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  1. Trigeminal Neuralgia

    Science.gov (United States)

    ... affect your interaction with friends and family, your productivity at work, and the overall quality of your ... www.mayoclinic.org/diseases-conditions/trigeminal-neuralgia/basics/definition/CON-20043802 . Mayo Clinic Footer Legal Conditions and ...

  2. Trigeminal neuralgia

    Science.gov (United States)

    Cruccu, Giorgio; Finnerup, Nanna B.; Jensen, Troels S.; Scholz, Joachim; Sindou, Marc; Svensson, Peter; Zakrzewska, Joanna M.; Nurmikko, Turo

    2016-01-01

    Trigeminal neuralgia (TN) is an exemplary condition of neuropathic facial pain. However, formally classifying TN as neuropathic pain based on the grading system of the International Association for the Study of Pain is complicated by the requirement of objective signs confirming an underlying lesion or disease of the somatosensory system. The latest version of the International Classification of Headache Disorders created similar difficulties by abandoning the term symptomatic TN for manifestations caused by major neurologic disease, such as tumors or multiple sclerosis. These diagnostic challenges hinder the triage of TN patients for therapy and clinical trials, and hamper the design of treatment guidelines. In response to these shortcomings, we have developed a classification of TN that aligns with the nosology of other neurologic disorders and neuropathic pain. We propose 3 diagnostic categories. Classical TN requires demonstration of morphologic changes in the trigeminal nerve root from vascular compression. Secondary TN is due to an identifiable underlying neurologic disease. TN of unknown etiology is labeled idiopathic. Diagnostic certainty is graded possible when pain paroxysms occur in the distribution of the trigeminal nerve branches. Triggered paroxysms permit the designation of clinically established TN and probable neuropathic pain. Imaging and neurophysiologic tests that establish the etiology of classical or secondary TN determine definite neuropathic pain. PMID:27306631

  3. Triggering trigeminal neuralgia.

    Science.gov (United States)

    Di Stefano, Giulia; Maarbjerg, Stine; Nurmikko, Turo; Truini, Andrea; Cruccu, Giorgio

    2017-01-01

    Introduction Although it is widely accepted that facial pain paroxysms triggered by innocuous stimuli constitute a hallmark sign of trigeminal neuralgia, very few studies to date have systematically investigated the role of the triggers involved. In the recently published diagnostic classification, triggered pain is an essential criterion for the diagnosis of trigeminal neuralgia but no study to date has been designed to address this issue directly. In this study, we set out to determine, in patients with trigeminal neuralgia, how frequently triggers are present, which manoeuvres activate them and where cutaneous and mucosal trigger zones are located. Methods Clinical characteristics focusing on trigger factors were collected from 140 patients with trigeminal neuralgia, in a cross-sectional study design. Results Provocation of paroxysmal pain by various trigger manoeuvres was reported by 136 of the 140 patients. The most frequent manoeuvres were gentle touching of the face (79%) and talking (54%). Trigger zones were predominantly reported in the perioral and nasal region. Conclusion This study confirms that in trigeminal neuralgia, paroxysmal pain is associated with triggers in virtually all patients and supports the use of triggers as an essential diagnostic feature of trigeminal neuralgia.

  4. New insight into trigeminal neuralgia

    OpenAIRE

    Truini, A.; Galeotti, F; Cruccu, G

    2005-01-01

    Trigeminal neuralgia is universally considered the neuropathic facial pain most and best known in medical practice. We propose a short review on trigeminal neuralgia reporting its main clinical aspects, unsolved problems and highlighting differential diagnosis between classical and symptomatic trigeminal neuralgia.

  5. [Treatment of trigeminal neuralgia].

    Science.gov (United States)

    Bakker, Nicolaas A; van Dijk, J M C Marc; Wagemakers, Michiel; van der Weide, Hiske L; Beese, Uli; Metzemaekers, Jan D M

    2014-01-01

    Classic idiopathic trigeminal neuralgia is characterized by sharp unilateral shooting pain in the distribution of one or more branches of the trigeminal nerve. It involves a diagnosis of exclusion. Initially, therapy consists of medical therapy, preferably with carbamazepine or oxcarbazepine. For patients refractory to medical therapy, microvascular decompression of the trigeminal nerve provides the best long-term outcomes, at a relatively low complication risk. In case of surgical contraindications, there are other options: radiosurgery or a neurodestructive procedure of the trigeminal ganglion. Short-term outcomes after neurodestructive therapy are good, however effects diminish over time. Every patient with idiopathic trigeminal neuralgia in whom medical therapy has failed, should be counselled at an experienced centre in which neurosurgical treatment is available.

  6. Neuralgias of the Trigeminal Nerve

    OpenAIRE

    Gordon, Allan S

    2000-01-01

    Practitioners are often presented with patients who complain bitterly of facial pain. The trigeminal nerve is involved in four conditions that are sometimes mixed up. The four conditions - trigeminal neuralgia, trigeminal neuropathic pain, postherpetic neuralgia and atypical facial pain - are discussed under the headings of clinical features, differential diagnosis, cause and treatment. This article should help practitioners to differentiate one from the other and to manage their care.

  7. Neuralgias of the Trigeminal Nerve

    Directory of Open Access Journals (Sweden)

    Allan S Gordon

    2000-01-01

    Full Text Available Practitioners are often presented with patients who complain bitterly of facial pain. The trigeminal nerve is involved in four conditions that are sometimes mixed up. The four conditions - trigeminal neuralgia, trigeminal neuropathic pain, postherpetic neuralgia and atypical facial pain - are discussed under the headings of clinical features, differential diagnosis, cause and treatment. This article should help practitioners to differentiate one from the other and to manage their care.

  8. Radiosurgical management of trigeminal neuralgia.

    Science.gov (United States)

    Chan, Michael D; Shaw, Edward G; Tatter, Stephen B

    2013-10-01

    Over the past several decades, stereotactic radiosurgery has become a viable noninvasive treatment option for patients with trigeminal neuralgia. The scientific literature regarding the radiosurgical treatment of trigeminal neuralgia has evolved to identify factors that predict both efficacy and toxicity. Radiosurgical management has, thus, become complementary to medical management, microvascular decompression, and percutaneous ablative procedures. Thus, effective management often requires multidisciplinary collaboration. The intent of this review is to discuss the role of radiosurgery in the modern management of trigeminal neuralgia and to review radiosurgical outcomes, targeting, and controversies. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Historical characterization of trigeminal neuralgia.

    Science.gov (United States)

    Eboli, Paula; Stone, James L; Aydin, Sabri; Slavin, Konstantin V

    2009-06-01

    TRIGEMINAL NEURALGIA IS a well known clinical entity characterized by agonizing, paroxysmal, and lancinating facial pain, often triggered by movements of the mouth or eating. Historical reviews of facial pain have attempted to describe this severe pain over the past 2.5 millennia. The ancient Greek physicians Hippocrates, Aretaeus, and Galen, described kephalalgias, but their accounts were vague and did not clearly correspond with what we now term trigeminal neuralgia. The first adequate description of trigeminal neuralgia was given in 1671, followed by a fuller description by physician John Locke in 1677. André described the convulsive-like condition in 1756, and named it tic douloureux; in 1773, Fothergill described it as "a painful affection of the face;" and in 1779, John Hunter more clearly characterized the entity as a form of "nervous disorder" with reference to pain of the teeth, gums, or tongue where the disease "does not reside." One hundred fifty years later, the neurological surgeon Walter Dandy equated neurovascular compression of the trigeminal nerve with trigeminal neuralgia.

  10. Microvascular decompression for trigeminal neuralgia.

    Science.gov (United States)

    Sade, Burak; Lee, Joung H

    2014-10-01

    The microvascular decompression procedure has proven to be a safe and effective option in the surgical management of neurovascular compression syndromes in general and trigeminal neuralgia in particular. This article aims to serve as an overview of the decision-making process, application of the surgical technique, and clinical outcome pertaining to this procedure.

  11. Pharmacological treatment of trigeminal neuralgia.

    Science.gov (United States)

    Di Stefano, Giulia; Truini, Andrea

    2017-10-01

    Unique among the different neuropathic pain conditions, trigeminal neuralgia frequently has an excellent response to some selected drugs, which, on the other hand, often entail disabling side effects. Physicians should be therefore acquainted with the management of these drugs and the few alternative options. Areas covered: This article, based on a systematic literature review, describes the pharmacological options, and indicates the future perspectives for treating trigeminal neuralgia. The article therefore provides current, evidence-based knowledge about the pharmacological treatment of trigeminal neuralgia, and suggests a practical approach to the various drugs, including starting dose, titration and side effects. Expert commentary: Carbamazepine and oxcarbazepine are the reference standard drugs for treating patients with trigeminal neuralgia. They are effective in most patients. The undesired effects however cause withdrawal from treatment or a dosage reduction to an insufficient level in many patients. Sodium channel blockers selective for the sodium channel 1.7 (Nav1.7) receptor, currently under development, might be an alternative, better-tolerated pharmacological option in the next future.

  12. Trigeminal neuralgia: a new therapy?

    Science.gov (United States)

    Collet, C; Haen, P; Laversanne, S; Brignol, L; Thiéry, G

    2013-12-01

    Trigeminal neuralgia (TN) is a rare form of neuropathic pain that results in sudden, unilateral and recurrent pains in the distribution of one or more branches of the trigeminal nerve. The aetiology of TN remains unclear and several theories have been proposed. Many medical and surgical methods have been applied with only partial effectiveness and several side effects. New hypotheses and therapeutic methods are urgently needed. Using evidence presented in a literature review and in our own case report, we hypothesize that pain resulting from trigeminal neuralgia can be caused by demyelinating lesions in the trigger zone. These lesions can be repaired through the injection of fat containing Adipose-Derived Stem Cells (ADSC). Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Evaluation of surgical procedures for trigeminal neuralgia.

    OpenAIRE

    Ong, K. S.; Keng, S. B.

    2003-01-01

    Trigeminal neuralgia is a type of facial pain that is difficult to treat. The pain can be excruciating and debilitating. The wide range of treatments currently used for trigeminal neuralgia is ample evidence that there is no simple answer to how it should be managed. This review will evaluate the current surgical procedures used for the treatment of trigeminal neuralgia. A critical analysis of the evidence-based studies to date was done to evaluate and compare the efficacy of the different su...

  14. Trigeminal Neuralgia and Radiofrequency Lesioning

    Directory of Open Access Journals (Sweden)

    Andy R. Eugene

    2015-12-01

    Full Text Available Trigeminal Neuralgia is a disorder that is characterized with electrical-type shocking pain in the face and jaw. This pain may either present as sharp unbearable pain unilateral or bilaterally. There is no definite etiology for this condition. There are various treatment methods that are currently being used to relieve the pain. One of the pharmacological treatments is Carbamazepine and the most prevalent surgical treatments include Gamma Knife Surgery (GKS, Microvascular Decompression (MVD and Radiofrequency Lesioning (RFL. Although, MVD is the most used surgical method it is not an option for all the patients due to the intensity of the procedure. RFL is used when MVD is not suitable. In this paper we present the various treatments and Monte-Carlo based pharmacokinetic simulations of Carbamazepine in treatment of Trigeminal Neuralgia.

  15. Trigeminal neuralgia - diagnosis and treatment.

    Science.gov (United States)

    Maarbjerg, Stine; Di Stefano, Giulia; Bendtsen, Lars; Cruccu, Giorgio

    2017-01-01

    Introduction Trigeminal neuralgia (TN) is characterized by touch-evoked unilateral brief shock-like paroxysmal pain in one or more divisions of the trigeminal nerve. In addition to the paroxysmal pain, some patients also have continuous pain. TN is divided into classical TN (CTN) and secondary TN (STN). Etiology and pathophysiology Demyelination of primary sensory trigeminal afferents in the root entry zone is the predominant pathophysiological mechanism. Most likely, demyelination paves the way for generation of ectopic impulses and ephaptic crosstalk. In a significant proportion of the patients, the demyelination is caused by a neurovascular conflict with morphological changes such as compression of the trigeminal root. However, there are also other unknown etiological factors, as only half of the CTN patients have morphological changes. STN is caused by multiple sclerosis or a space-occupying lesion affecting the trigeminal nerve. Differential diagnosis and treatment Important differential diagnoses include trigeminal autonomic cephalalgias, posttraumatic or postherpetic pain and other facial pains. First line treatment is prophylactic medication with sodium channel blockers, and second line treatment is neurosurgical intervention. Future perspectives Future studies should focus on genetics, unexplored etiological factors, sensory function, the neurosurgical outcome and complications, combination and neuromodulation treatment as well as development of new drugs with better tolerability.

  16. Overview and History of Trigeminal Neuralgia.

    Science.gov (United States)

    Patel, Smruti K; Liu, James K

    2016-07-01

    Although the symptoms associated with trigeminal neuralgia have been well documented, the root cause of this disease initially eluded most surgeons. Although early remedies were haphazard because of a lack of understanding about the condition, near the 20th century both medical and procedural therapies were established for the treatment of trigeminal neuralgia. These treatments include a variety of medications, chemoneurolysis, radiofrequency lesioning, percutaneous ablative procedures, stereotactic radiosurgery, and open rhizotomy and microvascular decompression. This report recounts the history of trigeminal neuralgia, from its earliest descriptions to the historical evolution of nonsurgical and surgical therapies. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Stereotactic Radiosurgery for Classical Trigeminal Neuralgia

    Directory of Open Access Journals (Sweden)

    Henry Kodrat

    2016-04-01

    Full Text Available Trigeminal neuralgia is a debilitating pain syndrome with a distinct symptom mainly excruciating facial pain that tends to come and go unpredictably in sudden shock-like attacks. Medical management remains the primary treatment for classical trigeminal neuralgia. When medical therapy failed, surgery with microvascular decompression can be performed. Radiosurgery can be offered for classical trigeminal neuralgia patients who are not surgical candidate or surgery refusal and they should not in acute pain condition. Radiosurgery is widely used because of good therapeutic result and low complication rate. Weakness of this technique is a latency period, which is time required for pain relief. It usually ranges from 1 to 2 months. This review enlightens the important role of radiosurgery in the treatment of classical trigeminal neuralgia.

  18. Treatment options in trigeminal neuralgia

    Science.gov (United States)

    Obermann, Mark

    2010-01-01

    The incidence of trigeminal neuralgia (TN) is 4.3 per 100,000 persons per year, with a slightly higher incidence for women (5.9/100,000) compared with men (3.4/100,000). There is a lack of certainty regarding the aetiology and pathophysiology of TN. The treatment of TN can be very challenging despite the numerous options patients and physicians can choose from. This multitude of treatment options poses the question as to which treatment fits which patient best. The preferred medical treatment for TN consists of anticonvulsant drugs, muscle relaxants and neuroleptic agents. Large-scale placebo-controlled clinical trials are scarce. For patients refractory to medical therapy, Gasserian ganglion percutaneous techniques, gamma knife surgery and microvascular decompression are the most promising invasive treatment options. PMID:21179603

  19. Trigeminal neuralgia in an HIV patient

    Directory of Open Access Journals (Sweden)

    Mohammad A Hashmi

    2010-01-01

    Full Text Available Trigeminal neuralgia is a painful condition affecting face. Its commonest cause is the tortuous vessels in prepontine cistern. There are other causes also, like brainstem lesions and mass lesions, as well as inflammatory causes. We present a case of an HIV patient with marked involvement of trigeminal nerves, which is a unique finding in immunocompromised patients.

  20. Percutaneous microballoon compression for trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    LIU Hong-bing; MA Yi; ZOU Jian-jun; LI Xin-gang

    2007-01-01

    Background Percutaneous microballoon compression (PMC) for trigeminal neuralgia is an important therapeutic method. The aim of this study was to review the effects of PMC for trigeminal neuralgia in 276 patients.Methods From December 2000 to May 2003, 276 patients with trigeminal neuralgia were treated with PMC. The course of the disease ranged from 3 months to 38 years. Under the guidance of C-arm X-ray, 14# needle was placed into the foramen ovale using the classical Hakanson's technique. Fogarty balloon catheter was navigated into the Meckel's cave tenderly. A small amount of Omnipaque was slowly injected to inflate the balloon and compress the trigeminal ganglion for 3 to10 minutes.Results A total of 290 PMC were performed on the 276 patients. Among them, 252 had immediate relief from pain. The patients were followed up for a mean of 18.7 months (range, 4 to 32), 14 of them had a recurrence. Of the 14 patients, 12 were re-operated with PMC, and the pain was all controlled successfully.Conclusions PMC is an effective and technically simple method for trigeminal neuralgia. For older patients with trigeminal neuralgia, it may be the first choice.

  1. Trigeminal neuralgia: report of 3 cases

    Energy Technology Data Exchange (ETDEWEB)

    Park, Geum Mee; Ki, Joo Yeon; Cho, Bong Hae; Nah, Kyung Soo [College of Dentistry, Pusan National University, Pusan (Korea, Republic of)

    2002-03-15

    Orofacial pain can be caused by intracranial disorders or can be musculoskeletal, vascular, internal derangemental, and neurologic in origin. The neurologic pain is derived from structural and functional disorders of nerve, and the trigeminal neuralgia is the typical manifestation. Trigeminal neuralgia is known from centuries ago, and is one of the most common pains in human. We present our experience with three patients who have trigeminal neuralgia. The first case is a 50-year-old female who had no specific evidence radiographically. Second is a 50-year-old male with microvascular compression on right trigeminal nerve. The third case is a 60-year-old female who had a neoplasm in cerebellopontine angle with associated mass effect.

  2. Management of trigeminal neuralgia in sclerosteosis.

    Science.gov (United States)

    de Andrade, Emerson Magno; Beer-Furlan, André; Duarte, Kleber Paiva; Fonoff, Erich Talamoni; Teixeira, Manoel Jacobsen

    2013-01-01

    Sclerosteosis is a rare bone disorder characterized by a progressive craniotubular hyperostosis. The diagnosis of sclerosteosis is based on characteristic clinical and radiographic features and a family history consistent with autosomal recessive inheritance. The skull overgrowth may lead to lethal elevation of intracranial pressure, distortion of the face, and entrapment of cranial nerves, resulting in recurrent facial palsy or secondary trigeminal neuralgia. The authors reported cases of two siblings who were diagnosed with familial sclerosteosis and presented with secondary trigeminal neuralgia. The patients were 28 and 40-year-old and presented with pain in the right V2-V3 and V3 distributions, respectively. The facial pain was resistant to medications and was treated with percutaneous techniques. The foramen ovale puncture was complicated initially and the difficulty increased over the years due to stenosis of the foramen. The treatment of the trigeminal neuralgia secondary to hyperostosis and resistant to medications presents a dilemma. The narrowing of the foramen oval and difficulty in the identifying and approaching of the foramen makes the percutaneous technique a challenge for the neurosurgeon in patients harboring sclerosteosis. Microvascular decompression should not be considered since the primary cause of the trigeminal neuralgia is the nerve entrapment by the narrowing of neurovascular foramina and not the neurovascular conflict related to essential trigeminal neuralgia. Stereotactic radiosurgery may be a good treatment option, but there is a lack of published data supporting the use of this method in cranial hyperostosis.

  3. Small-fiber dysfunction in trigeminal neuralgia

    DEFF Research Database (Denmark)

    Cruccu, G.; Leandri, M.; Iannetti, G. D.

    2001-01-01

    Background: In patients with trigeminal neuralgia, results of clinical examination of sensory function are normal. Reflex and evoked potential studies have already provided information on large-afferent (non-nociceptive) function. Using laser-evoked potentials (LEP), the authors sought information...... on small-afferent (nociceptive) function. Methods: The brain potentials evoked by CO2-laser pulses directed to the perioral and supraorbital regions were studied in 67 patients with idiopathic or symptomatic trigeminal neuralgia and 30 normal subjects. Of the 67 patients, 49 were receiving carbamazepine....... Results: All patients with symptomatic and 51% of those with idiopathic trigeminal neuralgia had frankly abnormal LEP on the painful side. The mean latency was significantly higher and mean amplitude lower on the painful than the nonpainful side. However, even on the nonpainful side, the mean latency...

  4. Trigeminal neuralgia treatment dosimetry of the Cyberknife

    Energy Technology Data Exchange (ETDEWEB)

    Ho, Anthony [Department of Radiation Oncology, Stanford University, Stanford, CA (United States); Lo, Anthony T., E-mail: tonyho22003@yahoo.com [Department of Radiation Oncology, Stanford University, Stanford, CA (United States); Dieterich, Sonja; Soltys, Scott G.; Gibbs, Iris C. [Department of Radiation Oncology, Stanford University, Stanford, CA (United States); Chang, Steve G.; Adler, John R. [Department of Neurosurgery, Stanford University, Stanford, CA (United States)

    2012-04-01

    There are 2 Cyberknife units at Stanford University. The robot of 1 Cyberknife is positioned on the patient's right, whereas the second is on the patient's left. The present study examines whether there is any difference in dosimetry when we are treating patients with trigeminal neuralgia when the target is on the right side or the left side of the patient. In addition, we also study whether Monte Carlo dose calculation has any effect on the dosimetry. We concluded that the clinical and dosimetric outcomes of CyberKnife treatment for trigeminal neuralgia are independent of the robot position. Monte Carlo calculation algorithm may be useful in deriving the dose necessary for trigeminal neuralgia treatments.

