疼痛部位评估图谱进行综述,以期为准确评估疼痛、精确评价治疗护理效果提供依据与参考。

3D Slicer三维影像重建技术在显微血管减压术治疗原发性三叉神经痛中的应用

目的探讨3D Slicer三维影像重建技术在显微血管减压术(MVD)治疗原发性三叉神经痛(PTN)中的应用价值。方法回顾性分析2020年1月至2022年12月MVD治疗的56例PTN的临床资料。术前行3D-TOF-MRA、3D-FIESTA扫描,并应用3D Slicer软件进行三维影像重建,了解血管与神经的关系、责任血管走行并模拟手术;术中显微镜下不能充分暴露或操作困难时,应用神经内镜进行观察及操作。结果55例术中确认存在责任血管,其中12例在神经内镜下确认;1例术中未发现责任血管。53例术前三维重建影像发现的责任血管与术中发现一致;3例术前三维重建影像为阴性,包括术中证实为静脉压迫2例、未发现责任血管1例。42例术后疼痛即刻消失,明显减轻13例,无变化1例。术后出现面部麻木4例、口周疱疹1例,对症治疗后缓解。术后随访15~47个月,BNI疼痛分级Ⅰ~Ⅱ级53例,Ⅲ级2例,Ⅳ级1例;有效率为94.6%。结论应用MVD治疗PTN时,3D Slicer三维影像重建技术有助于术前明确责任血管及其走行,可模拟手术以优化手术规划,减少术中不必要的探查与牵拉。神经内镜可弥补显微镜视野盲区,有助于暴露责任血管,减少责任血管遗漏,并可辅助确认及调整棉片的位置,提高手术效果。