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

ÖZETTrigeminal 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.SUMMARYTrigeminal 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.

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Çelebisoy M. Trigeminal nerve diseases. Turkiye Klinikleri J Int Med Sci 2006, 2 (40): 23-34.
Hupp JR, Ellis E, Tucker MR. Contemporary oral and maxillofacial surgery. Mosby Elsevier, 2008: 5,h ed.
Katsuhiro T. Operative treatment of trigeminal neuralgia: review of current techniques. Oral Surg, Oral Med., Oral Path, Oral Rad and End. 2008; 106: 788-804.
Lloyd JW, Barnard JD, Glynn CJ. Cryoanalgesia. A new approach to pain relief. Lancet 1976; 30: 932-4.
Pradel W. Hlawitschka M, Eckelt U, Herzog R, Koch K. Cryosurgical treatment of genuine trigeminal neuralgia. Br J Oral Maxillofac Surg 2002; 40: 244-7.
Fardy MJ, Zakrzewska JM, Patton DW. Peripheral surgical techniques for the management of trigeminal neuralgia—alcohol and glycerol injections. Acta Neurochir (Wien). 1994; 129: 181-4.
Fromm GH, Terence CF, Maroon JC. Trigeminal neuralgia: current concepts regarding etiology and pathogenesis . Arch Neurol 1984; 41: 1204-7.
Jannetta PJ. Operative techniques and clinicopathologic correlation in the surgical treatment of cranial rhizopathies. Clin Neurosurg 1997; 44: 181-195.
Spatz AL, Zakrzewska JM, Kay EJ. Decision analysis of medical and surgical treatments for trigeminal neuralgia: how patient evaluations of benefits and risks affect the utility of treatment decisions. Pain. 2007; 131: 302-10.
Jay Jagannathan, Chun-Po Yen, Ladislau Steiner. Gamma Knife Radiosurgery for idiopathic Trigeminal Neuralgia. Contempo rary Neurosurgery 2008; 30: 1-8.
Cohen J. Role of the neurologist in the evaluation and treatment of patient with trigeminal neuralgia. J Neurosurg 1989; 71: 359-67.
Zakrzewska JM. Nally FF. The role of cryotherapy (cryoanalgesia) in the management of paroxysmal trigeminal neuralgia: a six year experience. Br J Oral Maxillofac Surg. 19SS; 26: 18-25.
Rahnama M,Gaweda A. Trigeminal neuralgia own observations.Ann Univ Mariae Curie Sklodowska 2003; 58: 185-6.
Zakrewska JM, Thomas DG. Patients' assessment of outcome after surgical procedures for the management of trigeminal neuralgia.Acta Neurchir 1993; 122: 225-30.
Zakrzewska JM, Nally FF. Flint SR. Cryotherapy in the management of paroxysmal trigeminal neuralgia. Four year follow up of 39 patients. J Maxillofac Slug. 1986; 14: 5-7.
Fardy MJ, Patton DW. Complications associated with peripheral alcohol injections in the management of trigeminal neuralgia. Br J Oral Maxillofac Surg 1991: 29: 1-4.
Oturai AB, Jensen K. Eriksen J, Madsen F. Neurosurgery for trigeminal neuralgia:compa rison of alcohol block,neurectomy ,and radiofrequency coagulation.Clin J Pain 1996: 12:311-5.
Bederson JB, Wilson CB. Evaluation of microvaskiiler decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. J Neurosurg 1989; 71: 359-367.
Broggi G, Ferroli P, Franzini A, Servello D, Dones I. Microvascular decompression for trigeminal neuralgiaxomments on a series of 250 cases.including 10 patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 2000; 68: 59-64.
Bremerich A, Krisschek, Bremerich P. Therapie der Trigeminusneuralgie. Dtsch Z Mund Keifer Geischtschir 1991; 15: 369-375.
Jannetta PJ. Microsurgical approach to the trigeminal nevre for the tic doloureux. Krayenbuhl FIA, eds. Progress in neurological surgery, vol 7. Basel: Karger 1976; 180-200.
Kondziolka I). Functional radiosurgery. Neurosurgery 1999; 44: 12-20.
Mullan S. Lichtor T. Percutaneous microcomp ression of the trigeminal ganglion for trigeminal neuralgia.J Neurosurg 1983; 59:1007-12.
Sweet WH„ Wespic JG. Controlled thermocoagulation of trigeminal ganglion and rootles for differential destruction of pain fibres. Part l:Trigeminal neuralgia. J neurosurg 1974: 39: 143-156.
Young RF, Vermeulen SS, Grimm P, Blasko J, Posewitz A. Gamma knife radiosurgery for the treatment of trigeminal neuralgia: idiopathic and tumor related. Neurology 1997; 48: 608 614.
Joanna M, Zakrewska, MD. Trigeminal Neuralgia and Facial Pain. Seminars in Pain Medicine Vol 2. 2004.
Lopez BC, Hamyln PJ, Zakrewska JM. Radiosurgery for primary trigeminal neuralgia: State of the evidence and recommendations for future reports.J Neurol Neurosurg Psychiatry 2004; 75 (7): 1019-24.
Lopez BC, Hamyln PJ, Zakrewska JM. Systematic review of ablative neurosurgical techniques in the management of trigeminal neuralgia. Neurosurgery 2004; 54: 973-83.
Brown JA, Chittum CJ, Sabol D, Gouda JJ. Percutaneous balloon compression of the trigeminal nerve for treatment of trigeminal neuralgia. Neurosurg Focus 1996; 15: 1 (2): e4.
Barker FG, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long term outcome of microvascular decompression for trigeminal neuralgia . N Engl J Med 1996; 25: 334.
Kanpolat Y. Savas A, Bekar A, Berk C. Percutanous controlled radiofrequencv trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25 year experience with 1.600 patients. Neurosurg 2001:48: 524-32.
Brown JA, Plitsis JG. Percutaneous balloon compression for the treatment of trigeminal neuralgianesults in 56 patients based on balloon compression pressure monitoring. Neurosurg Focus 2005: IS: E10.