  5. [Update on the management of trigeminal neuralgia].

    Science.gov (United States)

    Alcántara Montero, A; Sánchez Carnerero, C I

    2016-01-01

    Trigeminal neuralgia is one of the most severe facial pain syndromes. The annual incidence varies between 4-13% and has a significant effect on patient quality of life. The initial treatment of trigeminal neuralgia is pharmacological, and although other drugs have demonstrated efficacy, albeit in more limited form, carbamazepine is the only drug with sufficient level of evidence. When medical treatment fails, surgery should be considered and can opt for open surgery or minimally invasive percutaneous techniques. This paper reviews the medical and surgical therapeutic options for the treatment of trigeminal neuralgia, based on current available evidence. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Comparison of Trigeminal and Postherpetic Neuralgia

    OpenAIRE

    Watson, C. Peter N.

    1996-01-01

    Although postherpetic neuralgia and trigeminal neuralgia (tic douloureux) are common causes of facial pain, they have very little in common aside from lancinating pain (other qualities of pain in each disorder are different). Each disorder affects different areas of the face and the treatment of each is quite dissimilar. The pathogenesis of these two disorders quite likely involves different mechanisms. This report reviews aspects of these two difficult pain problems, particularly with refere...

  7. MRI of the Trigeminal Nerve in Patients With Trigeminal Neuralgia Secondary to Vascular Compression.

    Science.gov (United States)

    Hughes, Marion A; Frederickson, Andrew M; Branstetter, Barton F; Zhu, Xiao; Sekula, Raymond F

    2016-03-01

    Trigeminal neuralgia is a debilitating facial pain disorder, frequently caused by vascular compression of the trigeminal nerve. Vascular compression that results in trigeminal neuralgia occurs along the cisternal segment of the nerve. Imaging combined with clinical information is critical to correctly identify patients who are candidates for microvascular decompression. The purpose of this article is to review trigeminal nerve anatomy and to provide strategies for radiologists to recognize important MRI findings in patients with trigeminal neuralgia.

  8. Trigeminal Neuralgia due to Vertebrobasilar Dolichoectasia

    Directory of Open Access Journals (Sweden)

    Wuilker Knoner Campos

    2012-01-01

    Full Text Available We presented a case of drug-resistant trigeminal neuralgia attributed to vertebrobasilar dolichoectasia, a rare condition characterized by enlargement, tortuosity, or elongation of intracranial arteries. Dolichoectatic vessels can cause dysfunction of cranial nerves through direct vascular compression. The relationships of vertebrobasilar dolichoectasia with the particularities of neurovascular conflict and images findings are discussed.

  9. Trigeminal neuralgia and facial pain imaging.

    Science.gov (United States)

    Graff-Radford, Steven; Gordon, Rachael; Ganal, John; Tetradis, Sotirois

    2015-06-01

    The trigeminal nerve or fifth cranial nerve has an extensive distribution in the head and face. It is the source for pain conduction and thereby is often implicated in a variety of disorders including inflammatory and neoplastic diseases. To determine the disease source, understanding the trigeminal nerve anatomy is essential, and further being able to image the trigeminal nerve provides insight into the location and type of pathology. The best approach to imaging is to consider the nerve in segments. The nerve segments may be divided into the brainstem, cisternal, Meckel's cave, cavernous sinus, and peripheral divisions. This review utilizes these segments to explore imaging options to help understand trigeminal neuralgia and pain in the trigeminal nerve distribution.

  10. Gamma-knife radiosurgery for trigeminal neuralgia

    Energy Technology Data Exchange (ETDEWEB)

    Kannan, V.; Deopujari, C.E.; Misra, B.K.; Shetty, P.G.; Shroff, M.M.; Pendse, A.M. [PD Hinduja National Hospital and Medical Research Centre, Mumbai, (India)

    1999-08-01

    Gamma knife was installed at the PD Hinduja National Hospital and Medical Research Centre, Mumbai, India, in January 1997. In the first year of gamma-knife radiosurgery to January 1998, we treated 110 patients, of whom six had medically refractory trigeminal neuralgia. Seven treatments were administered to this group of six patients (one had bilateral neuralgia). This report evaluates the effectiveness of radiosurgery treatment in these patients. The median age of the patients was 56 years and there were five males and one female. Following Leksell stereotactic frame fixation, a magnetic resonance imaging scan was done in all. The Leksell gamma plan was used for planning. A radiosurgery dose of 70-80 Gy was delivered to the trigeminal root entry zone, 2-4 mm anterior to the junction of the pons and trigeminal nerve with a single 4 mm collimator helmet. Complete pain relief was achieved in four patients. Two had partial relief. No patient developed any radiosurgery related morbidity during the follow-up period of 5-16 months. Radiosurgery seems to be an effective approach for medically or surgically refractory trigeminal neuralgia. Copyright (1999) Blackwell Science Pty Ltd 10 refs., 2 figs.

  11. Comparison of Trigeminal and Postherpetic Neuralgia

    Directory of Open Access Journals (Sweden)

    C Peter N Watson

    1996-01-01

    Full Text Available Although postherpetic neuralgia and trigeminal neuralgia (tic douloureux are common causes of facial pain, they have very little in common aside from lancinating pain (other qualities of pain in each disorder are different. Each disorder affects different areas of the face and the treatment of each is quite dissimilar. The pathogenesis of these two disorders quite likely involves different mechanisms. This report reviews aspects of these two difficult pain problems, particularly with reference to the work of the late Gerhard Fromm, to whom this is dedicated.

  12. Rare cause of trigeminal neuralgia: Meckel's cave meningocele.

    Science.gov (United States)

    Alobaid, Abdullah; Schaeffer, Todd; Virojanapa, Justin; Dehdashti, Amir R

    2015-07-01

    The most common etiology of classic trigeminal neuralgia is vascular compression. However, other causes must be excluded. It is very unlikely that a meningocele presents with symptomatic trigeminal neuralgia. We present a rare case of a patient presenting with left trigeminal neuralgia. Thin-slice CT and MRI showed a transclival Meckel's cave meningocele. The patient underwent endoscopic repair of the meningocele, which resulted in complete resolution of her symptoms. Meckel's cave meningocele or encephalocele should be considered among the differential diagnoses of trigeminal neuralgia. Meningocele repair should be suggested as the first treatment option in this rare situation.

  13. Radiology of trigeminal neuralgia; With special reference to CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Matsumoto, Shunichi; Kishikawa, Takashi; Kudo, Sho (Saga Medical School, Saga (Japan)) (and others)

    1990-05-01

    CT findings in ninty-nine patients with trigeminal neuralgia were reviewed. Brain tumors including three trigeminal neurinomas, three meningiomas, one epidermoid, one acoustic neurinoma, were found in eight cases as a cause of symptomatic trigeminal neuralgia. Among seventy-nine patients with idiopathic trigeminal neuralgia, four cases had vascular decompression surgery because of the tortuous, ectatic or anomalous vertebrobasilar artery. Among the other seventy-five non-surgical cases, seventeen cases showed the tortuous and/or ectatic vertebrobasilar artery on CT, and this group of patients showed slightly higher recurrence rate of trigeminal neuralgia after nerve block or medication compared with other non-surgical patients. CT is thought to be a useful screening imaging modality for evaluation of patients with trigeminal neuralgia, and angiography is required for precise evaluation of the compressing vessels when surgical treatment is contemplated. (author).

  14. Case series: non vascular considerations in trigeminal neuralgia.

    Science.gov (United States)

    Balasundram, Sathesh; Cotrufo, Stefano; Liew, Colin

    2012-02-01

    An abnormal vascular course of the superior cerebellar artery is often cited as the cause for trigeminal neuralgia. However, among patients with TN-like symptoms, 6% to 16% are variously reported to have intracranial tumours. Aneurysms, tumours, or other lesions may impinge or irritate the trigeminal nerve along its course. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. We would like to present a series of unusual lesions, all of which initially presented with neuralgic-like symptoms and were refractory to treatment. Collated case series with photographs and imaging are reviewed in this paper. Discussion of case presentation and management are done for evaluation. A wide range of other compressive lesions can cause trigeminal neuralgia. This paper illustrates the clinical presentation of atypical trigeminal neuralgia and emphasises the value of diagnostic imaging in trigeminal neuralgia patient. Suggested algorithm for management of trigeminal neuralgia.

  15. Meckel's cave epidermoid with trigeminal neuralgia: CT findings.

    Science.gov (United States)

    Kapila, A; Steinbaum, S; Chakeres, D W

    1984-12-01

    An epidermoid tumor of Meckel's cave was found in a middle-aged woman with trigeminal neuralgia. On CT the lesion had negative attenuation numbers of fat and extended from an expanded Meckel's cave through the porous trigeminus into the ambient and cerebellopontine angle cisterns. Surgical excision provided relief of the patient's trigeminal neuralgia.

  16. Trigeminal neuralgia secondary to basilar impression: A case report

    Science.gov (United States)

    de Almeida Holanda, Maurus Marques; Pereira Neto, Normando Guedes; de Moura Peixoto, Gustavo; Pinheiro Santos, Rayan Haquim

    2015-01-01

    We report a rare case of trigeminal neuralgia. A 23-year-old woman with a history of 1 year of typical trigeminal neuralgia manifested the characteristics of basilar impression. Magnetic resonance imaging (MRI) demonstrated basilar impression, deformity of the posterior fossa with asymmetry of petrous bone, and compression of medulla oblongata in the topography of the odontoid apophysis. The operation was performed through a suboccipital craniectomy. The neuralgia disappeared after surgery and remains completely resolved until today. This is the second reported case of trigeminal neuralgia in a patient with basilar impression in Brazil. PMID:25972713

  17. Significance of neurovascular contact in classical trigeminal neuralgia

    DEFF Research Database (Denmark)

    Maarbjerg, Stine; Wolfram, Frauke; Gozalov, Aydin

    2015-01-01

    Neurovascular contact is considered a frequent cause of classical trigeminal neuralgia and microvascular decompression with transposition of a blood vessel is preferred over other surgical options in medically refractory patients with classical trigeminal neuralgia. However, the prevalence...... of neurovascular contact has not been investigated in a representative cohort of patients with classical trigeminal neuralgia based in a neurological setting and using high-quality neuroimaging and blinded evaluation. We aimed to investigate whether presence and degree of neurovascular contact are correlated...... to pain side in classical trigeminal neuralgia. Consecutive classical trigeminal neuralgia patients with unilateral symptoms were referred to 3.0 T magnetic resonance imaging and included in a cross-sectional study. Magnetic resonance imaging scans were evaluated blindly and graded according to presence...

  18. Differences in individual susceptibility affect the development of trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    Yusuf Kurtulu(s) Duransoy; Mesut Mete; Emrah Ak(c)ay; Mehmet Sel(c)uki1

    2013-01-01

    Trigeminal neuralgia is a syndrome due to dysfunctional hyperactivity of the trigeminal nerve, and is characterized by a sudden, usually unilateral, recurrent lancinating pain arising from one or more divisions of the nerve. The most accepted pathogenetic mechanism for trigeminal neuralgia is compression of the nerve at its dorsal root entry zone or in its distal course. In this paper, we report four cases with trigeminal neuralgia due to an unknown mechanism after an intracranial intervention. The onset of trigeminal neuralgia after surgical interventions that are unrelated to the trigeminal nerve suggests that in patients with greater individual susceptibility, nerve contact with the vascular structure due to postoperative pressure and changes in cerebrospinal fluid flow may cause the onset of pain.

  19. Trigeminal Neuralgia — A Debilitating Facial Pain

    Science.gov (United States)

    2011-01-01

    Trigeminal neuralgia (TN) is characterised by sudden usually unilateral severe, brief, stabbing, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve. Diagnosis is largely based on clinical history due to the current lack of objective investigations. MRI can identify those patients who have TN secondary to an underlying pathology such as multiple sclerosis. The first line medical management remains carbamazepine, with oxcarbazepine being the second choice medication. Both percutaneous techniques targeting the Gasserian ganglion and microvascular decompression can be considered effective in the management of TN. Microvascular decompression is considered to provide on average, the longest pain free period post surgery. There are a number of TN associations and support groups which provide a valued service to patients and clinicians. Due to a dearth of high quality studies in many aspects of the condition, TN requires further research to be conducted. PMID:26527120

  20. Repeat Gamma Knife Radiosurgery for Trigeminal Neuralgia

    Energy Technology Data Exchange (ETDEWEB)

    Aubuchon, Adam C., E-mail: acaubuchon@gmail.com [Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC (United States); Chan, Michael D. [Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC (United States); Lovato, James F. [Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (United States); Balamucki, Christopher J. [Department of Radiation Oncology, University of Florida, Gainesville, FL (United States); Ellis, Thomas L.; Tatter, Stephen B. [Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, NC (United States); McMullen, Kevin P.; Munley, Michael T.; Deguzman, Allan F.; Ekstrand, Kenneth E.; Bourland, J. Daniel; Shaw, Edward G. [Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC (United States)

    2011-11-15

    Purpose: Repeat gamma knife stereotactic radiosurgery (GKRS) for recurrent or persistent trigeminal neuralgia induces an additional response but at the expense of an increased incidence of facial numbness. The present series summarized the results of a repeat treatment series at Wake Forest University Baptist Medical Center, including a multivariate analysis of the data to identify the prognostic factors for treatment success and toxicity. Methods and Materials: Between January 1999 and December 2007, 37 patients underwent a second GKRS application because of treatment failure after a first GKRS treatment. The mean initial dose in the series was 87.3 Gy (range, 80-90). The mean retreatment dose was 84.4 Gy (range, 60-90). The dosimetric variables recorded included the dorsal root entry zone dose, pons surface dose, and dose to the distal nerve. Results: Of the 37 patients, 81% achieved a >50% pain relief response to repeat GKRS, and 57% experienced some form of trigeminal dysfunction after repeat GKRS. Two patients (5%) experienced clinically significant toxicity: one with bothersome numbness and one with corneal dryness requiring tarsorraphy. A dorsal root entry zone dose at repeat treatment of >26.6 Gy predicted for treatment success (61% vs. 32%, p = .0716). A cumulative dorsal root entry zone dose of >84.3 Gy (72% vs. 44%, p = .091) and a cumulative pons surface dose of >108.5 Gy (78% vs. 44%, p = .018) predicted for post-GKRS numbness. The presence of any post-GKRS numbness predicted for a >50% decrease in pain intensity (100% vs. 60%, p = .0015). Conclusion: Repeat GKRS is a viable treatment option for recurrent trigeminal neuralgia, although the patient assumes a greater risk of nerve dysfunction to achieve maximal pain relief.

  1. Clinical outcome following micro-vascular decompression for trigeminal neuralgia

    Directory of Open Access Journals (Sweden)

    Godugu Bhaskar Rao

    2015-07-01

    Conclusion: Micro-vascular decompression is safe and effective in producing good pain relief over a long term in patients with Trigeminal neuralgias refractive to medical treatment. [Int J Res Med Sci 2015; 3(7.000: 1741-1744

  2. Pain in trigeminal neuralgia: neurophysiology and measurement: a comprehensive review

    OpenAIRE

    Rastogi, S; S. Kumar; Mahendra, P.; Bansal, M; L. Chandra

    2013-01-01

    Abstract Trigeminal neuralgia (TN) is defined as sudden, usually unilateral, severe, brief, stabbing recurrent episodes of pain within the distribution of one or more branches of the trigeminal nerve. It is the most frequent cranial neuralgia, the incidence being 1 per 1,000,00 persons per year. Pain attacks start abruptly and last several seconds but may persist 1 to 2 minutes. The attacks are initiated by non painful physical stimulation of specific areas (trigger points or zones) that are ...

  3. Wallenberg’s syndrome and symptomatic trigeminal neuralgia

    OpenAIRE

    Ordás, Carlos M.; Cuadrado, María L.; Simal, Patricia; Barahona, Raúl; Casas, Javier; Matías-Guiu Antem, Jordi; Porta-Etessam, Jesús

    2011-01-01

    Symptomatic trigeminal neuralgia due to a brainstem infarction is said to be rare. However, facial pain is not uncommon in Wallenberg’s syndrome. Facial pain related to a Wallenberg’s syndrome may be either persistent of intermittent, and occasionally occurs in brief attacks. Here, we report a patient with a right lateral medullary infarction who started having first division trigeminal neuralgia 1 month after the stroke. The pain paroxysms were suppressed with gabapentin.

  4. Linear accelerator radiosurgery for trigeminal neuralgia: case report

    Energy Technology Data Exchange (ETDEWEB)

    Yun, Hyong Geun [Dongguk University International Hospital, Goyang (Korea, Republic of)

    2006-06-15

    Trigeminal neuralgia is defined as an episodic electrical shock-like sensation in a dermatomal distribution of the trigeminal nerve. When medications fail to control pain, various procedures are used to attempt to control refractory pain. Of available procedures, stereotactic radiosurgery is the least invasive procedure and has been demonstrated to produce significant pain relief with minimal side effects. Recently, linear accelerators were introduced as a tool for radiosurgery of trigeminal neuralgia beneath the already accepted gamma unit. Author have experienced one case with trigeminal neuralgia treated with linear accelerator. The patient was treated with 85 Gy by means of 5 mm collimator directed to trigeminal nerve root entry zone. The patient obtained pain free without medication at 20 days after the procedure and remain pain free at 6 months after the procedure. He didn't experience facial numbness or other side effects.

  5. [A case of combined glossopharyngeal and trigeminal neuralgia].

    Science.gov (United States)

    Katoh, Masahito; Aida, Toshimitsu; Moriwaki, Takuya; Yoshino, Masami; Aoki, Takeshi; Abumiya, Takeo; Imamura, Hiroyuki; Ogata, Akihiko

    2012-06-01

    It is well-known that idiopathic neuralgias of the trigeminal and glossopharyngeal nerves are caused by vascular compression at the root entry zone of the cranial nerves. Because they are functional diseases, initial treatment is medical, especially with carbamazepine. However, if medical therapy fails to adequately manage the pain, microvascular decompression (MVD) is prescribed. Glossopharyngeal neuralgia is rare, and combined trigeminal and glossopharyngeal neuralgia is an extremely rare disorder. A 70-year-old woman presented herself to Hokkaido Neurosurgical Memorial Hospital because of paroxysms of lancinating pain in her left pharynx and another lancinating pain in her left cheek. Carbamazepine, which was prescribed at another hospital, favorably relieved the pain; however, drug eruption compelled her to discontinue the medication. The multi-volume method revealed that a root entry zone of the left glossopharyngeal nerve was compressed by the left posterior inferior cerebellar artery, and the left trigeminal artery was compressed by the left superior cerebellar artery. MVD for both nerves was performed employing a left lateral suboccipital craniotomy. She experienced complete relief of pain immediately after MVD. Combined trigeminal and glossopharyngeal neuralgia is extremely rare, but some groups noted a relatively high incidence of concurrent trigeminal neuralgia in patients with glossopharyngeal neuralgia up until the 1970's. Glossopharyngeal neuralgia includes pain near the gonion; therefore, there is an overlap of symptoms between glossopharyngeal and trigeminal neuralgias. By virtue of recent progress in imaging technology, minute preoperative evaluations of microvascular compression are possible. Until the 1970's, there might have been some misunderstanding regarding the overlap of symptoms because of lack of the concept of microvascular compression as a cause of neuralgia and rudimentary imaging technology. Minute evaluations of both symptoms and

  6. Pharmaceutical management of trigeminal neuralgia in the elderly

    NARCIS (Netherlands)

    Oomens, M.A.E.M.; Forouzanfar, T.

    2015-01-01

    Classical trigeminal neuralgia (CTN) is a severe neuropathic pain in the distribution of one or more branches of the trigeminal nerve, which occurs in recurrent episodes, causing deterioration in quality of life, affecting everyday habits and inducing severe disability. The aim of this review is to

  7. Trigeminal neuralgia and persistent idiopathic facial pain.

    Science.gov (United States)

    Obermann, Mark; Holle, Dagny; Katsarava, Zaza

    2011-11-01

    Trigeminal neuralgia (TN) and persistent idiopathic facial pain (PIFP) are two of the most puzzling orofacial pain conditions and affected patients are often very difficult to treat. TN is characterized by paroxysms of brief but severe pain followed by asymptomatic periods without pain. In some patients a constant dull background pain may persist. This constant dull pain sometimes makes the distinction from PIFP difficult. PIFP is defined as continuous facial pain, typically localized in a circumscribed area of the face, which is not accompanied by any neurological or other lesion identified by clinical examination or clinical investigations. The pain usually does not stay within the usual anatomic boundaries of the trigeminal nerve distribution and is a diagnosis of exclusion. Epidemiologic evidence on TN, and even more so on PIFP, is quite scarce, but generally both conditions are considered to be rare diseases. The etiology and underlying pathophysiology of TN, and more so PIFP, remain unknown. Treatment is based on only few randomized controlled clinical trials and insufficiently evaluated surgical procedures.

