| Abstract | Nervus trigeminus peti je kranijalni živac koji ima tri glavne grane: nervus ophtalmicus, nervus maxilaris i nervus mandibularis. Inervacijsko područje nervusa maxillarisa i mandibularisa najčešće je zahvaćeno bolovima pri neuralgiji trigeminusa. Ostali dijagnostički kriteriji su rekurentnost bolova, unilateralni paroksizmi, jaka bol koja traje do dvije minute te izazivanje napadaja bezazlenim podražajima. U etiologiji je najčešće prisutna kompresija u proksimalnom dijelu trigeminalnoga živca od strane krvne žile, najčešće arterije. Trigeminalnu neuralgiju prema etiologiji dijelimo na klasičnu, sekundarnu i idiopatsku. Diferencijalna dijagnoza uključuje rijedak oblik cefalgije, odontogenu bol i druge vrste neuralgija i neuropatija. Inicijalna terapija je farmakoterapija. Koriste se antiepileptici karbamazepin i okskarbazepin. Kao alternativa ili nadopuna koriste se lamotrigin, baklofen i gabapentin. Najveći problem kod farmakoterapije predstavljaju nuspojave, od kojih su najčešće somnolencija, vrtoglavica, povraćanje. Akutne egzacerbacije mogu se liječiti blokadama lidokainom. Kirurška terapija indicirana je kod neučinkovitosti farmakoterapije. Nosi veći rizik od komplikacija. Metoda koja se najčešće koristi je mikrovaskularna dekompresija, a alternativne perkutane metode su kompresija balonom, rizotomija i radiofrekventna termokoagulacija. |
| Abstract (english) | The trigeminal nerve, also known as the fifth cranial nerve, has three main branches: the ophthalmic nerve, the maxillary nerve, and the mandibular nerve. Pain in trigeminal neuralgia commonly affects the innervation area of the maxillary and mandibular nerves. Other diagnostic criteria include recurrent pain, unilateral paroxysms, severe pain lasting up to two minutes, and triggering of attacks by harmless stimuli. The most common etiology involves compression of the proximal part of the trigeminal nerve by a blood vessel, typically an artery. Trigeminal neuralgia is classified into classic, secondary, and idiopathic types based on etiology. The differential diagnosis includes rare forms of headache, odontogenic pain, and other types of neuralgia and neuropathy. The initial treatment is pharmacotherapy, with the use of antiepileptic drugs such as carbamazepine and oxcarbazepine. Lamotrigine, baclofen, and gabapentin can be used as alternatives or adjuncts. The main challenge in pharmacotherapy is managing the side effects, which commonly include drowsiness, dizziness, and vomiting. Acute exacerbations can be treated with lidocaine blocks. Surgical therapy is indicated when pharmacotherapy is ineffective but carries a higher risk of complications. The most frequently used method is microvascular decompression, and alternative percutaneous methods include balloon compression, rhizotomy, and radiofrequency thermocoagulation. |
