眼窩深部痛の4症例 Deep Orbital Pain : Report of Four Cases
目的: 種々の疾患でみられる眼窩深部痛の病態を4臨床例より検討し, 治療法について考察した. 症例1: 72歳, 女性. 眼窩深部痛で発症した内頸動脈海綿静脈洞瘻であった. 症例2: 34歳,女性. 慢性群発頭痛. 翼口蓋神経節 (PPG) の高周波熱凝固 (RFTC) が有効であった. 症例3: 51歳, 男性. 眼窩深部痛を主訴とし, 後頭神経痛も併した大後頭三叉神経症候群であった. C<sub>2</sub>神経節RFTCで眼窩深部痛は残存したが星状神経節ブロックの併用で軽快した. 症例4: 67歳, 男性. 三叉神経痛. 群発頭痛として治療されていたが, 絞られるような痛みのなかに穿刺痛の要素があり, 三叉神経血管減圧術を行って眼窩深部痛の消失をみた. 考察: 眼窩深部痛は顔面痛のうちでも, 群発頭痛, 三叉神経痛, 耳鼻科疾患の関連痛, 眼疾患など種々の疾患でみられる興味深い症状である. 著者は上記症例の経験と眼窩周囲の神経分布形態より, 眼窩深部痛はPPGの刺激を引き起こす病態, すなわち局所の炎症のみならず, 中間神経刺激, 三叉神経刺激, 海綿静脈洞内圧上昇, 交感・副交感神経刺激などを引き起こすさまざまな病態からの結果であると結論した. 診断的意義の大きい症状であるとともに, 治療には局所神経解剖学の知識が不可欠と思われる.
Reported are 4 patients with deep pain of the orbital region with regard to the potential mechanisms and treatment strategies. Case 1 was a 72-y-o female with left eye pain and mild chemosis. Magnetic resonance angiogram revealed abnormal vasculature at the intracranial cavernous portion, which was confirmed by DSA as the carotid cavernous sinus fistula. In this case, orbital pain may be caused by increased cavernous sinus pressure, resulting in mechanical stretching of the trigeminal branches or nerve plexus around the internal carotid artery. Case 2 was a 34-y-o female who had had continuous type of cluster headache for the last 2 years. None but lithium ever relieved her from the right eye pain. Radiofrequency thermocoagulation at the pterygopalatine ganglion (PPG) made her almost pain free for two months. In this case the cause of her eye pain may have been derived from some kind of neuronal irritation at the PPG. Case 3 was a 51-y-o depressed man who complained of bilateral occipital pain and left deep eye pain. Great occipital trigeminal syndrome was suspected, and bilateral C<sub>2</sub> ganglion thermocoagulation was performed. His eye pain did not improve, but stellate ganglion blockade, which had had no effect before the procedure, became effective for his eye pain, suggesting that a potential irritation of the trigeminal nerve region could be sympathetic-mediated, and thus relieved by stellate ganglion blockade. Case 4 was a 67-y-o male who had been treated for the cluster headache for 2 years. Stabbing deep pain of the right eye was diagnosed as the trigeminal neuralgia. After a successful Gasselian ganglion blockade, routine microvascular decompression was performed uneventfully, and his stabbing eye pain disappeared. Four patients with deep pain of orbital regions described may indicate that the irritation of the trigeminal nerve (V2) involving the automatic nervous activity seems to induce the pain around the PPG.
- The journal of the Japan Society of Pain Clinicians = 日本ペインクリニック学会誌
The journal of the Japan Society of Pain Clinicians = 日本ペインクリニック学会誌 8(2), 90-95, 2001-04-25