  8. Trigeminal neuralgia: unilateral episodic facial pain.

    Science.gov (United States)

    Zakrzewska, Joanna M

    2015-06-01

    Trigeminal neuralgia is a rare cause of episodic unilateral facial pain and often in the initial presentation dental causes need to be eliminated, as it frequently presents in the lower trigeminal divisions. The pain description is characteristic of electric shock-like pain that is light-touch provoked, paroxysmal, and occurring daily; the condition can go into remission for weeks or months, however. The first-line drug is either carbamazepine or oxcarbazepine and has to be started in low doses. Over 70% of patients will initially obtain immediate relief. If efficacy or tolerability becomes a problem, then referral to a secondary care specialist should be made. Magnetic resonance imaging (MRI) scans can determine if there is a symptomatic cause and whether surgery is indicated. Surgical options provide longest pain relief periods. Patients need to be given information about all treatment options so they can make a decision about treatment. This report is adapted from paineurope 2014; Issue 4, © Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be viewed via the Web site: www.paineurope.com , at which health professionals can find links to the original articles and request copies of the quarterly publication and access additional pain education and pain management resources.

  9. Efficacy, safety and tolerability of duloxetine in idiopathic trigeminal neuralgia.

    Science.gov (United States)

    Anand, K S; Dhikav, V; Prasad, A; Shewtengna

    2011-04-01

    Trigeminal neuralgia (TN) is the most common type of neuralgia affecting facial region and is considered to be one of the most painful conditions. Treatment is often unsatisfactory. Newer treatment modalities are therefore being tried. Duloxetine is FDA approved drug for painful diabetic neuropathy and has been used in painful symptoms of depression as well. Safety and efficacy of duloxetine was evaluated in patients with trigeminal neuralgia; another chronically painful condition, in an open label manner. A total of 15 patients who fulfilled the diagnostic criteria of International Headache Society for Trigeminal Neuralgia were administered duloxetine 40 mg daily. The efficacy of the drug was evaluated by face scale and Likert's numerical scale. Statistically significant pain relief was reported in 9 out of 15 patients of trigeminal neuralgia. The pain relief was reported as early as in one week and was maintained for 16 weeks. The drug was well tolerated and side-effects reported were mild and reversible. No adverse drug reaction requiring hospitalisation or drug discontinuation was reported in the present study. Duloxetine showed statistically significant pain relief in trigeminal neuralgia. Double-blind, placebo-controlled studies are needed to confirm findings at a large scale.

  10. CT-Guided Trigeminal Neuralgia in MS

    Directory of Open Access Journals (Sweden)

    Jalal Jalal Shokouhi

    2011-05-01

    Full Text Available Background/Objective: Multiple sclerosis has nonspecific"nsigns in MR images and clinic and also has pain,"none of the pain syndromes in MS cases is trigeminal"nneuralgia. 12 patients of our 38 trigeminal neuralgic"npatients etiology were known as MS cases. All of them"nwere young (20-40 years old."nIntroduction: Multiple sclerosis diagnosis is by clinic,"nMRI, CSF electrophoresis and evocked potensial tests."nImaging diagnostis is not suggestive and specific but in"nthis article we show imaging help not only in diagnosis"nalso in treatment of complications. Trigeminal neuralgia"nis the worse clinical condition in M.S patients and may"npush them to addiction or suicide."nMaterials and Methods: X-ray CT machine is used for"nguidance of L.P or coaxial 10cm needle with 22G, local"nanesthesia and ethanol injection. One time treatment"nmade for all patients and they were pain free after"ninterventional drug injection. 5-6 cc bupivicain 0.5%"nand 3-4cc ethanol 96% are used for treatment."nResults: All patients were pain free and very happy"nafter treatment. One of them had pain for 12 years"nand had tried all the other treatments with no good"nresponse. No complication was seen in our treatments."n15 to 20 minutes time is needed for each examination"nor treatment."nConclusion: Despite known MS cases and relative"ndrug therapies for patients it is not possible to treat"ntrigeminal paint except using interventional therapy"nand CT-guidance is exactive and easy. There was"nno complication except irritation in the middle ear"nbecause of Eustachian tube compression by injected"nvolume of drugs

  11. Peripheral neuromodulation for the treatment of refractory trigeminal neuralgia

    Directory of Open Access Journals (Sweden)

    Naum Shaparin

    2015-01-01

    Full Text Available Trigeminal neuralgia is a type of orofacial pain that is diagnosed in 150,000 individuals each year, with an incidence of 12.6 per 100,000 person-years and a prevalence of 155 cases per 1,000,000 in the United States. Trigeminal neuralgia pain is characterized by sudden, severe, brief, stabbing or lancinating, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve, which can cause significant suffering for the affected patient population.

  12. Gamma Knife® radiosurgery for trigeminal neuralgia.

    Science.gov (United States)

    Yen, Chun-Po; Schlesinger, David; Sheehan, Jason P

    2011-11-01

    Trigeminal neuralgia is characterized by a temporary paroxysmal lancinating facial pain in the trigeminal nerve distribution. The prevalence is four to five per 100,000. Local pressure on nerve fibers from vascular loops results in painful afferent discharge from an injured segment of the fifth cranial nerve. Microvascular decompression addresses the underlying pathophysiology of the disease, making this treatment the gold standard for medically refractory trigeminal neuralgia. In patients who cannot tolerate a surgical procedure, those in whom a vascular etiology cannot be identified, or those unwilling to undergo an open surgery, stereotactic radiosurgery is an appropriate alternative. The majority of patients with typical facial pain will achieve relief following radiosurgical treatment. Long-term follow-up for recurrence as well as for radiation-induced complications is required in all patients undergoing stereotactic radiosurgery for trigeminal neuralgia.

  13. Radiosurgery for the management of refractory trigeminal neuralgia

    Directory of Open Access Journals (Sweden)

    Ajay Niranjan

    2016-01-01

    Full Text Available Gamma Knife stereotactic radiosurgery (SRS is a minimally invasive surgical approach for managing medically refractory trigeminal neuralgia (TN. The goal of trigeminal neuralgia SRS is to eliminate or reduce the facial pain in order to improve the quality of life. Over the past 28 years, 1250 patients have undergone gamma knife SRS for TN at our institution. In our retrospective review of 503 patients who underwent SRS for management of refractory TN, 449 patients (89% experienced initial pain relief at a median latency of 1 month. At the one year mark, 73% patients were pain free (with or without medications and 80% had pain control. Repeat radiosurgery was performed for 193 patients (43%. At the one year mark, 26% of these patients were completely pain free and 78% were pain free with or without medications. The role of gamma Knife SRS in the management of medically refractory trigeminal neuralgia has evolved over the past two decades. SRS is a minimally invasive procedure and is associated with 60-90% rate of pain relief in patents with medical refractory trigeminal neuralgia. Early intervention with SRS as the initial surgical procedure for management of refractory trigeminal neuralgia is associated with faster, better, and longer pain relief. As SRS is the least invasive procedure for TN, it is a good treatment option for patients with other high-risk medical conditions. SRS is an attractive alternative especially to those who do not want to accept the greater risk associated with other surgical procedures.

  14. Radiofrequency trigeminal rhizolysis for the treatment of trigeminal neuralgia secondary to brainstem infarction. Report of two cases.

    Science.gov (United States)

    Foroohar, M; Herman, M; Heller, S; Levy, R M

    1997-01-15

    Although percutaneous radiofrequency trigeminal rhizolysis (RFL) has been used to treat idiopathic trigeminal neuralgia thought secondary to multiple sclerosis, the use of RFL for trigeminal neuralgia caused by brainstem infarction has not been advocated. The authors report two patients with trigeminal neuralgia following pontine infarction in whom aggressive medical management failed, but who were successfully treated with RFL. Pain relief has persisted for the 3- and 6-year duration of follow-up examinations. Descending trigeminal reticular fibers may be affected by brainstem infarction and result in trigeminal neuralgia; thus, treatment by rhizotomy may be effective in decreasing the peripheral afferent input into the spinal trigeminal nucleus thus decreasing the pain. These two cases demonstrate the utility of RFL in the relief of ischemia-induced trigeminal neuralgia and lead the authors to suggest that its use be broadened to include this indication.

  15. Tic versus TAC: differentiating the neuralgias (trigeminal neuralgia) from the cephalalgias (SUNCT and SUNA).

    Science.gov (United States)

    VanderPluym, Juliana; Richer, Lawrence

    2015-01-01

    Trigeminal neuralgia, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with autonomic symptoms (SUNA) are classified as distinct disorders in the International Classification of Headache Disorders 3 beta (ICHD-3 beta). SUNCT and SUNA are primary headache disorders included among the trigeminal autonomic cephalalgias. Trigeminal neuralgia is classified under painful cranial neuropathies and other facial pains. The classification criteria of these conditions overlap significantly which could lead to misdiagnosis. The reported overlap among these conditions has called into question whether they should be considered distinct entities or rather a continuum of the same disorder. This review explores the known overlap and how other features not included in the ICHD-3 beta criteria may better differentiate the "Tics" (trigeminal neuralgia) from the "TACs" (SUNCT and SUNA).

  16. Measurement of Trigeminal Neuralgia Pain: Penn Facial Pain Scale.

    Science.gov (United States)

    Lee, John Y K

    2016-07-01

    Pain is a subjective experience that cannot be directly measured. Therefore, patient-reported outcome is one of the currently accepted methods to capture pain intensity and its impact on activities of daily living. This article focuses on five patient-reported outcomes that have been used to measure trigeminal neuralgia pain-Visual Analog Scale, numeric rating scale, Barrow Neurological Institute Pain Intensity Score, McGill Pain Questionnaire, and Penn Facial Pain Scale. Each scale is evaluated for its practicality, applicability, comprehensiveness, reliability, validity, and sensitivity to measuring trigeminal neuralgia pain. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Peripheral neuromodulation for the treatment of refractory trigeminal neuralgia.

    Science.gov (United States)

    Shaparin, Naum; Gritsenko, Karina; Garcia-Roves, Diego Fernandez; Shah, Ushma; Schultz, Todd; DeLeon-Casasola, Oscar

    2015-01-01

    Trigeminal neuralgia is a type of orofacial pain that is diagnosed in 150,000 individuals each year, with an incidence of 12.6 per 100,000 person-years and a prevalence of 155 cases per 1,000,000 in the United States. Trigeminal neuralgia pain is characterized by sudden, severe, brief, stabbing or lancinating, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve, which can cause significant suffering for the affected patient population. In many patients, a combination of medication and interventional treatments can be therapeutic, but is not always successful. Peripheral nerve stimulation has gained popularity as a simple and effective neuromodulation technique for the treatment of many pain conditions, including chronic headache disorders. Specifically in trigeminal neuralgia, neurostimulation of the supraorbital and infraorbital nerves may serve to provide relief of neuropathic pain by targeting the distal nerves that supply sensation to the areas of the face where the pain attacks occur, producing a field of paresthesia within the peripheral distribution of pain through the creation of an electric field in the vicinity of the leads. The purpose of the present case report is to introduce a new, less-invasive interventional technique, and to describe the authors' first experience with supraorbital and infraorbital neurostimulation therapy for the treatment of trigeminal neuralgia in a patient who had failed previous conservative management.

  18. Update on neuropathic pain treatment for trigeminal neuralgia

    Science.gov (United States)

    Al-Quliti, Khalid W.

    2015-01-01

    Trigeminal neuralgia is a syndrome of unilateral, paroxysmal, stabbing facial pain, originating from the trigeminal nerve. Careful history of typical symptoms is crucial for diagnosis. Most cases are caused by vascular compression of the trigeminal root adjacent to the pons leading to focal demyelination and ephaptic axonal transmission. Brain imaging is required to exclude secondary causes. Many medical and surgical treatments are available. Most patients respond well to pharmacotherapy; carbamazepine and oxcarbazepine are first line therapy, while lamotrigine and baclofen are considered second line treatments. Other drugs such as topiramate, levetiracetam, gabapentin, pregabalin, and botulinum toxin-A are alternative treatments. Surgical options are available if medications are no longer effective or tolerated. Microvascular decompression, gamma knife radiosurgery, and percutaneous rhizotomies are most promising surgical alternatives. This paper reviews the medical and surgical therapeutic options for the treatment of trigeminal neuralgia, based on available evidence and guidelines. PMID:25864062

  19. [Malignant lymphoma in a perineural spreading along trigeminal nerve, which developed as trigeminal neuralgia].

    Science.gov (United States)

    Mano, Tomoo; Matsuo, Koji; Kobayashi, Yosuke; Kobayashi, Yasushi; Ozawa, Hiroaki; Arakawa, Toshinao

    2014-01-01

    A rare cause of trigeminal neuralgia is malignant lymphoma which spread along the trigeminal nerve. We report a 79-year-old male presented with 4-month history of neuralgic pain in right cheek. He was diagnosed as classical trigeminal neuralgia. It had improved through medication of carbamazepine. Four months later, the dull pain unlike neuralgia complicated on the right cheeks, it was ineffective with the medication. Furthermore, diplopia and facial palsy as the other cranial nerve symptoms appeared. Gadolinium-enhanced magnetic resonance imaging (MRI) revealed contrast-enhanced mass lesion extend both external pterygoid muscle and brainstem through the swelling trigeminal nerve. The patient was pathological diagnosed of diffuse large B cell lymphoma by biopsy. Malignant lymphoma should be considered in the different diagnosis of cases with a minimal single cranial nerve symptom.

  20. Update of Diagnostic and Treatment of Trigeminal Neuralgia

    OpenAIRE

    Chumpitaz Cerrate, Víctor; Profesor Auxiliar del Departamento de Ciencias Básicas de la Facultad de Odontología UNMSM.; Sayán Sánchez, Cristian; Bachiller en Odontología de la Facultad de Odontología UNMSM.; Ruíz Ramírez, Eliberto; Bachiller en Odontología de la Facultad de Odontología UNMSM.; Franco Quino, César; Estudiante de Odontología de la Facultad de Odontología UNMSM.; Eche Herrera, Juan; Estudiante de Odontología de la Facultad de Odontología UNMSM.; Caldas Cueva, Victoria; Estudiante de Odontología de la Facultad de Odontología UNMSM.; Castro Rodríguez, Yuri; Estudiante de Odontología de la Facultad de Odontología UNMSM.; Erazo Paredes, Carlos; Bachiller en Odontología de la Facultad de Odontología UNMSM.

    2014-01-01

    Trigeminal neuralgia (TN) is a painful neuropathic condition that involves one or more branches of the trigeminal nerve. The pain produced for the TN is described as a very intense acute pain, stabbing or shooting, as an electric shock that usually occurs of form unilateral and that goes all the way of the nerve involved. It is important to make the opportune diagnosis of the condition of TN for adequately differentiate of some odontogenic painful conditions and to prevent that the patient re...

  1. Stereotactic radiosurgery for trigeminal neuralgia: outcomes and complications.

    Science.gov (United States)

    Loescher, Alison R; Radatz, Matthias; Kemeny, Andras; Rowe, Jeremy

    2012-02-01

    Stereotactic radiosurgery is one of a number of recognised treatments for the management of trigeminal neuralgia refractory to drug therapy. The reported success of stereotactic radiosurgery in managing patients with trigeminal neuralgia varies in different units from 22 to 75%. This paper reports the outcomes of patients with trigeminal neuralgia who were treated at the National Centre for Stereotactic Radiosurgery in Sheffield, UK. The study reports the outcome of 72 patients treated consecutively between October 2004 and May 2008. Data were collected prospectively by a postal questionnaire sent to patients at 6, 12 and 24 months after treatment. The median age was 65.6 years (39 males: 33 females). Fourteen patients had secondary trigeminal neuralgia (eight multiple sclerosis). Fifteen of the patients included in the study were receiving a second treatment (an initial treatment having improved their pain significantly for at least 6 months). All radiosurgical procedures were performed using a single 4 mm collimator isocenter covering the region of the dorsal root entry zone with a maximal radiation dose of 80 Gy. The percentage of patients defined as having an excellent outcome (pain free without medication) was 39% after 6 months, 36% after 12 months and 64% after 24 months. The percentage of patients who reported being very satisfied with treatment was 71% after 6 months, 57% after 12 months and 53% after 24 months. Half the patients with secondary trigeminal neuralgia were pain free without medication after treatment, and 60% of patients who underwent a second treatment were pain free. A new trigeminal sensory deficit was reported by 31% of patients after radiosurgical treatment.

  2. Update on the challenges of treating trigeminal neuralgia

    Directory of Open Access Journals (Sweden)

    Obermann M

    2015-04-01

    Full Text Available Mark Obermann Department of Neurology, University of Duisburg-Essen, Essen, Germany Abstract: Despite the multitude of treatment options currently available for trigeminal neuralgia, its management remains challenging in a considerable number of patients. The response to any particular treatment can be quite variable interindividually, and personalized treatment options are both resource-consuming and time-consuming. Anticonvulsant drugs, muscle relaxants, and neuroleptic agents are the preferred medical treatment for trigeminal neuralgia. Large placebo-controlled clinical trials are scarce, and no specific established substance has been developed for the treatment of trigeminal neuralgia. Promising new treatment options currently in clinical evaluation are botulinum neurotoxin type A injections and CNV1014802, a novel sodium channel blocker that selectively blocks the Nav1.7 sodium channel. Patients who do not respond to medical therapy may be eligible for more invasive treatment options, such as percutaneous Gasserian ganglion techniques, gamma knife surgery, and microvascular decompression. Keywords: trigeminal neuralgia, treatment, current, future, options, orphan drugs 

  3. A Survey on Acupuncture Treatment of Trigeminal Neuralgia

    Institute of Scientific and Technical Information of China (English)

    TIAN Li-fang

    2010-01-01

    @@ In modern medicine, various measures such as medication, nerve block, radio frequency and surgeries can all be adopted for treating trigeminal neuralgia. However, acupuncture-moxibustion is still one of the important clinical measures for the treatment because of its less side effects, com-plications and relapse. A review on its clinical investigations is presented as follows.

  4. Repeat microvascular decompression for recurrent idiopathic trigeminal neuralgia

    NARCIS (Netherlands)

    Bakker, Nicolaas A.; van Dijk, J. Marc C.; Immenga, Steven; Wagemakers, Michiel; Metzemaekers, Jan D. M.

    2014-01-01

    Object. Microvascular decompression (MVD) is considered the method of choice to treat idiopathic trigeminal neuralgia (TN) refractory to medical treatment. However, repeat MVD for recurrent TN is not well established. In this paper, the authors describe a large case series in which patients underwen

  5. Comparison of different microsurgery methods for trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    Zihang Xie; Lin Chen; Yan Wang; Zhiqiang Cui; Shijie Wang; Qiang Ao; Yuqi Zhang; Huancong Zuo

    2016-01-01

    Objective: To study the influence of different microsurgical methods on surgical outcomes and complications, and to improve the surgical outcomes for trigeminal neuralgia. Methods: The clinical data of 109 patients with trigeminal neuralgia, who were treated with microsurgery, were analyzed retrospectively. All patients were divided into 3 groups according to surgical modality: the trigeminal neuralgia decompression group (TND group, 19 patients), the TND and rhizotomy group (rhizotomy group, 55 patients), and the TND and selective lesioning group (lesioning group, 35 patients). The mid-term and short-term effects of microsurgery, and the occurrences of com-plications, were compared between the 3 groups. Results: There were no statistical differences in the frequency of complications between the 3 groups (P > 0.05). Eighty-four patients were followed up for 6 to 33 months. The rate of pain disappearance was found to be 94.4% in the TND group, and 100% in both the rhizotomy and lesioning groups; thus, no significant differences were found between these 3 groups (P > 0.05). Additionally, 50% of the patients in the rhizotomy group and 3.6% of the patients in the lesioning group had facial numbness while no patients were affected with facial numbness in the TND group, and the differences between these 3 groups were significant (P < 0.05). Conclusions: Microsurgery is effective and safe for trigeminal neuralgia. The use of TND, in combination with selective lesioning, ensures therapeutic efficacy and improves the quality of life in postoperative patients.

  6. Repeat microvascular decompression for recurrent idiopathic trigeminal neuralgia

    NARCIS (Netherlands)

    Bakker, Nicolaas A.; van Dijk, J. Marc C.; Immenga, Steven; Wagemakers, Michiel; Metzemaekers, Jan D. M.

    2014-01-01

    Object. Microvascular decompression (MVD) is considered the method of choice to treat idiopathic trigeminal neuralgia (TN) refractory to medical treatment. However, repeat MVD for recurrent TN is not well established. In this paper, the authors describe a large case series in which patients

  7. Cryotherapy in the management of paroxysmal trigeminal neuralgia.

    OpenAIRE

    Zakrzewska, J. M.

