三叉神経痛の歴史—神経減圧術が登場するまで

History of Trigeminal Neuralgia:Before the Era of Modern Treatment

Point

・三叉神経痛様の疼痛は歴史上2世紀頃より，古代ローマ，イスラム世界などで記載されてきた．

・18世紀の英国の医師Fothergillが，顔面痛についての詳細な記録を残した．

・三叉神経と顔面神経の働きが別であることは，18世紀にBellらによって発見された．

・なかなか有効な治療法がなく，三叉神経やガッセル神経節を切除する手術がCushing, Frazier, Dandyらによって18世紀の終わり〜20世紀前半に行われた．アルコールによるブロック療法も行われた．

・有効な内服治療の登場は遅く，1942年のフェニトイン，1962年のカルバマゼピンまで待たなくてはならなかった．

・20世紀中盤を過ぎ，ようやくTaarnhøj，Gardner，Jannettaによる神経減圧の時代が始まった．

　Descriptions of what appears to be trigeminal neuralgia（TN）appear in medical literature from around the 2nd century AD. Aretaeus of Cappadocia is believed to be the first person in history to have specifically described TN. TN or TN-like facial pain was once known as Fothergill's disease, following a detailed description of the symptoms by Fothergill in the 18th century. For a long time, no effective oral therapy for TN was available, and only surgical treatments were used, such as severing of the trigeminal nerve or resection of the Gasserian ganglion. In the 19th and 20th centuries, Hartley, Krauss, Cushing, Spiller and Frazier developed techniques for approaching the Gasserian ganglion through the middle cranial fossa, and Dandy pioneered trigeminal nerve transection through the posterior fossa. Also at this time, Harris introduced nerve block using alcohol. Later, various oral medications, such as phenytoin（1942）and carbamazepine（1962）, were introduced and these became effective treatments. Modern surgical treatment began in the mid-20th century, when Taarnhøj, Gardner and Jannetta introduced nerve decompression.