    1987-01-01

    Cryotherapy for the relief of pain is widely used in many conditions. The results of 83 cryotherapy sessions in 29 patients with paroxysmal trigeminal neuralgia are reviewed over a five year period. Sixty three per cent of treated nerves, 41% of patients were pain free over one year and there was no permanent sensory loss.

  8. Magnetic resonance tomographic angiography: diagnostic value in trigeminal neuralgia

    Energy Technology Data Exchange (ETDEWEB)

    Umehara, F. [Third Dept. of Internal Medicine, Faculty of Medicine, Kagoshima Univ. (Japan); Kamishima, K. [Div. of Diagnostic Neuroradiology, Kagoshima Univ. (Japan); Kashio, N. [Third Dept. of Internal Medicine, Faculty of Medicine, Kagoshima Univ. (Japan); Yamaguchi, K. [Div. of Diagnostic Neuroradiology, Kagoshima Univ. (Japan); Sakimoto, T.; Osame, M. [Third Dept. of Internal Medicine, Faculty of Medicine, Kagoshima Univ. (Japan)

    1995-07-01

    A combination of MRI, MR angiography and MR tomographic angiography (MRTA) was used to study the relationship of the root exit zone of the trigeminal nerve to surrounding vascular structures in seven patients with trigeminal neuralgia (TN) and ten patients with no evidence at a lesion in this region. MRTA is the technique for showing the relationship between vessels, cranial nerves and brain stem. MRTA clearly demonstrated the presence of a vessel at the root exit zone of the trigeminal nerve in all patients with TN. In the ten other patients, examination of 20 trigeminal nerves revealed that only one nerve (5%) was in contact with a vessel at the root exit zone. This study supports vascular compression of trigeminal nerves as a cause of TN, and demonstrates the value of MRTA as noninvasive technique for demonstrating compression. (orig.)

  9. Rhabdomyomatous mesenchymal hamartoma of the face causing trigeminal neuralgia.

    Science.gov (United States)

    White, Leon R; Agrawal, Vaidehi; Sutton, Lisa; Balbosa, Aiysha C

    2015-06-03

    Rhabdomyomatous mesenchymal hamartoma (RMH) is a benign, potentially pigmented lesion that occurs in the head and neck region. It generally consists of haphazardly arranged skeletal muscle with adipose tissue, blood vessels, collagen and nerve fibers and is largely asymptomatic. Trigeminal neuralgia is pain due to compression of the trigeminal nerve. TN may be idiopathic or associated with lesion-mediated compression. We describe the case of a 14-year-old female presenting with trigeminal neuralgia (TN) associated with RMH. On initial consultation, the patient presented with a history of right-sided lower facial swelling, numbness, and pain. Evaluation by various specialists confirmed TN. Surgical resection of the lesion resolved the condition and pathology confirmed RMH. This is the first case report demonstrating RMH-mediated TN. Surgical resection of the RMH is a safe management approach for this diagnosis.

  10. Trigemino-cardiac reflex during microvascular trigeminal decompression in cases of trigeminal neuralgia.

    Science.gov (United States)

    Schaller, Bernhard

    2005-01-01

    The trigemino-cardiac reflex (TCR) is a well-recognized phenomenon consisting of bradycardia, arterial hypotension, apnea, and gastric hypermotility during ocular surgery or other manipulations in and around the orbit. Thus far, it could bee shown that central stimulation of the trigeminal nerve during transsphenoidal surgery and surgery for tumors in the cerebellopontine angle can lead to TCR. In cases of microvascular trigeminal decompression for trigeminal neuralgia, no data of the possible occurrence of TCR are available. TCR was defined as a drop in mean arterial blood pressure (MABP) and the heart rate (HR) of more than 20% to the baseline values before the stimulus and coinciding with the manipulation of the trigeminal nerve. Electronic anesthetic recorded perioperative HR and MABP values were reviewed retrospectively in 28 patients who received microvascular trigeminal decompression in cases of trigeminal neuralgia and were divided into two subgroups on the basis of occurrence of TCR during surgery. Of the 28 patients, 5 (18%) showed evidence of TCR during manipulation at the trigeminal radix by separation from microvascular structures. Their HR fell 46% and their MABP 57% during operative procedures near the trigeminal nerve as compared with levels immediately before the stimulus. After cessation of manipulation, HR and MABP returned (spontaneously) to levels before the stimulus. Risk factors of TCR were compared with results from the literature. In conclusion, the present results give evidence of TCR during manipulation of the central part of the trigeminal nerve during microvascular trigeminal decompression in cases of trigeminal neuralgia under a standardized anesthetic protocol.

  11. Diabetes mellitus in classical trigeminal neuralgia: A predisposing factor for its development.

    Science.gov (United States)

    Xu, Zhenq; Zhang, Ping; Long, Li; He, Huiy; Zhang, Jianch; Sun, Shup

    2016-12-01

    A higher prevalence of diabetes mellitus in classical trigeminal neuralgia patients was observed in few pilot surveys. The study was aimed to investigate whether diabetes mellitus is a predisposing factor for developing trigeminal neuralgia. Patients with classical trigeminal neuralgia were enrolled in the case study group. The control group consisted of the same number of age- and gender-matched, randomly sampled subjects without trigeminal neuralgia. Characteristics of classical trigeminal neuralgia cases were analyzed. The prevalence of diabetes mellitus in the cases and controls was calculated using the Chi-square test. The onset age ranged from 31 to 93 in 256 patients affected classical trigeminal neuralgia (162 females; 94 males) with a peak age between the fifth and seventh decade; right-side involvement and mandibular branch affliction occurred at a greater frequency. 21.9% patients in the study group was affected by diabetes mellitus compared to 12.9% of controls. The increased prevalence of diabetes mellitus in the trigeminal neuralgia group was statistically significant (P=0.01). Diabetes is a risk factor to the development of classical trigeminal neuralgia, and nerve damage duing to hyperglycemia might be the linkage to the two diseases. More works should be done to consolidate the correlation and to clarify the underlying mechanism for the positive association which would provide new insight into the pathogenesis of trigeminal neuralgia and may open new therapeutic perspectives. Copyright © 2016 Elsevier B.V. All rights reserved.

  12. Acute onset of trigeminal neuralgia, facial paresis and dysphagia after mild head injury.

    Science.gov (United States)

    Gkekas, Nikolaos; Primikiris, Panagiotis; Georgakoulias, Nikolaos

    2014-01-01

    The authors report the rare and first documented case of concomitant microvascular decompression of trigeminal, facial and glossopharyngeal nerves for the management of intractable to medical therapy acute onset of trigeminal neuralgia, facial paresis and dysphagia after mild head injury.

  13. MRI volumetry for the preoperative diagnosis of trigeminal neuralgia

    Energy Technology Data Exchange (ETDEWEB)

    Kress, Bodo; Schindler, Markus; Haehnel, Stefan; Sartor, Klaus; Stippich, Christoph [University of Heidelberg, Division of Neuroradiology, Department of Neurology, Medical Center, 69120 Heidelberg (Germany); Rasche, Dirk; Tronnier, Volker [University of Heidelberg, Department of Neurosurgery, Medical Center, 69120 Heidelberg (Germany)

    2005-07-01

    To assess whether quantitative measuring methods can help improve the reliability of MRI-based evaluations of the pathological role of a neurovascular conflict between an artery and the trigeminal nerve. In a prospective study, magnetic resonance images were obtained from 62 patients with unilateral facial pain and 50 healthy test subjects. In coronal T1- and T2-weighted sequences volume measurements were performed by regions of interest and compared intraindividually (healthy versus affected side in the patient populations and right versus left side in the group of test subjects) and on the basis of the different clinical pictures (t test for dependent and independent samples, p<0.05). In patients with trigeminal neuralgia, the affected nerve showed a smaller volume than the trigeminal nerve on the healthy side (p<0.001). Such a volume difference was noted neither in the other patients nor in the healthy test subjects. Quantitative MRI measurements allow a pathological neurovascular conflict to be distinguished from a nonpathological condition where an artery is in close proximity to the trigeminal nerve. The measured volume difference between the healthy and the affected nerve in patients with neuralgia is indicative of trigeminal nerve atrophy resulting from damage to the nerve. (orig.)

  14. Treatment of trigeminal neuralgia: role of radiofrequency ablation

    Directory of Open Access Journals (Sweden)

    Dessy R Emril

    2010-12-01

    Full Text Available Dessy R Emril1 Kok-Yuen Ho21Neurology Department, Syiah Kuala University/Dr Zainoel Abidin Hospital, Banda Aceh, Indonesia; 2Pain Management Centre, Raffles Hospital, SingaporeAbstract: Trigeminal neuralgia (TN is a neuropathic pain condition affecting the face. It has a significant impact on the quality of life and physical function of patients. Evidence suggests that the likely etiology is vascular compression of the trigeminal nerve leading to focal demyelination and aberrant neural discharge. Secondary causes such as multiple sclerosis or brain tumors can also produce symptomatic TN. Treatment must be individualized to each patient. Carbamazepine remains the drug of choice in the first-line treatment of TN. Minimally invasive interventional pain therapies and surgery are possible options when drug therapy fails. Younger patients may benefit from microvascular decompression. Elderly patients with poor surgical risk may be more suitable for percutaneous trigeminal nerve rhizolysis. The technique of radiofrequency rhizolysis of the trigeminal nerve is described in detail in this review.Keywords: interventional treatment, minimally invasive, pain management, radiofrequency rhizolysis, trigeminal neuralgia 

  15. Percutaneous Procedures for the Treatment of Trigeminal Neuralgia.

    Science.gov (United States)

    Bender, Matthew T; Bettegowda, Chetan

    2016-07-01

    Three major percutaneous procedures are currently used to treat trigeminal neuralgia (TN). Percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation interrupt afferent pain fibers by injury to the trigeminal nerve root or ganglion. Each is capable of offering immediate and durable pain relief. Each is associated with relatively low, but variable rates of complications. Patient heterogeneity, technical variation, and nonstandard outcomes plague the existing outcomes literature and limit comparisons of treatments. Rendering treatment selection a function of individual physician preference and practice patterns. Randomized, prospective trials are needed; in the meantime, percutaneous rhizotomy remains an excellent treatment for selected patients.

  16. TREATMENT OF 18 CASES OF TRIGEMINAL NEURALGIA WITH ELONGATED NEEDLE

    Institute of Scientific and Technical Information of China (English)

    李建兰; 阎巍; 岳仍丽

    2004-01-01

    In this paper, a total of 18 cases of primary trigeminal neuralgia were treated with elongated needle. Of the 18 cases, 5 were male and 15 female, ranging in age from 27 to 58 years and in disease duration from 3 days to 8 years. Main acupoints used were Taiyang (EX-HN 5) to Xiaguan (ST 7, for penetration needling), Xiajiache, Fengchi (GB 20), Yanglingquan (GB 34) and Taichong (LR 3). The treatment was given once daily, with 12 sessions being a therapeutic course. After 2 courses of treatment, of the 18 cases, 10 cases were cured, 7 experienced improvement in pain and one failed in the treatment, with an effective rate of 94.4%. The key point for treating trigeminal neuralgia is applying penetrative needling from EX-HN 5 to ST 7 to achieve ideal needling sensations.

  17. Lacrimal dacryostenosis with severe facial pain misdiagnosed as trigeminal neuralgia.

    Science.gov (United States)

    Tanigawa, Tohru; Sasaki, Hirokazu; Kaneda, Masahiro; Kuruma, Tessei; Ueda, Hiromi

    2012-04-01

    A 47-year-old woman developed intermittent shooting pain around the right side of the nose and eyes. A neurologist initially diagnosed trigeminal neuralgia, but carbamazepine did not improve the pain. Two months later, she presented with a pus-like eye discharge and was referred to us for further examination. Poor saline irrigation from the lacrimal puncta and computed tomography findings of a swollen lacrimal sac indicated a diagnosis of lacrimal dacryostenosis. At this point, the pain and dizziness as a side effect of carbamazepine had become intolerable. Endoscopic intranasal dacryocystorhinostomy confirmed stenosis of the nasolachrymal duct and a thickened lacrimal sac. The postoperative course was uneventful, and the facial pain disappeared. This experience suggests the importance of recognizing lacrimal dacryostenosis as a differential diagnosis of facial pain around the eyes and nose. We also recommend a review of an original diagnosis of trigeminal neuralgia if carbamazepine fails to relieve facial pain. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  18. Beneficial effects of botulinum toxin type A in trigeminal neuralgia

    OpenAIRE

    Zúñiga, Carlos; Díaz,Sergio; Piedimonte, Fabián; Micheli, Federico

    2008-01-01

    Botulinum toxin has been thoroughly studied as a potential tool in the treatment of several pain syndromes. Therefore, we assessed the clinical effects of botulinum toxin type A injections in 12 patients with otherwise unresponsive idiopathic trigeminal neuralgia. Patients were infiltrated with 20-50 units of botulinum toxin in trigger zones. Those who presented with mandibular involvement were also infiltrated in the masseter muscle. The patients were assessed on a weekly basis using the Vis...

  19. Spontaneous Meckel's cave hematoma: A rare cause of trigeminal neuralgia

    OpenAIRE

    Concetta Alafaci; Giovanni Grasso; Francesca Granata; Daniele Marino; Salpietro, Francesco M.; Francesco Tomasello

    2015-01-01

    Background: The most common etiology of classic trigeminal neuralgia (TN) is vascular compression. However, other causes must be considered. Among these, spontaneous hematoma of the Meckel′s cave (MC) causing symptomatic TN is very rare. Case Description: We present the case of a 60-year-old woman with a 2-month history of left TN and diplopia. Neuroradiological examinations revealed a well-defined hematoma in the left MC. The patient underwent surgical decompression with a progressive ne...

  20. Beneficial effects of botulinum toxin type A in trigeminal neuralgia

    OpenAIRE

    Carlos Zúñiga; Sergio Díaz; Fabián Piedimonte; Federico Micheli

    2008-01-01

    Botulinum toxin has been thoroughly studied as a potential tool in the treatment of several pain syndromes. Therefore, we assessed the clinical effects of botulinum toxin type A injections in 12 patients with otherwise unresponsive idiopathic trigeminal neuralgia. Patients were infiltrated with 20-50 units of botulinum toxin in trigger zones. Those who presented with mandibular involvement were also infiltrated in the masseter muscle. The patients were assessed on a weekly basis using the Vis...

  1. Effect of the gamma knife treatment on the trigeminal nerve root in Chinese patients with primary trigeminal neuralgia.

    Science.gov (United States)

    Song, Zhi-Xiu; Qian, Wei; Wu, Yu-Quan; Sun, Fang-Jie; Fei, Jun; Huang, Run-Sheng; Fang, Jing-Yu; Wu, Cai-Zhen; An, You-Ming; Wang, Daxin; Yang, Jun

    2014-01-01

    To understand the mechanism of the gamma knife treating the trigeminal neuralgia. Using the MASEP-SRRS type gamma knife treatment system, 140 Chinese patients with trigeminal neuralgia (NT) were treated in our hospital from 2002 to 2010, in which the pain relief rate reached 95% and recurrence rate was 3% only. We investigated the effect of the gamma knife treatment on the trigeminal nerve root in 20 Chinese patients with primary trigeminal neuralgia by the magnetic resonance imager (MRI) observation. 1) The cross-sectional area of trigeminal nerve root became smaller and MRI signals were lower in the treatment side than those in the non-treatment side after the gamma knife treatment of primary trigeminal neuralgia; 2) in the treatment side, the cross-sectional area of the trigeminal nerve root decreased significantly after the gamma knife treatment; 3) there was good correlation between the clinical improvement and the MRI findings; and 4) the straight distance between the trigeminal nerve root and the brainstem did not change after the gamma knife treatment. The pain relief induced the gamma knife radiosurgery might be related with the atrophy of the trigeminal nerve root in Chinese patients with primary trigeminal neuralgia.

  2. Trigeminal Neuralgia, Glossopharyngeal Neuralgia, and Myofascial Pain Dysfunction Syndrome: An Update.

    Science.gov (United States)

    Khan, Mohammad; Nishi, Shamima Easmin; Hassan, Siti Nazihahasma; Islam, Md Asiful; Gan, Siew Hua

    2017-01-01

    Neuropathic pain is a common phenomenon that affects millions of people worldwide. Maxillofacial structures consist of various tissues that receive frequent stimulation during food digestion. The unique functions (masticatory process and facial expression) of the maxillofacial structure require the exquisite organization of both the peripheral and central nervous systems. Neuralgia is painful paroxysmal disorder of the head-neck region characterized by some commonly shared features such as the unilateral pain, transience and recurrence of attacks, and superficial and shock-like pain at a trigger point. These types of pain can be experienced after nerve injury or as a part of diseases that affect peripheral and central nerve function, or they can be psychological. Since the trigeminal and glossopharyngeal nerves innervate the oral structure, trigeminal and glossopharyngeal neuralgia are the most common syndromes following myofascial pain dysfunction syndrome. Nevertheless, misdiagnoses are common. The aim of this review is to discuss the currently available diagnostic procedures and treatment options for trigeminal neuralgia, glossopharyngeal neuralgia, and myofascial pain dysfunction syndrome.

  3. Trigeminal Neuralgia, Glossopharyngeal Neuralgia, and Myofascial Pain Dysfunction Syndrome: An Update

    Directory of Open Access Journals (Sweden)

    Mohammad Khan

    2017-01-01

    Full Text Available Neuropathic pain is a common phenomenon that affects millions of people worldwide. Maxillofacial structures consist of various tissues that receive frequent stimulation during food digestion. The unique functions (masticatory process and facial expression of the maxillofacial structure require the exquisite organization of both the peripheral and central nervous systems. Neuralgia is painful paroxysmal disorder of the head-neck region characterized by some commonly shared features such as the unilateral pain, transience and recurrence of attacks, and superficial and shock-like pain at a trigger point. These types of pain can be experienced after nerve injury or as a part of diseases that affect peripheral and central nerve function, or they can be psychological. Since the trigeminal and glossopharyngeal nerves innervate the oral structure, trigeminal and glossopharyngeal neuralgia are the most common syndromes following myofascial pain dysfunction syndrome. Nevertheless, misdiagnoses are common. The aim of this review is to discuss the currently available diagnostic procedures and treatment options for trigeminal neuralgia, glossopharyngeal neuralgia, and myofascial pain dysfunction syndrome.

  4. Trigeminal Neuralgia, Glossopharyngeal Neuralgia, and Myofascial Pain Dysfunction Syndrome: An Update

    Science.gov (United States)

    Nishi, Shamima Easmin; Hassan, Siti Nazihahasma

    2017-01-01

    Neuropathic pain is a common phenomenon that affects millions of people worldwide. Maxillofacial structures consist of various tissues that receive frequent stimulation during food digestion. The unique functions (masticatory process and facial expression) of the maxillofacial structure require the exquisite organization of both the peripheral and central nervous systems. Neuralgia is painful paroxysmal disorder of the head-neck region characterized by some commonly shared features such as the unilateral pain, transience and recurrence of attacks, and superficial and shock-like pain at a trigger point. These types of pain can be experienced after nerve injury or as a part of diseases that affect peripheral and central nerve function, or they can be psychological. Since the trigeminal and glossopharyngeal nerves innervate the oral structure, trigeminal and glossopharyngeal neuralgia are the most common syndromes following myofascial pain dysfunction syndrome. Nevertheless, misdiagnoses are common. The aim of this review is to discuss the currently available diagnostic procedures and treatment options for trigeminal neuralgia, glossopharyngeal neuralgia, and myofascial pain dysfunction syndrome. PMID:28827979

  5. Reactivation of trigeminal neuralgia following distraction osteogenesis in an 8-year-old child: Report of a unique case

    Directory of Open Access Journals (Sweden)

    Ramanathan M

    2007-03-01

    Full Text Available Trigeminal neuralgia is extremely rare in children. No concrete treatment protocols seem to be available for management of this condition in the pediatric population. Although trigeminal neuralgia may achieve remission, the possibility of reactivation of a hitherto quiescent condition cannot be ruled out. We present a case of pediatric trigeminal neuralgia following distraction osteogenesis of the mandible.

  6. Trigeminal neuralgia: An overview of the clinical entity

    Directory of Open Access Journals (Sweden)

    Nargis Qayoom

    2015-01-01

    Full Text Available Trigeminal neuralgia (TN is a rare neurological disease that causes sudden, severe, brief, stabbing recurrent episodes of facial pain in one or more branches of the trigeminal nerve. Over the last few decades, there is evidence that TN may be a result of compression of the trigeminal nerve root at or near the dorsal root entry zone by a blood vessel. TN is treated on an outpatient basis, unless neurosurgical intervention is required. Treatment can be subdivided into pharmacologic therapy, percutaneous procedures, surgery, and radiosurgery. Medical therapy is often sufficient and effective, allowing surgical consideration only if pharmacological treatment fails. Medical therapy alone is an adequate treatment for 75% of patients.

  7. [Orofacial pain - Trigeminal neuralgia and posttraumatic trigeminal neuropathy: Common features and differences].

    Science.gov (United States)

    Thieme, V

    2016-02-01

    Neuropathic pain is the result of a lesion or disease of the somatosensory system in the peripheral or central nervous system. Classical trigeminal neuralgia and posttraumatic trigeminal neuropathy are pain disorders which oral and maxillofacial surgeons and dentists are confronted with in the differential diagnostics in routine daily practice. The etiopathogenesis of classical trigeminal neuralgia is attributable to pathological blood vessel-nerve contact in the trigeminal nerve root entry zone to the brain stem. The typical pain symptoms are characterized by sudden stabbing pain attacks. The pharmaceutical prophylaxis is based on the individually titrated administration of anticonvulsant drugs. The indications for interventional treatment are dependent on the course, response to drug treatment, resilience and wishes of the patient. The neuropathic mechanism of posttraumatic trigeminal neuropathy originates from nerve damage, which leads to peripheral and central sensitization with lowering of the pain threshold and multiple somatosensory disorders. The prophylaxis consists of avoidance of excessive acute and long-lasting pain stimuli. Against the background of the biopsychosocial pain model, the treatment of posttraumatic trigeminal neuropathy necessitates a multimodal, interdisciplinary concept.

  8. Surgical treatment of trigeminal neuralgia. Results from the use of glycerol injection, microvascular decompression, and rhizotomia

    DEFF Research Database (Denmark)

    Degn, Jørgen; Brennum, Jannick

    2010-01-01

    The study aims to assess the efficacy and safety of surgical treatment of trigeminal neuralgia (TN) in our department and to identify prognostic factors.......The study aims to assess the efficacy and safety of surgical treatment of trigeminal neuralgia (TN) in our department and to identify prognostic factors....

  9. Trigeminal postherpetic neuralgia responsive to treatment with capsaicin 8 % topical patch: a case report.

    Science.gov (United States)

    Sayanlar, Jennifer; Guleyupoglu, Nilufer; Portenoy, Russell; Ashina, Sait

    2012-10-01

    Postherpetic neuralgia has been variably defined but is generally understood to be pain that persists for longer than a few months after an attack of herpes zoster. Pain persists for years in approximately 10 % of those afflicted with acute herpes zoster. The likelihood of postherpetic neuralgia increases with older age, severity of the zoster, trigeminal location, and other factors. Postherpetic neuralgia is a neuropathic pain and treatment usually involves sequential trials of topical and systemic drugs; a variety of other therapies may be considered in refractory cases. A new topical capsaicin 8 % patch has been approved for this indication based on the positive studies in patients with non-trigeminal postherpetic neuralgia. Experience with the use of the capsaicin 8 % patch for trigeminal distribution neuralgia is lacking. We report a case of trigeminal postherpetic neuralgia which was safely and effectively treated with capsaicin 8 % patch.

  10. Trigeminal neuralgia in patients with vertebrobasilar dolichoectasia: review of three cases

    OpenAIRE

    Alcalá-Cerra Gabriel; Gutiérrez-Paternina Juan José; Niño-Hernández Lucía; Moscote-Salazar Luis Rafael; Lozano-Tangua Carlos Fernando; Sabogal-Barrios Rubén

    2011-01-01

    Trigeminal neuralgia is a clinical syndrome whose cause often involves nerve compressionby adjacent vascular structures of normal anatomic conformation, especially thesuperior cerebellar artery. Vertebro-basilar dolichoectasia is another potential cause oftrigeminal neuralgia, however, less than 2% of the cases are related to this condition.There were three cases of trigeminal neuralgia as an initial manifestation of vertebralbasilardolichoectasia attended by members of the Department of Neur...

  11. Treatment of atypical trigeminal neuralgia with microvascular decompression

    Directory of Open Access Journals (Sweden)

    Hai Jian

    2006-01-01

    Full Text Available Aim: To explore the methods for achieving pain relief in patients with atypical trigeminal neuralgia (TN using microvascular decompression (MVD. Study Design and Settings: Retrospective study of 26 patients treated during the years 2000 to 2004. Materials and Methods: Twenty-six patients in whom vascular compression of the trigeminal nerve was identified by high definition magnetic resonance tomographic angiography (MRTA were treated with MVD for atypical TN in our department. Clinical presentations, surgical findings and clinical outcomes were analyzed retrospectively. Results: In this study, single trigeminal division was involved in only 2 patients (8% and two or three divisions in the other 24 patients (92%. Of prime importance is the fact that in 46.2% of the patients, several conflicting vessels were found in association. Location of the conflicts around the circumference of the trigeminal root was supero-medial to the root in 53.5%, supero-lateral in 30.8% and inferior in 15.7%. MVD for atypical TN resulted in complete pain relief in 50% of the patients with complete decompression, partial pain relief in 30.8% and poor pain relief or pain recurrence in 19.2% of the patients without complete decompression postoperatively. Conclusions: Complete decompression of the entire trigeminal root plays an important role in achieving pain relief in patients with atypical TN with MVD.

  12. Peripheral nerve field stimulation for trigeminal neuralgia, trigeminal neuropathic pain, and persistent idiopathic facial pain.

    Science.gov (United States)

    Klein, Johann; Sandi-Gahun, Sahr; Schackert, Gabriele; Juratli, Tareq A

    2016-04-01

    Peripheral nerve field stimulation (PNFS) is a promising modality for treatment of intractable facial pain. However, evidence is sparse. We are therefore presenting our experience with this technique in a small patient cohort. Records of 10 patients (five men, five women) with intractable facial pain who underwent implantation of one or several subcutaneous electrodes for trigeminal nerve field stimulation were retrospectively analyzed. Patients' data, including pain location, etiology, duration, previous treatments, long-term effects and complications, were evaluated. Four patients suffered from recurrent classical trigeminal neuralgia, one had classical trigeminal neuralgia and was medically unfit for microvascular decompression. Two patients suffered from trigeminal neuropathy attributed to multiple sclerosis, one from post-herpetic neuropathy, one from trigeminal neuropathy following radiation therapy and one from persistent idiopathic facial pain. Average patient age was 74.2 years (range 57-87), and average symptom duration was 10.6 years (range 2-17). Eight patients proceeded to implantation after successful trial. Average follow-up after implantation was 11.3 months (range 5-28). Using the visual analog scale, average pain intensity was 9.3 (range 7-10) preoperatively and 0.75 (range 0-3) postoperatively. Six patients reported absence of pain with stimulation; two had only slight constant pain without attacks. PNFS may be an effective treatment for refractory facial pain and yields high patient satisfaction. © International Headache Society 2015.

  13. Trigeminal neuralgia and neuropathy in large sporadic vestibular schwannomas.

    Science.gov (United States)

    Neff, Brian A; Carlson, Matthew L; O'Byrne, Megan M; Van Gompel, Jamie J; Driscoll, Colin L W; Link, Michael J

    2017-01-13

    OBJECTIVE The aim of this study was to evaluate the incidence, presentation, and treatment outcomes of trigeminal nerve-mediated symptoms secondary to large vestibular schwannomas (VSs) with trigeminal nerve contact. Specifically, the symptomatic results of pain, paresthesias, and numbness after microsurgical resection or stereotactic radiosurgery (SRS) were examined. METHODS The authors conducted a retrospective review of a database for concomitant diagnosis of trigeminal neuralgia (TN) or trigeminal neuropathy and VS between 1994 and 2014 at a tertiary academic center. All patients with VS with TN or neuropathy were included, with the exception of those patients with neurofibromatosis Type 2 and patients who elected observation. Patient demographic data, symptom evolution, and treatment outcomes were collected. Population data were summarized, and outcome comparisons between microsurgery and SRS were analyzed at last follow-up. RESULTS Sixty (2.2%) of 2771 total patients who had large VSs and either TN or neuropathy symptoms met inclusion criteria. The average age of trigeminal symptom onset was 53.6 years (range 24-79 years), the average age at VS diagnosis was 54.4 years (range 25-79 years), and the average follow-up for the microsurgery and SRS groups was 30 and 59 months, respectively (range 3-132 months). Of these patients, 50 (83%) had facial numbness, 16 (27%) had TN pain, and 13 (22%) had paresthesias (i.e., burning or tingling). Subsequently, 50 (83%) patients underwent resection and 10 (17%) patients received SRS. Treatment of VS with SRS did not improve trigeminal symptoms in any patient. This included 2 subjects with unimproved facial numbness and 4 patients with worsened numbness. Similarly, SRS worsened TN pain and paresthesias in 5 patients and failed to improve pain in 2 additional patients. The Barrow Neurological Institute neuralgia and hypesthesia scale scores were significantly worse for patients undergoing SRS compared with microsurgery

  14. Trigeminal neuralgia – a coherent cross-specialty management program

    DEFF Research Database (Denmark)

    Heinskou, Tone; Maarbjerg, Stine; Rochat, Per Bjørnstad

    2015-01-01

    BACKGROUND: Optimal management of patients with classical trigeminal neuralgia (TN) requires specific treatment programs and close collaboration between medical, radiological and surgical specialties. Organization of such treatment programs has never been described before. With this paper we aim......: The described cross-speciality management program proved to be feasible and to have acceptable waiting times for referral and highly specialized work-up of TN patients in a public tertiary referral centre for headache and facial pain. Early high quality MRI ensured correct diagnosis and that the neurosurgeons...

  15. Neuroradiological diagnosis of trigeminal neuralgia and hemifacial spasm

    Energy Technology Data Exchange (ETDEWEB)

    Hosoya, Takaaki; Uchimura, Fumiaki; Yamaguchi, Koichi; Yamagiwa, Osamu; Itagaki, Shinichi (Yamagata Univ. (Japan))

    1983-12-01

    Recently excellent results have been reported with microvascular decompression in cases of trigeminal neuralgia (TN) and hemifacial spasm (HFS). The neuroradiological diagnosis of TN and HFS. however, is not satisfactory. As a trial, we performed metrizamide CT cisternography (MCT) or gas CT cisternography (GCT) in order to reveal the nerve and the adjacent structures in the cisternal portion for preoperative diagnosis. MCT was performed in two patients with TN and in two patients with HFS, while GCT was performed in three patients with TN and in two patients with HFS. One case with TN was examined by both MCT and GCT. Therefore, the diagnostic value of MCT and GCT in TN or HFS has been evaluated in nine examinations in eight cases. MCT and GCT are both useful in delineating the trigeminal nerve, the facial nerve, and the adjacent arteries. Therefore, it is possible thus to diagnose the vascular compressing point and the offending artery in patients with TN and HFS.

  16. Tractography delineates microstructural changes in the trigeminal nerve after focal radiosurgery for trigeminal neuralgia.

    Directory of Open Access Journals (Sweden)

    Mojgan Hodaie

    Full Text Available PURPOSE: Focal radiosurgery is a common treatment modality for trigeminal neuralgia (TN, a neuropathic facial pain condition. Assessment of treatment effectiveness is primarily clinical, given the paucity of investigational tools to assess trigeminal nerve changes. Since diffusion tensor imaging (DTI provides information on white matter microstructure, we explored the feasibility of trigeminal nerve tractography and assessment of DTI parameters to study microstructural changes after treatment. We hypothesized that trigeminal tractography provides more information than 2D-MR imaging, allowing detection of unique, focal changes in the target area after radiosurgery. Changes in specific diffusivities may provide insight into the mechanism of action of radiosurgery on the trigeminal nerve. METHODS AND MATERIALS: Five TN patients (4 females, 1 male, average age 67 years treated with Gamma Knife radiosurgery, 80 Gy/100% isodose line underwent 3Tesla MR trigeminal nerve tractography before and sequentially up to fourteen months after treatment. Fractional anisotropy (FA, radial (RD and axial (AD diffusivities were calculated for the radiosurgical target area defined as the region-of-interest. Areas outside target and the contralateral nerve served as controls. RESULTS: Trigeminal tractography accurately detected the radiosurgical target. Radiosurgery resulted in 47% drop in FA values at the target with no significant change in FA outside the target, demonstrating highly focal changes after treatment. RD but not AD changed markedly, suggesting that radiosurgery primarily affects myelin. Tractography was more sensitive than conventional gadolinium-enhanced post-treatment MR, since FA changes were detected regardless of trigeminal nerve enhancement. In subjects with long term follow-up, recovery of FA/RD correlated with pain recurrence. CONCLUSIONS: DTI parameters accurately detect the effects of focal radiosurgery on the trigeminal nerve, serving as an

  17. Can pontine trigeminal T2-hyperintensity suggest herpetic etiology of trigeminal neuralgia?

    Science.gov (United States)

    Russo, Carmela; Ugga, Lorenzo; Mazio, Federica; Capone, Elisa; D’Arco, Felice; Mankad, Kshitij; Caranci, Ferdinando; Marano, Enrico; Brunetti, Arturo

    2016-01-01

    Background Trigeminal neuralgia (TN) is usually classified into two different categories: idiopathic and secondary. We have investigated the frequency of brainstem pontine lesions in patients with idiopathic TN without multiple sclerosis (MS) or stroke, and their association with herpes zoster (HZ) infection. Methods Brain magnetic resonance imaging (MRI) studies of 28 patients with TN were retrospectively reviewed. Results We found seven patients with clinical suspicion of HZ infection and pontine T2 hyperintense lesions, associated with nerve atrophy in one case. Fifteen patients had a neurovascular conflict (NVC) without brainstem involvement, two of them associated with trigeminal atrophy, while four patients had only volumetric reduction of the nerve. In all patients MRI findings were ipsilateral to the side of TN. Conclusions Pontine T2 hyperintensities could be considered as a MRI sign of TN in patients without NVCs. This “trigeminal pontine sign” (TPS) is frequently found in association with herpetic infections. PMID:27942467

  18. Structural magnetic resonance imaging can identify trigeminal system abnormalities in classical trigeminal neuralgia

    Directory of Open Access Journals (Sweden)

    Danielle DeSouza

    2016-10-01

    Full Text Available Classical trigeminal neuralgia (TN is a chronic pain disorder that has been described as one ofthe most severe pains one can suffer. The most prevalent theory of TN etiology is that the trigeminal nerve is compressed at the root entry zone (REZ by blood vessels. However, there is significant evidence showing a lack of neurovascular compression (NVC for many cases of classical TN. Furthermore, a considerable number of patients who are asymptomatic have MR evidence of NVC. Since there is no validated animal model that reproduces the clinical features of TN, our understanding of TN pathology mainly comes from biopsy studies that have limitations. Sophisticated structural MRI techniques including diffusion tensor imaging provide new opportunities to assess the trigeminal nerves and CNS to provide insight into TN etiology and pathogenesis. Specifically, studies have used high-resolution structural MRI methods to visualize patterns of trigeminal nerve-vessel relationships and to detect subtle pathological features at the trigeminal REZ. Structural MRI has also identified CNS abnormalities in cortical and subcortical gray matter and white matter and demonstrated that effective neurosurgical treatment for TN is associated with a reversal of specific nerve and brain abnormalities. In conclusion, this review highlights the advanced structural neuroimaging methods that are valuable tools to assess the trigeminal system in TN and may inform our current understanding of TN pathology. These methods may in the future have clinical utility for the development of neuroimaging-based biomarkers of TN.

  19. Structural Magnetic Resonance Imaging Can Identify Trigeminal System Abnormalities in Classical Trigeminal Neuralgia

    Science.gov (United States)

    DeSouza, Danielle D.; Hodaie, Mojgan; Davis, Karen D.

    2016-01-01

    Classical trigeminal neuralgia (TN) is a chronic pain disorder that has been described as one of the most severe pains one can suffer. The most prevalent theory of TN etiology is that the trigeminal nerve is compressed at the root entry zone (REZ) by blood vessels. However, there is significant evidence showing a lack of neurovascular compression (NVC) for many cases of classical TN. Furthermore, a considerable number of patients who are asymptomatic have MR evidence of NVC. Since there is no validated animal model that reproduces the clinical features of TN, our understanding of TN pathology mainly comes from biopsy studies that have limitations. Sophisticated structural MRI techniques including diffusion tensor imaging provide new opportunities to assess the trigeminal nerves and CNS to provide insight into TN etiology and pathogenesis. Specifically, studies have used high-resolution structural MRI methods to visualize patterns of trigeminal nerve-vessel relationships and to detect subtle pathological features at the trigeminal REZ. Structural MRI has also identified CNS abnormalities in cortical and subcortical gray matter and white matter and demonstrated that effective neurosurgical treatment for TN is associated with a reversal of specific nerve and brain abnormalities. In conclusion, this review highlights the advanced structural neuroimaging methods that are valuable tools to assess the trigeminal system in TN and may inform our current understanding of TN pathology. These methods may in the future have clinical utility for the development of neuroimaging-based biomarkers of TN. PMID:27807409

  20. A case of facial myofascial pain syndrome presenting as trigeminal neuralgia.

    Science.gov (United States)

    Yoon, Seung Zhoo; Lee, Sang Ik; Choi, Sung Uk; Shin, Hye Won; Lee, Hye Won; Lim, Hae Ja; Chang, Seong Ho

    2009-03-01

    Facial pain has many causes, including idiopathic factors, trigeminal neuralgia, dental problems, temporomandibular joint disorders, cranial abnormalities, and infections. However, the clinical diagnosis of facial pain is sometimes difficult to establish because clinical manifestations commonly overlap. The diagnosis of trigeminal neuralgia is based solely on clinical findings. Therefore, a careful evaluation of the patient history and a thorough physical examination are essential. This case describes a patient with facial myofascial pain syndrome involving the right zygomaticus, orbicularis oculi, and levator labii muscles, which presented as trigeminal neuralgia.

  1. Treatment of recurrent trigeminal neuralgia due to Teflon granuloma.

    Science.gov (United States)

    Capelle, Hans-Holger; Brandis, Almuth; Tschan, Christoph A; Krauss, Joachim K

    2010-08-01

    Recurrent trigeminal neuralgia after microvascular decompression (MVD) may be due to insufficient decompression, dislocation of the implant to pad the neurovascular contact, or the development of granuloma. Here, we report on our experience with Teflon granuloma including its treatment and histopathological examination. In a series of 200 patients with trigeminal neuralgia MVD was performed with Teflon felt according to Jannetta's technique. In three patients with recurrent facial pain Teflon granuloma was found to be the cause for recurrence. In each instance, the granuloma was removed for histopathological examination. Mean age at the first procedure was 62.3 years and at the second procedure 66.3 years. Recurrence of pain occurred between 1 and 8.5 years after the first procedure. MRI scans demonstrated local gadolineum enhancement in the cerebellopontine angle, and CT scans showed local calcification. Intraoperatively dense fibrous tissue was found at the site of the Teflon granuloma. Histopathological examination revealed foreign body granuloma with multinuclear giant cells, collagen-rich hyalinized scar tissue, focal hemosiderin depositions, and microcalcifications. The Teflon granuloma was completely removed, and a new Teflon felt was used for re-decompression. Patients were free of pain after the second procedure at a mean of 40.3 months of follow-up. Teflon granuloma is a rare cause for recurrent facial pain after MVD. Small bleeding into the Teflon felt at surgery might trigger its development. A feasible treatment option is surgical re-exploration, nerve preserving removal of the granuloma, and repeat MVD.

  2. Brain Abscess after Percutaneous Therapy for Trigeminal Neuralgia

    Directory of Open Access Journals (Sweden)

    Michele Acqui

    2015-01-01

    Full Text Available We report a case of brain abscess following the percutaneous treatment for trigeminal neuralgia. This procedure envisages the access with a needle into the middle cranial fossa through the oral cavity. Thus, in this case, the bacterial infection can be more likely ascribed to the possible contamination of the needle inside the oral cavity rather than to other frequent and more controllable causes of infection like an imperfect sterilization of surgical instruments or an inadequate antiseptic preparation of both operator’s hands and patient’s skin. The subsequent brain abscess was treated with antibiotic therapy (Vancomycin 2 gr a day and Meropenem 8 g a day for 22 days before the surgical procedure and 30 days after, until complete normalization of laboratory parameters, clinical parameters, and neurological symptoms and surgical drainage, although the culture of the abscess capsule and the purulent material resulted sterile. In conclusion, the percutaneous therapy for trigeminal neuralgia can be objectively related to risks, even if performed by expert hands. Therefore, it is important that the patient should be advised regarding risks/benefits and/or septic complications of such procedures, even if they occur very seldom. An association of surgery and antibiotic therapy results as effective treatment for this pathologic condition.

  3. Trigeminal neuralgia and facial nerve paralysis

    Energy Technology Data Exchange (ETDEWEB)

    Borges, Alexandra [IPOFG, Department of Radiology, Lisbon (Portugal)

    2005-03-01

    The trigeminal nerve is the largest of the cranial nerves. It provides sensory input from the face and motor innervation to the muscles of mastication. The facial nerve is the cranial nerve with the longest extracranial course, and its main functions include motor innervation to the muscles of facial expression, sensory control of lacrimation and salivation, control of the stapedial reflex and to carry taste sensation from the anterior two-thirds of the tongue. In order to be able adequately to image and follow the course of these cranial nerves and their main branches, a detailed knowledge of neuroanatomy is required. As we are dealing with very small anatomic structures, high resolution dedicated imaging studies are required to pick up normal and pathologic nerves. Whereas CT is best suited to demonstrate bony neurovascular foramina and canals, MRI is preferred to directly visualize the nerve. It is also the single technique able to detect pathologic processes afflicting the nerve without causing considerable expansion such as is usually the case in certain inflammatory/infectious conditions, perineural spread of malignancies and in very small intrinsic tumours. Because a long course from the brainstem nuclei to the peripheral branches is seen, it is useful to subdivide the nerve in several segments and then tailor the imaging modality and the imaging study to that specific segment. This is particularly true in cases where topographic diagnosis can be used to locate a lesion in the course of these nerves. (orig.)

  4. Concomitant Persistent Pain in Classical Trigeminal Neuralgia – Evidence for Different Subtypes

    DEFF Research Database (Denmark)

    Maarbjerg, Stine; Gozalov, Aydin; Olesen, Jes

    2014-01-01

    OBJECTIVE: To describe the clinical characteristics in classical trigeminal neuralgia (TN) with concomitant persistent pain and to investigate whether TN with concomitant persistent pain represents a distinct phenotype. BACKGROUND: There has been much debate about the possible pathophysiological...

  5. Mind-Refreshing Acupuncture Therapy for Facial Spasm,Trigeminal Neuralgia and Stubborn Facial Paralysis

    Institute of Scientific and Technical Information of China (English)

    刘正; 方桂梅

    2004-01-01

    @@ Facial spasm, trigeminal neuralgia and stubborn facial paralysis are commonly seen in clinic. The authors have obtained quite good therapeutic results for the above diseases by using the mind-refreshing acupuncture therapy. These are introduced in the following.

  6. Ophthalmic branch radiofrequency thermocoagulation for atypical trigeminal neuralgia:a case report.

    Science.gov (United States)

    Du, Shibin; Ma, Xiaoliang; Li, Xiaoqin; Yuan, Hongjie

    2015-01-01

    Trigeminal neuralgia is an intense neuralgia involving facial areas supplied by trigeminal nerve. The pain is characterized by sudden onset, short persistence, sharp or lancinating. Trigeminal neuralgia commonly affects frontal areas, infraorbital or paranasal areas, mandibular areas and teeth. While Trigeminal neuralgia affecting merely the upper eyelid is rare. Here we report a case of atypical Trigeminal neuralgia confined to the upper eyelid. The patient was pain free during the follow-up period of 6 months after unusual ophthalmic branch radiofrequency thermocoagulation. A 55-year-old female patient was diagnosed as primary trigeminal neuralgia involving the right upper eyelid. As the pain could not be controlled by drug therapy, peripheral nerve branch radiofrequency thermocoagulation was recommended. A combination of infratrochlear, supratrochlear and lacrimal radiofrequency thermocoagulation was implemented in this case. The point where the bridge of the nose abuts the supraorbital ridge and the point slightly above the lateral canthus along outer border of the orbit were selected respectively as the puncture sites. After positive diagnostic test, radiofrequency thermocoagulation of the above-mentioned nerve branches was performed respectively. The patient was pain free immediately after the treatment and during the follow-up period of 6 months. Trigeminal neuralgia is a common severe and chronic facial neuralgia which requires accurate diagnosis and effective therapy. With typical clinical symptoms, normal neurological signs, normal CT and MRI findings, the patient was diagnosed as classic trigeminal neuralgia. As the patient was drug resistant, some invasive treatments were considered. Peripheral branch neurolysis was chosen for its minimal invasiveness, convenience, low risk and not affecting further invasive treatments. According to the anatomic data and the diagnostic test results, infratrochlear, supratrochlear and lacrimal nerve were responsible

  7. Application of magnetic resonancetomographic angiography in treatment of trigeminal neuralgia with Adriamycin

    Institute of Scientific and Technical Information of China (English)

    Bin Xu; Yong Zhang; Ni-Ka Chen; Lu-Ming Chen; Yang-Kui Ou

    2016-01-01

    Objective:To observe the application value of magnetic resonancetomographic angiography (MRTA) in the treatment of primary trigeminal neuralgia with Adriamycin and to explore its pathogenesis.Methods:A total of 53 cases of primary trigeminal neuralgia without aberrant blood vessels oppressed trigeminal nerve were screened out by MRTA and was treated with Adriamycin. Another 62 former cases with primary trigeminal neuralgia treated by Adriamycin served as control. The treating efficacy and the recurrence rate of 3 and 6 months past were observed.Results:The efficacy of two groups after 14 d showed no difference. The recurrence rates of the observation group was significantly lower than the control on the both.Conclusions:The patients without trigeminal nerve oppressed by aberrant blood vessels by MRTA screening show low in recurrence rate and part of them seems to have self-healing mechanism.

  8. Are internet sites providing evidence-based information for patients suffering with Trigeminal Neuralgia?

    Science.gov (United States)

    Demetriades, Andreas K; Alg, Varinder Singh; Hardwidge, Carl

    2014-05-01

    Trigeminal neuralgia has a variety of treatments with variable efficacy. Sufferers present to a spectrum of disciplines. While traditional delivery of medical information has been by oral/printed communication, up to 50-80% patients access the internet for information. Confusion, therefore, may arise when seeking treatment for trigeminal neuralgia. We evaluated the quality of information on the internet for trigeminal neuralgia using the DISCERN© instrument. Only 54% websites had clear objectives; 42% delivered on these. A total of 71% provided relevant information on trigeminal neuralgia, 54% being biased/unbalanced; 71% not providing clear sources of information. No website detailed the side-effect profile of treatments; 79% did not inform patients of the consequences/natural history if no treatment was undertaken; it was unclear if patients could anticipate symptoms settling or when treatment would be indicated. Internet information on trigeminal neuralgia is of variable quality; 83% of sites assessed were of low-to-moderate quality, 29% having 'serious shortcomings.' Only two sites scored highly, only one being in the top 10 search results. Websites on trigeminal neuralgia need to appreciate areas highlighted in the DISCERN© instrument, in order to provide balanced, reliable, evidence-based information. To advise patients who may be misguided from such sources, neurosurgeons should be aware of the quality of information on the internet.

  9. Three common neuralgias. How to manage trigeminal, occipital, and postherpetic pain.

    Science.gov (United States)

    Ashkenazi, Avi; Levin, Morris

    2004-09-01

    The pain experienced by patients with trigeminal, occipital, or postherpetic neuralgia is often severe, chronic, and difficult to treat. In this article, Drs Ashkenazi and Levin outline the pathologic mechanisms of pain in these common neuralgias and discuss individually tailored pharmacologic and surgical approaches to their treatment.

  10. Synchronous presentation of trigeminal, glossopharyngeal and geniculate neuralgias in a single patient.

    Science.gov (United States)

    Homeida, Lujain; Elmuradi, Sophia; Sollecito, Thomas P; Stoopler, Eric T

    2016-06-01

    Orofacial pain disorders can present as a diagnostic and therapeutic challenge for oral health care providers. Odontogenic and nonodontogenic sources of orofacial pain should be considered and cranial neuralgias may be included in the differential diagnosis. Synchronous presentation of multiple cranial neuralgias is a rare occurrence. We report a case of a patient with a synchronous presentation of trigeminal, glossopharyngeal, and geniculate neuralgias. To our knowledge, this is the first case of a synchronous presentation of these conditions reported to date.

  11. Advances in diagnosis and treatment of trigeminal neuralgia

    Science.gov (United States)

    Montano, Nicola; Conforti, Giulio; Di Bonaventura, Rina; Meglio, Mario; Fernandez, Eduardo; Papacci, Fabio

    2015-01-01

    Various drugs and surgical procedures have been utilized for the treatment of trigeminal neuralgia (TN). Despite numerous available approaches, the results are not completely satisfying. The need for more contemporaneous drugs to control the pain attacks is a common experience. Moreover, a number of patients become drug resistant, needing a surgical procedure to treat the neuralgia. Nonetheless, pain recurrence after one or more surgical operations is also frequently seen. These facts reflect the lack of the precise understanding of the TN pathogenesis. Classically, it has been related to a neurovascular compression at the trigeminal nerve root entry-zone in the prepontine cistern. However, it has been evidenced that in the pain onset and recurrence, various neurophysiological mechanisms other than the neurovascular conflict are involved. Recently, the introduction of new magnetic resonance techniques, such as voxel-based morphometry, diffusion tensor imaging, three-dimensional time-of-flight magnetic resonance angiography, and fluid attenuated inversion recovery sequences, has provided new insight about the TN pathogenesis. Some of these new sequences have also been used to better preoperatively evidence the neurovascular conflict in the surgical planning of microvascular decompression. Moreover, the endoscopy (during microvascular decompression) and the intraoperative computed tomography with integrated neuronavigation (during percutaneous procedures) have been recently introduced in the challenging cases. In the last few years, efforts have been made in order to better define the optimal target when performing the gamma knife radiosurgery. Moreover, some authors have also evidenced that neurostimulation might represent an opportunity in TN refractory to other surgical treatments. The aim of this work was to review the recent literature about the pathogenesis, diagnosis, and medical and surgical treatments, and discuss the significant advances in all these fields

  12. Case Report: Trigeminal Neuralgia Caused by a Minute Meningioma with Hyperostosed Suprameatal Tubercle

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    Yukitomo Ishi

    2015-08-01

    Full Text Available Cerebellopontine angle tumors might occasionally provoke trigeminal neuralgia but are usually large enough to be diagnosed radiographically. We present a case of trigeminal neuralgia caused by a very small meningioma covering the suprameatal tubercle that displayed hyperostosis at the entrance of Meckel's cave and was not obvious on routine magnetic resonance (MR images. A 72-year-old woman with intractable trigeminal neuralgia in the left V3 territory was referred to our institution. Preoperative imaging studies revealed that the left trigeminal nerve was medially distorted at the entrance of Meckel's cave by a laterally seated bone bulge covered by a minute enhanced lesion. Trigeminal nerve decompression surgery was performed via a retrosigmoid intradural suprameatal approach. We found a small meningioma that had compressed and flattened the trigeminal nerve root at the entrance of Meckel's cave, which was grossly and totally removed by suprameatal tubercle resection. There was no vascular compression of the trigeminal nerve root. The trigeminal neuralgia ceased completely after the operation. Accurate preoperative determination of the causative pathologies is essential to achieve adequate surgical results after microvascular decompression for neurovascular compression syndrome. Because conventional MR sequences are inadequate for the precise interpretation of complex neurovascular anatomy in the cerebellopontine angle and such small tumors can be overlooked on routine MR studies, high-resolution thin-slice MR examinations and careful radiological interpretations are required for correct diagnosis and treatment.

  13. Case Report: Trigeminal Neuralgia Caused by a Minute Meningioma with Hyperostosed Suprameatal Tubercle.

    Science.gov (United States)

    Ishi, Yukitomo; Asaoka, Katsuyuki; Sugiyama, Taku; Yokoyama, Yuka; Yamazaki, Kazuyoshi; Echizenya, Sumire; Itamoto, Koji; Echizenya, Kohei

    2015-01-01

    Cerebellopontine angle tumors might occasionally provoke trigeminal neuralgia but are usually large enough to be diagnosed radiographically. We present a case of trigeminal neuralgia caused by a very small meningioma covering the suprameatal tubercle that displayed hyperostosis at the entrance of Meckel's cave and was not obvious on routine magnetic resonance (MR) images. A 72-year-old woman with intractable trigeminal neuralgia in the left V3 territory was referred to our institution. Preoperative imaging studies revealed that the left trigeminal nerve was medially distorted at the entrance of Meckel's cave by a laterally seated bone bulge covered by a minute enhanced lesion. Trigeminal nerve decompression surgery was performed via a retrosigmoid intradural suprameatal approach. We found a small meningioma that had compressed and flattened the trigeminal nerve root at the entrance of Meckel's cave, which was grossly and totally removed by suprameatal tubercle resection. There was no vascular compression of the trigeminal nerve root. The trigeminal neuralgia ceased completely after the operation. Accurate preoperative determination of the causative pathologies is essential to achieve adequate surgical results after microvascular decompression for neurovascular compression syndrome. Because conventional MR sequences are inadequate for the precise interpretation of complex neurovascular anatomy in the cerebellopontine angle and such small tumors can be overlooked on routine MR studies, high-resolution thin-slice MR examinations and careful radiological interpretations are required for correct diagnosis and treatment.

  14. Early therapeutic effects of cyberknife radiosurgery on trigeminal neuralgia

    Energy Technology Data Exchange (ETDEWEB)

    Mun, Seong Kwon; Choi, Byung Ock; Choi, Ihl Bohng; Kang, Young Nam; Jang, Ji Sun [The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of); Kang, Ki Mun [Gyeongsang National University School of Medicine, Jinju (Korea, Republic of)

    2006-06-15

    We evaluated whether Cyberknife radiosurgery is an effective and safe method of therapy for medically intractable trigeminal neuralgia (TN). We retrospectively analyzed the outcome of 26 patients, who failed to surgery or were not suitable candidates for invasive intervention and were treated by Cyberknife radiosurgery between March 2004 and May 2005. Radiosurgery doses of 60 {approx} 64 Gy were delivered to the 80% isodose line prescribed to an 6 mm length of the nerve, sparing the most proximal 3 mm away from the trigeminal nerve root entry zone (median dose: 64 Gy). Follow-up period was 3 {approx} 15 months (median follow-up period: 9 months) Preliminary results from a cohort of 26 patients undergoing Cyberknife radiosurgery for TN showed that pain relief was achieved in 50% (13/26) of patients within the first 24 hrs after treatment. At last follow-up, 96.2% (25/26) of patients reported early pain relief within 7 days. Treatment failure developed in 2 of 26. Poor response occurred in one patient and relapse was observed in the other patient. 3 patients had hypoesthesia (11.5%), which was the only complication observed with any of our patients. With these results, authors assumed that Cyberknife radiosurgery for TN could be one of safe and effective therapeutic methods.

  15. Botulinum Toxin as Monotherapy in Symptomatic Trigeminal Neuralgia.

    Science.gov (United States)

    Lunde, Hanne Marie Bøe; Torkildsen, Øivind; Bø, Lars; Bertelsen, Anne Kjørsvik

    2016-06-01

    Trigeminal neuralgia (TN) is one of the most agonizing facial pain disorders that humans endure. Studies on onabotulinum toxin A (BTX-A) treatment for TN are limited, but promising with respect to TN of no identifiable cause. We aimed to investigate the efficiency and safety of BTX-A treatment in a 60-year-old male with diabetes mellitus who in March 2013 presented with TN caused by an exostosis in Meckel's cave. The patient was medically treatment refractory due to insufficient pain relief and adverse events of hyperglycemia, and surgery was declined due to complex anatomy. As a last resort, BTX-A was injected into the pain trigger zones of the trigeminal nerve (V5). Complete analgesia was reported 2 weeks after BTX-A injection. Pain medications were discontinued and laboratory values returned to acceptable levels. Regular BTX-A treatment during the next 28 months showed sustained analgesic effect. BTX-A has an excellent safety profile and may be efficient for patients with symptomatic TN not suited for conventional therapies. © 2016 American Headache Society.

  16. Congenital absence of the internal carotid artery diagnosed during investigation of trigeminal neuralgia

    Energy Technology Data Exchange (ETDEWEB)

    Uchino, A.; Sawada, A.; Kudo, S. [Department of Radiology, Saga Medical School, 5-1-1, Nabeshima, Saga (Japan); Hirakawa, N.; Totoki, T. [Department of Anesthesiology, Saga Medical School, 5-1-1, Nabeshima, Saga (Japan)

    2002-09-01

    Congenital absence of the unilateral internal carotid artery (ICA) was found in a patient during MR imaging examination for right trigeminal neuralgia. Magnetic resonance angiography showed complete absence of the right ICA and a large tortuous basilar artery (BA). The source images revealed a deformed right trigeminal nerve resulting from compression by the BA. Computed tomography of the skull base showed absence of the right carotid canal, suggesting agenesis of the right ICA. Longstanding hemodynamic stress may have caused the BA to become extremely tortuous, resulting in the trigeminal neuralgia. (orig.)

  17. [Teflon granuloma after microvascular decompression of the trigeminal nerve root in a patient with recurrent trigeminal neuralgia].

    Science.gov (United States)

    Rzaev, D A; Kulikova, E V; Moysak, G I; Voronina, E I; Ageeva, T A

    2016-01-01

    The use of a Teflon implant for Jannetta surgery in patients with trigeminal neuralgia is complicated in rare cases by the development of a Teflon granuloma and can cause recurrent facial pain. The article presents a clinical case of a Teflon granuloma developed after microvascular decompression of the trigeminal nerve root, describes the surgical findings and histological picture, and analyzes the literature, causes of granuloma development, and recommendations for treatment of these patients.

  18. Persistent trigeminal artery associated with trigeminal neuralgia: hypothesis of neurovascular compression

    Energy Technology Data Exchange (ETDEWEB)

    Bondt, Bert-Jan de [University Hospital Maastricht, Department of Radiology, Maastricht (Netherlands); Stokroos, Robert [University Hospital Maastricht, Department of Otorhinolaryngology-Head and Neck Surgery, Maastricht (Netherlands); Casselman, Jan [AZ St. Jan, Department of Radiology, Bruges (Belgium)

    2007-01-15

    The aim of this study was to determine the prevalence of persistent trigeminal artery (PTA) associated with trigeminal neuralgia (TN). From January 1998 to January 2004, 288 MRI scans of patients examined for trigeminal deficits were retrospectively evaluated. MRI was performed at 1.5 T. Scan protocols included cerebral TSE T2-weighted imaging, contrast enhanced SE T1-weighted imaging and thin-section 3D T2-weighted imaging of the temporal bones, 3D TOF pre- and postcontrast MR angiography. TN was defined as episodes of intense stabbing, electric shock-like pain in areas of the face supplied by the trigeminal branches. Neurovascular compression (NVC) was assumed to be present if the patient showed clinical features of TN, if there was contact between an artery and the trigeminal nerve on the affected side, and if other pathology had been excluded. The prevalence and confidence intervals were calculated (95% CI of the prevalence was based on the exact binomial distribution). Of 288 patients, 136 matched the criteria for TN. In this series a PTA was detected in three patients, which in all patients was on the same side as the TN. The prevalence of a PTA in patients presenting with TN was 2.2% (CI 0.005-0.06). Previous studies have shown PTA as an incidental finding in 0.1-0.6% of cerebral angiograms. The prevalence of a PTA in patients with TN was 2.2%. With respect to the clinical significance, a PTA has to be considered in TN and the diagnosis of a PTA can easily be made using MR imaging/angiography. (orig.)

  19. Using Diffusion Tensor Imaging to Evaluate Microstructural Changes and Outcomes after Radiofrequency Rhizotomy of Trigeminal Nerves in Patients with Trigeminal Neuralgia.

    Science.gov (United States)

    Chen, Shu-Tian; Yang, Jen-Tsung; Yeh, Mei-Yu; Weng, Hsu-Huei; Chen, Chih-Feng; Tsai, Yuan-Hsiung

    2016-01-01

    Trigeminal neuralgia is characterized by facial pain that may be sudden, intense, and recurrent. Our aim was to investigate microstructural tissue changes of the trigeminal nerve in patients with trigeminal neuralgia resulting from neurovascular compression by diffusion tensor imaging, and to test the predictive value of diffusion tensor imaging for determining outcomes after radiofrequency rhizotomy. Forty-three patients with trigeminal neuralgia were recruited, and diffusion tensor imaging was performed before radiofrequency rhizotomy. By selecting the cisternal segment of the trigeminal nerve manually, we measured the volume of trigeminal nerve, fractional anisotropy, apparent diffusion coefficient, axial diffusivity, and radial diffusivity. The apparent diffusion coefficient and mean value of fractional anisotropy, axial diffusivity, and radial diffusivity were compared between the affected and normal side in the same patient, and were correlated with pre-rhizotomy and post-rhizotomy visual analogue scale pain scores. The results showed the affected side had significantly decreased fractional anisotropy, increased apparent diffusion coefficient and radial diffusivity, and no significant change of axial diffusivity. The volume of the trigeminal nerve on affected side was also significantly smaller. There was a trend of fractional anisotropy reduction and visual analogue scale pain score reduction (P = 0.072). The results suggest that demyelination without axonal injury, and decreased size of the trigeminal nerve, are the microstructural abnormalities of the trigeminal nerve in patients with trigeminal neuralgia caused by neurovascular compression. The application of diffusion tensor imaging in understanding the pathophysiology of trigeminal neuralgia, and predicting the treatment effect has potential and warrants further study.

  20. Advances in diagnosis and treatment of trigeminal neuralgia

    Directory of Open Access Journals (Sweden)

    Montano N

    2015-02-01

    Full Text Available Nicola Montano,1 Giulio Conforti,1 Rina Di Bonaventura,1 Mario Meglio,2 Eduardo Fernandez,1 Fabio Papacci1 1Institute of Neurosurgery, Catholic University, Rome, 2Institute of Neurosurgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy Abstract: Various drugs and surgical procedures have been utilized for the treatment of trigeminal neuralgia (TN. Despite numerous available approaches, the results are not completely satisfying. The need for more contemporaneous drugs to control the pain attacks is a common experience. Moreover, a number of patients become drug resistant, needing a surgical procedure to treat the neuralgia. Nonetheless, pain recurrence after one or more surgical operations is also frequently seen. These facts reflect the lack of the precise understanding of the TN pathogenesis. Classically, it has been related to a neurovascular compression at the trigeminal nerve root entry-zone in the prepontine cistern. However, it has been evidenced that in the pain onset and recurrence, various neurophysiological mechanisms other than the neurovascular conflict are involved. Recently, the introduction of new magnetic resonance techniques, such as voxel-based morphometry, diffusion tensor imaging, three-dimensional time-of-flight magnetic resonance angiography, and fluid attenuated inversion recovery sequences, has provided new insight about the TN pathogenesis. Some of these new sequences have also been used to better preoperatively evidence the neurovascular conflict in the surgical planning of microvascular decompression. Moreover, the endoscopy (during microvascular decompression and the intraoperative computed tomography with integrated neuronavigation (during percutaneous procedures have been recently introduced in the challenging cases. In the last few years, efforts have been made in order to better define the optimal target when performing the gamma knife radiosurgery. Moreover, some authors have also evidenced that

  1. Phenytoin and carbamazepine in trigeminal neuralgia: marketing-based versus evidence-based treatment

    Directory of Open Access Journals (Sweden)

    Keppel Hesselink JM

    2017-07-01

    Full Text Available Jan M Keppel Hesselink,1 Michael E Schatman2,31Institute for Neuropathic Pain, Bosch en Duin, the Netherlands; 2Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA; 3Boston Pain Care, Waltham, MA, USAIntroductionMost review articles support carbamazepine as a first-line pharmacotherapy for idiopathic trigeminal neuralgia.1–3 However, the empirical support for this recommendation is somewhat suspect. Phenytoin, as the prototype for all anticonvulsants, was already positioned as an analgesic compound 70 years ago. Since these initial findings, the data that have been gathered have supported the use of anticonvulsants as painkillers – from phenytoin up to and including more recent anticonvulsants such as gabapentin and pregabalin. Since 1942, a number of papers supported phenytoin’s therapeutic effects in trigeminal neuralgia (Table 1. The introduction of carbamazepine in 1962 by Geigy shifted the interest of neurologists from phenytoin as a treatment for trigeminal neuralgia to carbamazepine, without sound scientific evidence. To date, no convincing randomized controlled trials (RCTs have been published supporting the role of carbamazepine in trigeminal neuralgia, and we could not identify a single study comparing the effects of phenytoin with those of carbamazepine. Accordingly, phenytoin should probably be considered more often as a viable therapy for (treatmentresistant trigeminal neuralgia.

  2. Rapid Management of Trigeminal Neuralgia and Comorbid Major Depressive Disorder With Duloxetine.

    Science.gov (United States)

    Hsu, Chung-Chih; Chang, Chun-Wei; Peng, Chia-Ho; Liang, Chih-Sung

    2014-08-01

    To describe a case of a patient diagnosed with major depressive disorder whose trigeminal neuralgia was unexpectedly but rapidly and efficiently responsive to duloxetine. A 37-year-old woman was diagnosed with trigeminal neuralgia, and the initial treatment with carbamazepine 800 mg/d did not improve her pain. In the following 3 years, she was poorly responsive to the combination therapy with several medications, including carbamazepine, valproate, baclofen, diclofenac, and acetaminophen. The repeated gamma knife radiosurgery still did not relieve her symptoms. She developed clinically significant depressive symptoms, and a diagnosis of major depressive disorder was made. Duloxetine 30 mg/d was initiated for the management of depression, with the dose gradually increased to 60 mg/d. Unexpectedly, at the dose of 60 mg/d, the patient reported remarkable relief in her trigeminal neuralgia within the first week. Her depressed mood gradually improved in the following 3 weeks. At the 4-year follow-up, she was gradually tapered off her medications, and her depression and trigeminal neuralgia were well managed on duloxetine 60 mg/d and carbamazepine 600 mg/d. The mechanisms may be related to duloxetine's ability to modulate norepinephrine and serotonin and antagonize N-methyl-d-aspartate (NMDA) receptors. The ignition hypothesis is a proposed etiology of trigeminal neuralgia, in that any individual hyperexcitable neuron can spread its discharge quickly to activate the entire population of neurons. We suggest that duloxetine exerts desynchronizing effects through its NMDA antagonism, modulating the hyperexcitable state of the trigeminal afferents. Duloxetine may be an adjuvant in treatment-resistant trigeminal neuralgia. © The Author(s) 2014.

  3. Neuralgia do trigêmeo bilateral: relato de caso Neuralgia del trigémino bilateral: relato de caso Bilateral trigeminal neuralgia: case report

    Directory of Open Access Journals (Sweden)

    Caio Marcio Barros de Oliveira

    2009-08-01

    ón intensamente dolorosa, caracterizada por brotes de dolor lancinantes y súbitos, del tipo descarga eléctrica, con una duración de pocos segundos a dos minutos y generalmente unilateral. Su incidencia anual es de cerca de 4,3 en 100.000 en la población general, manifestándose bilateralmente en solo un 3% de esos casos. El objetivo de este artículo fue describir un caso raro de neuralgia del trigémino primario bilateral. RELATO DEL CASO: Paciente de 61 años, del estado brasileño de Maranhão, casada, ama de casa, con antecedentes de hipertensión arterial y hace seis años quejándose de dolor intenso en V2-V3 a la izquierda, con una duración de 5 a 10 segundos en la región lateral de la nariz y la mandíbula, con empeoramiento al hablar, masticar y con una reducción de la temperatura. Ya había utilizado clorpromazina (3 mg a cada ocho horas, y carbamazepina (200 mg a cada ocho horas, durante seis meses sin que se le aliviase el dolor. Cuando se le examinó físicamente, presentaba alodinia térmica y mecánica en regiones de V2-V3. Estaba usando gabapentina (1.200 mg al día, con alivio parcial del dolor. Se le aumentó entonces la gabapentina para 1.500 mg al día y se le introdujo la amitriptilina 12,5 mg por la noche. La paciente desarrolló un ligero y esporádico dolor, con una reducción de su intensidad a lo largo de 10 meses de tratamiento, siendo reducida progresivamente la gabapentina para 600 mg al día y mantenida la amitriptilina 12,5 mg al día. Después de un año, empezó a presentar dolor de características similares en la región mandibular a la derecha, y mejoró con el aumento de la gabapentina para 900 mg al día. No presentaba exámenes de tomografía o resonancia magnética de encéfalo alterados. CONCLUSIONES: La carbamazepina es el fármaco de primera elección para el tratamiento de la neuralgia trigeminal, sin embargo la gabapentina ha sido cada vez más utilizada como primera medida farmacológica o en casos refractarios a la terapia

  4. Frameless image-guided radiosurgery for trigeminal neuralgia

    Science.gov (United States)

    Shields, Lisa B. E.; Shanks, Todd S.; Shearer, Andrew J.; Shelton, Lauren A.; Shelton, Brent J.; Howe, Jonathan; Coons, James M.; Plato, Brian; Spalding, Aaron C.

    2017-01-01

    Background: Frameless image-guided radiosurgery (IGRS) is a safe and effective noninvasive treatment for trigeminal neuralgia (TN). This study evaluates the use of frameless IGRS to treat patients with refractory TN. Methods: We reviewed the records of 20 patients diagnosed with TN who underwent frameless IGRS treatments between March 2012 and December 2013. Facial pain was graded using the Barrow Neurological Institute (BNI) scoring system. The initial setup uncertainty from simulation to treatment and the patient intrafraction uncertainty were measured. The median follow-up was 32 months. Results: All patients’ pain was BNI Grade IV or V before the frameless IGRS treatment. The mean intrafraction shift was 0.43 mm (0.28–0.76 mm), and the maximum intrafraction shift was 0.95 mm (0.53–1.99 mm). At last follow-up, 8 (40%) patients no longer required medications (BNI 1 or 2), 11 (55%) patients were pain free but required medication (BNI 3), and 1 (5%) patient had no pain relief (BNI 5). Patients who did not have prior surgery had a higher odds ratio for pain relief compared to patients who had prior surgery (14.9, P = 0.0408). Conclusions: Frameless IGRS provides comparable dosimetric and clinical outcomes to frame-based SRS in a noninvasive fashion for patients with medically refractory TN. PMID:28607821

  5. Percutaneous high-frequency selective rhizotomy in the trigeminal neuralgia therapy in multiple sclerosis

    Directory of Open Access Journals (Sweden)

    V. M. Tyurnikov

    2012-01-01

    Full Text Available Trigeminal neuralgia is a rare symptom of multiple sclerosis affecting the disability. Multiple sclerosis related trigeminal neuralgia has been attributed to a demyelinating lesion in the pons. When the adequate pain drug-relieve therapy is not possible or when the patient becomes refractory to the treatment or can not continue pharmacological treatment because of the side effects, surgical intervention, including percutaneous radiofrequency rhizotomy is being discussed. Literature review and the data upon the efficiency and safety of this neurosurgical treatment in 16 patients with multiple sclerosis have been analyzed. Percutaneous radiofrequency rhizotomy has been proved to be a safe, reproducible and effective method of the symptomatic surgical treatment of trigeminal neuralgia in patients with multiple sclerosis in cases of the intolerance/inefficiency of the pharmacological therapy.

  6. Trigeminal neuralgia: successful antiepileptic drug combination therapy in three refractory cases

    Directory of Open Access Journals (Sweden)

    Prisco L

    2011-08-01

    Full Text Available Lara Prisco1, Mario Ganau2, Federica Bigotto1, Francesca Zornada11Department of Anaesthesiology, Intensive Care and Emergency Medicine, University Hospital of Cattinara, 2Graduate School of Nanotechnology, University of Trieste, ItalyAbstract: Antiepileptic drug combination therapy remains an empirical second-line treatment approach in trigeminal neuralgia, after treatment with one antiepileptic drug or other nonantiepileptic drugs have failed. The results in three patients followed in our clinic are not sufficient to draw definitive conclusions, but suggest the possibility of developing this type of therapeutic approach further.Keywords: trigeminal neuralgia, antiepileptic drugs, combination therapy

  7. De novo superior cerebellar artery aneurysm following radiosurgery for trigeminal neuralgia.

    Science.gov (United States)

    Chen, Joseph C T; Chao, Kuo; Rahimian, Javad

    2017-04-01

    Stereotactic radiosurgery is a commonly used method for treatment of trigeminal neuralgia. Radiation has been known to be a factor in the later development of aneurysms. Aneurysms have been reported to occur after radiation delivered in a variety of methods including both externally delivered radiation radiosurgery and brachytherapy. We report here an incidence of a de novo aneurysm presenting following radiosurgery treatment for trigeminal neuralgia. The patient was treated using frame-based LINAC radiosurgery receiving 90Gy to the mid cisternal extent of the nerve via a 4mm conical collimator. The patient presented with progressive hypoesthesia 11years after treatment. Imaging evaluation demonstrated the presence of an aneurysm abutting the treated trigeminal nerve. The aneurysm was successfully coil embolized. The patient's facial hypoesthesia, however, did not improve following embolization. We believe that this is the first report of such an aneurysm occurring after radiosurgery for trigeminal neuralgia. De novo aneurysms are a recognized long term complication of radiotherapy and radiosurgery treatment. This report shows such aneurysms can occur with very small treatment volumes. Late sensory changes following radiosurgery for trigeminal neuralgia should prompt workup for de novo aneurysms as well as other late adverse radiation effects. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Role of endovascular embolization for trigeminal neuralgia related to cerebral vascular malformation.

    Science.gov (United States)

    Ge, Huijian; Lv, Xianli; Jin, Hengwei; He, Hongwei; Li, Youxiang

    2016-10-01

    The objective of this article is to describe the trigeminal neuralgia related to cerebral vascular malformation that is rarely reported and the experience referring to endovascular treatment. A total of 10 patients who had cerebral vascular malformation (AVM and dAVF) in a single center presented with trigeminal neuralgia. Clinical and angiographic presentations as well as their clinical outcomes after embolization were reviewed. Of the 10 cases, seven dAVFs and three AVMs were detected. In contrast to the dilated feeding arteries, an ectasia of the draining vein that is adjacent to the root entry zone of the trigeminal nerve such as the petrosal vein and lateral mesencephalic vein has the major role in causing the trigeminal neuralgia. All of these patients had relief of facial pain after endovascular embolization during follow-up (mean 57.3 months, range 5 to 100 months). There were no permanent neurological deficits. Endovascular embolization is an effective method in treating trigeminal neuralgia related to cerebral vascular malformation. © The Author(s) 2016.

  9. Update on neuropathic pain treatment for trigeminal neuralgia. The pharmacological and surgical options.

    Science.gov (United States)

    Al-Quliti, Khalid W

    2015-04-01

    Trigeminal neuralgia is a syndrome of unilateral, paroxysmal, stabbing facial pain, originating from the trigeminal nerve. Careful history of typical symptoms is crucial for diagnosis. Most cases are caused by vascular compression of the trigeminal root adjacent to the pons leading to focal demyelination and ephaptic axonal transmission. Brain imaging is required to exclude secondary causes. Many medical and surgical treatments are available. Most patients respond well to pharmacotherapy; carbamazepine and oxcarbazepine are first line therapy, while lamotrigine and baclofen are considered second line treatments. Other drugs such as topiramate, levetiracetam, gabapentin, pregabalin, and botulinum toxin-A are alternative treatments. Surgical options are available if medications are no longer effective or tolerated. Microvascular decompression, gamma knife radiosurgery, and percutaneous rhizotomies are most promising surgical alternatives. This paper reviews the medical and surgical therapeutic options for the treatment of trigeminal neuralgia, based on available evidence and guidelines.

  10. Trigeminal Neuralgia Due to a Small Meckel's Cave Epidermoid Tumor: Surgery Using an Extradural Corridor.

    Science.gov (United States)

    Furtado, Sunil V; Hegde, Alangar S

    2009-09-01

    Tumors at the petrous apex are associated with a variety of symptoms, which most often involve the trigeminal nerve. The authors present a rare case of a small epidermoid tumor in Meckel's cave that caused medically refractory trigeminal neuralgia. The surgical challenge associated with approaches to such lesions is discussed. The skull base tumor was excised completely through a small temporal craniotomy. The practicality of neuronavigation in reaching the petrous apex using a small extradural window is presented.

  11. Trigeminal Neuralgia Due to a Small Meckel's Cave Epidermoid Tumor: Surgery Using an Extradural Corridor

    OpenAIRE

    Sunil V Furtado; Hegde, Alangar S

    2009-01-01

    Tumors at the petrous apex are associated with a variety of symptoms, which most often involve the trigeminal nerve. The authors present a rare case of a small epidermoid tumor in Meckel's cave that caused medically refractory trigeminal neuralgia. The surgical challenge associated with approaches to such lesions is discussed. The skull base tumor was excised completely through a small temporal craniotomy. The practicality of neuronavigation in reaching the petrous apex using a small extradur...

  12. Percutaneous Radiofrequency Thermocoagulation for the Treatment of Different Types of Trigeminal Neuralgia:Evaluation of Quality of Life and Outcomes

    Institute of Scientific and Technical Information of China (English)

    黄轶忠; 倪家骧; 武百山; 何明伟; 杨力强; 王琦

    2010-01-01

    Radiofrequency thermocoagulation(RFT) of the gasserian ganglion is a routine and effective technique for the treatment of classical trigeminal neuralgia(CTN).In this study we compared its efficacy in patients with CTN and atypically symptomatic or mixed trigeminal neuralgia(MTN).Fifty-seven patients were treated with RFT for trigeminal neuralgia from June 2006 to February 2009.Thirty patients had CTN,and 27 had MTN.Outcomes were measured by using the visual analog pain scale(VAS) and patients' reports of qu...

  13. Long-Term Follow-Up of Microvascular Decompression for Trigeminal Neuralgia

    NARCIS (Netherlands)

    Oesman, Chenur; Mooij, Jan Jakob A.

    2011-01-01

    We conducted a study to evaluate the follow-up characteristics of patients with trigeminal neuralgia (TN) and to evaluate the factors affecting long-term outcome of microvascular decompression (MVD) in TN. Between 1983 and 2003, 156 patients with TN treated with MVD by 4 neurosurgeons at University

  14. Trigeminal neuralgia--a prospective systematic study of clinical characteristics in 158 patients

    DEFF Research Database (Denmark)

    Maarbjerg, Stine; Gozalov, Aydin; Olesen, Jes

    2014-01-01

    OBJECTIVE: To prospectively describe the clinical characteristics of classical trigeminal neuralgia (TN) in a standardized manner. BACKGROUND: TN is a rare disease and most clinicians only see a few patients. There is a lack of prospective systematic studies of the clinical characteristics of TN...

  15. Field-testing of the ICHD-3 beta diagnostic criteria for classical trigeminal neuralgia

    DEFF Research Database (Denmark)

    Maarbjerg, Stine; Sørensen, Morten Togo; Gozalov, Aydin

    2015-01-01

    INTRODUCTION: We aimed to field-test the beta version of the third edition of the International Classification of Headache Disorders (ICHD-3 beta) diagnostic criteria for classical trigeminal neuralgia (TN). The proposed beta draft of the 11th version of the International Classification of Diseases...

  16. Long-Term Follow-Up of Microvascular Decompression for Trigeminal Neuralgia

    NARCIS (Netherlands)

    Oesman, Chenur; Mooij, Jan Jakob A.

    We conducted a study to evaluate the follow-up characteristics of patients with trigeminal neuralgia (TN) and to evaluate the factors affecting long-term outcome of microvascular decompression (MVD) in TN. Between 1983 and 2003, 156 patients with TN treated with MVD by 4 neurosurgeons at University

  17. [Invasive management of trigeminal neuralgia. 8 years experience].

    Science.gov (United States)

    Sandoval-Balanzario, Miguel; Álvarez-Vázquez, Leonardo; Santos-Franco, Jorge Arturo

    2015-01-01

    Introducción: la neuralgia del trigémino (NT) se caracteriza por un dolor estereotipado, repetitivo, unilateral referido como eléctrico, desencadenado por la estimulación de  ramas del nervio trigémino. Se presenta con mayor frecuencia en mujeres, 2:1 con respecto a sexo masculino. El objetivo fue conocer la eficacia del tratamiento quirúrgico de NT contra el dolor mediante las técnicas de descompresión microvascular (DMV) y microcompresión percutánea con balón (MPB). Métodos: estudio retrospectivo, en el periodo entre enero de 2005 y enero de 2013, de 73 pacientes tratados por NT. Los 60 pacientes del grupo 1 fueron tratados con DMV, y los 13 del grupo 2 con MPB. Se evaluó la presencia de dolor de los pacientes en el postoperatorio inmediato y a 1, 3 y 5 años. Resultados: se incluyeron 55 pacientes del sexo femenino y 18 hombres. La edad media de presentación de NT fue a los 55 años de edad. En el grupo 1 hubo remisión del dolor en el postoperatorio inmediato en 95 % de los casos, en 92 % al primer año, 91 % a los 3 años y 88 % a los 5 años y en el grupo 2: 85 %, 84 %, 84% y 70 % respectivamente. Conclusiones: los dos procedimientos terapéuticos redujeron el dolor de NT a largo plazo en la mayoría de los pacientes. Nuestros resultados muestran resolución alta y perdurable del dolor con escasa morbimortalidad.

  18. Microstructural abnormalities in the trigeminal nerves of patients with trigeminal neuralgia revealed by multiple diffusion metrics

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Yaou [Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Beijing Key laboratory of MRI and Brain Informatics, Beijing (China); Li, Jiping [Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Butzkueven, Helmut [Department of Medicine, University of Melbourne, Parkville 3010 (Australia); Duan, Yunyun; Zhang, Mo [Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Shu, Ni [State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875 (China); Li, Yongjie [Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Zhang, Yuqing, E-mail: yuqzhang@sohu.com [Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Li, Kuncheng, E-mail: kunchengli55@gmail.com [Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China)

    2013-05-15

    Objective: To investigate microstructural tissue changes of trigeminal nerve (TGN) in patients with unilateral trigeminal neuralgia (TN) by multiple diffusion metrics, and correlate the diffusion indexes with the clinical variables. Methods: 16 patients with TN and 6 healthy controls (HC) were recruited into our study. All participants were imaged with a 3.0 T system with three-dimension time-of-flight (TOF) magnetic resonance angiography and fluid attenuated inversion recovery (FLAIR) DTI-sequence. We placed regions of interest over the root entry zone of the TGN and measured fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD). The mean values of FA, MD, AD and RD were compared between the affected and unaffected sides in the same patient, and to HC values. The correlation between the side-to-side diffusion metric difference and clinical variables (disease duration and visual analogy scale, VAS) was further explored. Results: Compared with the unaffected side and HC, the affected side showed significantly decreased FA and increased RD; however, no significant changes of AD were found. A trend toward significantly increased MD was identified on the affected side comparing with the unaffected side. We also found the significant correlation between the FA reduction and VAS of pain (r = −0.55, p = 0.03). Conclusion: DTI can quantitatively assess the microstructural abnormalities of the affected TGN in patients with TN. Our results suggest demyelination without significant axonal injury is the essential pathological basis of the affected TGN by multiple diffusion metrics. The correlation between FA reduction and VAS suggests FA as a potential objective MRI biomarker to correlate with clinical severity.

  19. MR imaging of idiopathic trigeminal neuralgia. Correlation with non-surgical therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kuroiwa, Toshiro; Matsumoto, Shunichi; Kato, Akira; Harano, Kiyoshi; Totoki, Tadahide; Tabuchi, Kazuo; Kudo, Sho [Saga Medical School (Japan)

    1996-09-01

    Magnetic resonance (MR) findings in patients with idiopathic trigeminal neuralgia were evaluated and correlated with the effectiveness of non-surgical treatments. Thirty-four patients with idiopathic trigeminal neuralgia (ITN) were examined using T{sub 1}-and T{sub 2}-weighted spin-echo (SE) pulse sequence techniques to evaluate their trigeminal root-entry zones and the vessels contacted prior to non-surgical treatment (retrogasserian glycerol injection, peripheral nerve block, or only oral analgesics). Vascular contact at the proximal portion of the preganglionic segment (PGS) of the trigeminal nerve and deformity of the PGS on the affected side were observed in 97% and 47% of the patients, respectively. Non-surgical treatments were curative in 12 (67%) but failed in two (11%) of the 18 patients without deformed PGS. However, among 16 patients with deformed PGS, they were curative in only six (37.5%) and failed in four (25%). Results of this study suggest that MR imaging could be useful in the clinical assessment of trigeminal neuralgia prior to instituting non-surgical treatment. (author)

  20. Experimental study and chemical application of GaAs semiconductor laser treating trigeminal neuralgia

    Science.gov (United States)

    Qiu, Ke-Qum; Cao, Shu-Chen; Wang, Hu-Zhong; Wang, Ke-Ning; Xiao, Ton-Ha; Shen, Ke-Wei

    1993-03-01

    GaAs semiconductor laser was used to treat trigeminal neuralgia with an effective rate of 91.1%, and no side effects were found in 67 cases. Changes in and the recovery of the trigeminal nerve cell were studied with light and electromicroscope. Discussed in this article are the time length and quantity of laser treatment with low power. Experimental study and clinical application of the GaAs semiconductor laser have been carried out in our department since 1987. One-hundred-fifteen patients with various diseases in the maxillofacial region (including 67 cases of trigeminal neuralgia) have been treated with satisfactory effects and without any side-effects. The wavelength of the laser is 904 mu, the largest pulse length is 200 mu, and the average power is 2000 HZ.

  1. THREE-DIMENSIONAL COMPUTED TOMOGRAPHY-GUIDED RADIOFREQUENCY TRIGEMINAL RHIZOTOMY FOR TREATMENT OF IDIOPATHIC TRIGEMINAL NEURALGIA

    Institute of Scientific and Technical Information of China (English)

    Meng Liu; Cheng-yuan Wu; Yu-guang Liu; Hong-wei Wang; Fan-gang Meng

    2005-01-01

    Objective To evaluate the effectiveness of three-dimensional computed tomography (3D-CT) guided radiofrequency trige minal rhizotomy (RF-TR) in treatment of idiopathic trigeminal neuralgia (ITN). Methods From 1999 to 2001, 18 patients with ITN were treated with percutaneous controlled RF-TR. Intraoperative 3D-CT scanning was performed to guide the trajectory of the puncture. After correction of the needle tip according to the CT scans and stimulation effects, 2 to 5 lesions were made for a duration of 60-90 seconds at a temperature of 60℃ to 75℃ depend ing on the pain distribution and the age of patient. Results The needles located in foramen ovale. Pain alleviated immediately with no serious complication in all patients. The patients were followed up for an average of 31.5 months (range 24-41 months). Acute pain relief was experienced by 17 patients after the procedure, reaching an initial success rate of 94.4%. Early (< 6 months) pain recurrence was observed in 2 patients (11.1%), whereas late (> 6 months) recurrence was reported in 3 patients (16.7%). Thirteen patients had complete pain control, with no need for medication thereafter. Five cases experienced partial pain relief, but required medication at a lower dose than in the preoperative period. Conclusion 3D-CT foramen ovale locations can raise the successful rate of puncture, enhance the safety, and reduce the incidence rate of complication.

  2. Radiofrequency thermocoagulation rhizotomy for recurrent trigeminal neuralgia after microvascular decompression

    Institute of Scientific and Technical Information of China (English)

    ZHANG Liang-wen; LIU Yu-guang; WU Cheng-yuan; XU Shu-jun; ZHU Shu-gan

    2011-01-01

    Background Microvascular decompression (MVD) is a well accepted surgical treatment strategy for trigeminal neuralgia (TN) with satisfying long-term outcome.However,considerable recurrent patients need more effective management.The purpose of this study was to evaluate the effectiveness of radiofrequency thermocoagulation rhizotomy (RTR) on patients with recurrent TN after MVD.Methods Totally 62 cases of recurrent TN after MVD undergoing RTR from January 2000 to January 2010 were retrospectively evaluated.Based on surgical procedures undertaken,these 62 cases were classified into two subgroups:group A consisted of 23 cases that underwent traditional RTR by free-hand; group B consisted of 39 cases that underwent RTR under the guidance of virtual reality imaging technique or neuronavigation system.The patients in group Awere followed up for 14 to 70 months (mean,40±4),and those in group B were followed up for 13 to 65 months (mean,46±7).Kaplan-Meier analyses of the pain-free survival curves were used for the censored survival data,and the log-rank test was used to compare survival curves of the two groups.Results All patients in both groups A and B attained immediate pain relief after RTR.Both groups attained good pain relief rate within the first two years of follow-up:92.3%,84.6% and 82.6%,69.6% respectively (P >0.05).After 2 years,the virtual reality or neuronavigation assisted RTR group (group B) demonstrated higher pain relief rates of 82.5%,76.2% and 68.8% at 3,4 and 5 years after operation respectively,while those in group A was 57.2%,49.6%,and 36.4% (P <0.05).Low levels of minor complications were recorded,while neither mortalities nor significant morbidity was documented.Conclusions RTR was effective in alleviating the pain of TN cases suffering from unsuccessful MVD management.With the help of virtual reality imaging technique or neuronavigation system,the patients could attain better long-term pain relief.

  3. Affective Circuitry Alterations in Patients with Trigeminal Neuralgia

    Directory of Open Access Journals (Sweden)

    Dave J. Hayes

    2017-09-01

    Full Text Available Trigeminal neuralgia (TN is a severe chronic neuropathic facial pain disorder. Affect-related behavioral and structural brain changes have been noted across chronic pain disorders, but have not been well-studied in TN. We examined the potential impact of TN (37 patients: 23 with right-sided TN, 14 with left-sided TN, compared to age- and sex-matched healthy controls, on three major white matter tracts responsible for carrying affect-related signals—i.e., cingulum, fornix, and medial forebrain bundle. Diffusion magnetic resonance imaging (dMRI, deterministic multi-tensor tractography for tract modeling, and a model-driven region-of-interest approach was used. We also used volumetric gray matter analysis on key targets of these pathways (i.e., hippocampus, cingulate cortex subregions, nucleus accumbens, and ventral diencephalon. Hypotheses included: (1 successful modeling of tracts; (2 altered white matter microstructure of the cingulum and medial forebrain bundle (via changes in dMRI metrics such as fractional anisotropy, and mean, axial, and radial diffusivities compared to controls; (3 no alterations in the control region of the fornix; (4 corresponding decreases in gray matter volumes. Results showed (1 all 325 tracts were successfully modeled, although 11 were partially complete; (2 The cingulum and medial forebrain bundle (MFB were altered in those with TN, with dMRI metric changes in the middle (p = 0.001 and posterior cingulum (p < 0.0001, and the MFB near the ventral tegmental area (MFB-VTA (p = 0.001. The posterior cingulum and MFB-VTA also showed unilateral differences between right- and left-sided TN patients; (3 No differences were noted at any fornix subdivision; (4 decreased volumes were noted for the hippocampus, posterior cingulate, nucleus accumbens, and ventral diencephalon. Together, these results support the notion of selectively altered affective circuits in patients with TN, which may be related to the experience of

  4. Beneficial effects of botulinum toxin type A in trigeminal neuralgia Beneficio de la toxina botulínica tipo A en neuralgia del trigemino

    Directory of Open Access Journals (Sweden)

    Carlos Zúñiga

    2008-09-01

    Full Text Available Botulinum toxin has been thoroughly studied as a potential tool in the treatment of several pain syndromes. Therefore, we assessed the clinical effects of botulinum toxin type A injections in 12 patients with otherwise unresponsive idiopathic trigeminal neuralgia. Patients were infiltrated with 20-50 units of botulinum toxin in trigger zones. Those who presented with mandibular involvement were also infiltrated in the masseter muscle. The patients were assessed on a weekly basis using the Visual Analogic Scale for pain. Ten of our patients reported a significant benefit from botulinum toxin injections, with reduction or even disappearance of pain, and remained pain free for as long as 60 days. Our findings suggest that botulinum toxin may represent a useful therapeutic tool in the management of patients with this entity.La toxina botulínica ha sido estudiada en forma exhaustiva como una potencial herramienta en el tratamiento de múltiples síndromes dolorosos. Por lo tanto, evaluamos los efectos clínicos de la aplicación de toxina botulínica tipo A en 12 sujetos con neuralgia trigeminal idiopática resistente a manejo farmacológico. Se aplicaron en dichos sujetos entre 20 y 50 unidades de toxina botulínica tipo A en las zonas gatillo. Además se infiltró el músculo masetero en aquellos que presentaban involucro mandibular. Los sujetos fueron evaluados semanalmente con una escala visual análoga para dolor. Diez de los sujetos reportaron un beneficio significativo con el uso de toxina botulínica, con reducción e incluso desaparición del dolor, permaneciendo libres de dolor por un periodo de hasta 60 días. Nuestros hallazgos sugieren que la toxina botulínica puede representar una herramienta terapéutica útil en el manejo de pacientes con esta entidad.

  5. Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    @@ In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.

  6. Vertebrobasilar dolichoectasia as a cause of trigeminal neuralgia: the role of microvascular decompression. Case report Dolicoectasia vertebrobasilar como causa de neuralgia trigeminal: o papel da descompressão microvascular. Relato de caso

    Directory of Open Access Journals (Sweden)

    Jorge Luiz Kraemer

    2006-03-01

    Full Text Available Our purpose is to report a case of trigeminal neuralgia caused by vertebrobasilar dolichoectasia treated with microvascular decompression. A 63-year-old man sought treatment for a recurrent lancinating left facial pain in V2 and V3 trigeminal territories. The computed tomography angiography revealed a mechanical compression of the left trigeminal nerve due to vertebrobasilar dolichoectasia. The patient was submitted to a left suboccipital craniotomy. Shredded Teflon® was introduced in the conflicting neurovascular area, achieving a satisfactory decompression. The patient’s pain resolved immediately. Vertebrobasilar dolichoectasia is a rare cause of trigeminal neuralgia and a successful outcome can be achieved with microvascular decompression.O objetivo desse estudo é relatar um caso de neuralgia trigeminal causado por dolicoectasia vertebrobasilar tratado com descompressão microvascular. Um homem (63 anos consultou por neuralgia trigeminal recorrente na hemiface esquerda (territórios V2 e V3. A angiotomografia cerebral revelou compressão mecânica do nervo trigêmio esquerdo devido à dolicoectasia vertebrobasilar. O paciente foi submetido à craniotomia suboccipital esquerda. Introduziu-se Teflon® na área de conflito neurovascular, obtendo-se uma descompressão satisfatória. O paciente apresentou remissão da dor imediatamente. A dolicoectasia vertebrobasilar é uma causa rara de neuralgia trigeminal e uma excelente evolução pode ser alcançada com a descompressão microvascular.

  7. Selective source blocking for Gamma Knife radiosurgery of trigeminal neuralgia based on analytical dose modelling

    Science.gov (United States)

    Li, Kaile; Ma, Lijun

    2004-08-01

    We have developed an automatic critical region shielding (ACRS) algorithm for Gamma Knife radiosurgery of trigeminal neuralgia. The algorithm selectively blocks 201 Gamma Knife sources to minimize the dose to the brainstem while irradiating the root entry area of the trigeminal nerve with 70-90 Gy. An independent dose model was developed to implement the algorithm. The accuracy of the dose model was tested and validated via comparison with the Leksell GammaPlan (LGP) calculations. Agreements of 3% or 3 mm in isodose distributions were found for both single-shot and multiple-shot treatment plans. After the optimized blocking patterns are obtained via the independent dose model, they are imported into the LGP for final dose calculations and treatment planning analyses. We found that the use of a moderate number of source plugs (30-50 plugs) significantly lowered (~40%) the dose to the brainstem for trigeminal neuralgia treatments. Considering the small effort involved in using these plugs, we recommend source blocking for all trigeminal neuralgia treatments with Gamma Knife radiosurgery.

  8. Selective source blocking for Gamma Knife radiosurgery of trigeminal neuralgia based on analytical dose modelling

    Energy Technology Data Exchange (ETDEWEB)

    Li Kaile; Ma Lijun [Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD 21210 (United States)

    2004-08-07

    We have developed an automatic critical region shielding (ACRS) algorithm for Gamma Knife radiosurgery of trigeminal neuralgia. The algorithm selectively blocks 201 Gamma Knife sources to minimize the dose to the brainstem while irradiating the root entry area of the trigeminal nerve with 70-90 Gy. An independent dose model was developed to implement the algorithm. The accuracy of the dose model was tested and validated via comparison with the Leksell GammaPlan (LGP) calculations. Agreements of 3% or 3 mm in isodose distributions were found for both single-shot and multiple-shot treatment plans. After the optimized blocking patterns are obtained via the independent dose model, they are imported into the LGP for final dose calculations and treatment planning analyses. We found that the use of a moderate number of source plugs (30-50 plugs) significantly lowered ({approx}40%) the dose to the brainstem for trigeminal neuralgia treatments. Considering the small effort involved in using these plugs, we recommend source blocking for all trigeminal neuralgia treatments with Gamma Knife radiosurgery.

  9. The Effect of Low-level Laser Therapy on Trigeminal Neuralgia: A Review of Literature

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    Farnaz Falaki

    2014-03-01

    Full Text Available The effect of low intensity laser radiation in the treatment of acute and chronic pain is now established in many studies. Trigeminal neuralgia is a pain passes through nerve’s branches and its trigger is located in skin or mucosa that could lead to pain with a trigger stimulus. The pain involved branches of trigeminal nerve that sometimes has patients to seek the treatment for several years. Nowadays different treatments are used for relief of pain that most of them cause tolerance and various side effects. This paper reviews and summarizes scientific papers available in English literature published in PubMed, Scopus, Science Direct, Inter science, and Iran Medex from 1986 until July 2011 about the effect of these types of lasers on trigeminal neuralgia which is one of the most painful afflictions known. In different studies, the effect of laser therapy has been compared with placebo irradiation or medicinal and surgical treatment modalities. Low-level laser therapy (LLLT is a treatment strategy which uses a single wavelength light source. Laser radiation and monochromatic light may alter cell and tissue function. However, in most studies laser therapy was associated with significant reduction in the intensity and frequency of pain compared with other treatment strategies, a few studies revealed that between laser and placebo group there was not any significant difference according to the analgesic effect. Low-level laser therapy could be considered in treatment of trigeminal neuralgia without any side effects.

  10. SU-E-T-669: Radiosurgery Failure for Trigeminal Neuralgia: A Study of Radiographic Spatial Fidelity

    Energy Technology Data Exchange (ETDEWEB)

    Howe, J [Associates In Medical Physics, Louisville, KY (United States); Spalding, A [Norton Cancer Institute, Louisville, Kentucky (United States)

    2015-06-15

    Purpose: Management of Trigeminal Neuralgia with radiosurgery is well established, but often met with limited success. Recent advancements in imaging afford improvements in target localization for radiosurgery. Methods: A Trigeminal Neuralgia radiosurgery specific protocol was established for MR enhancement of the trigeminal nerve using a CISS scan with slice spacing of 0.7mm. Computed Tomography simulation was performed using axial slices on a 40 slice CT with slice spacing of 0.6mm. These datasets were registered using a mutual information algorithm and localized in a stereotactic coordinate system. Image registration between the MR and CT was evaluated for each patient by a Medical Physicist to ensure accuracy. The dorsal root entry zone target was defined on the CISS MR by a Neurosurgeon and dose calculations performed on the localized CT. Treatment plans were reviewed and approved by a Radiation Oncologist and Neurosurgeon. Image guided radiosurgery was delivered using positioning tolerance of 0.5mm and 1°. Eight patients with Trigeminal Neuralgia were treated with this protocol. Results: Seven patients reported a favorable response to treatment with average Barrow Neurological Index pain score of four before treatment and one following treatment. Only one patient had a BNI>1 following treatment and review of the treatment plan revealed that the CISS MR was registered to the CT via a low resolution (5mm slice spacing) T2 MR. All other patients had CISS MR registered directly with the localized CT. This patient was retreated 6 months later using direct registration between CISS MR and localized CT and subsequently responded to treatment with a BNI of one. Conclusion: Frameless radiosurgery offers an effective solution to Trigeminal Neuralgia management provided appropriate technology and imaging protocols (utilizing submillimeter imaging) are established and maintained.

  11. Thirty-Two Cases of Trigeminal Neuralgia Treated with Acupuncture plus Chinese Traditional Drugs

    Institute of Scientific and Technical Information of China (English)

    Zheng Xiangmei; Suo Yunxi; Chen Zhengqiu

    2006-01-01

    @@ Trigeminal neuralgia refers to the kind of pain occurring in the distribution areas of the trigeminal nerves. The pain attacking periodically is so intense like either knife-cutting or electric stroke. However,no abnormality is found in the patients when the attack ceases. By means of acupuncture plus Chinese traditional drugs, the authors had treated 32cases of the disease from March of 1999 to March of 2003, and its effect is compared with that of carbamazepine in 29 cases. A report follows.

  12. Small Radiation Beam Dosimetry for Radiosurgery of Trigeminal Neuralgia: One Case Analysis

    Science.gov (United States)

    García-Garduño, O. A.; Lárraga-Gutiérrez, J. M.; Rodríguez-Villafuerte, M.; Martínez-Dávalos, A.; Moreno-Jiménez, S.; Suárez-Campos, J. J.; Celis, M. A.

    2008-08-01

    The use of small radiation beams for trigeminal neuralgia (TN) treatment requires high precision and accuracy in dose distribution calculations and delivery. Special attention must be kept on the type of detector to be used. In this work, the use of GafChromic EBT® radiochromic and X-OMAT V2 radiographic films for small radiation beam characterization is reported. The dosimetric information provided by the films (total output factors, tissue maximum ratios and off axis ratios) is compared against measurements with a shielded solid state (diode) reference detector. The film dosimetry was used for dose distribution calculations for the treatment of trigeminal neuralgia radiosurgery. Comparison of the isodose curves shows that the dosimetry produced with the X-OMAT radiographic film overestimates the dose distributions in the penumbra region.

  13. Central nervous system lymphoma presenting as trigeminal neuralgia: A diagnostic challenge

    Science.gov (United States)

    Ang, Jensen W. J.; Khanna, Arjun; Walcott, Brian P.; Kahle, Kristopher T.; Eskandar, Emad N.

    2015-01-01

    We describe an atypical man with diffuse large B cell lymphoma localized to the sphenoid wing and adjacent cavernous sinus, initially presenting with isolated ipsilateral facial pain mimicking trigeminal neuralgia due to invasion of Meckel’s cave but subsequently progressing to intra-axial extension and having synchronous features of systemic lymphoma. Primary central nervous system lymphoma is uncommon, accounting for approximately 2% of all primary intra-cranial tumors, but its incidence has been steadily increasing in some groups [1]. It usually arises in periventricular cerebral white matter, reports of lymphoma in extra-axial regions are rare [2]. This man highlights the importance of maintaining lymphoma in the differential diagnosis of tumors of the skull base presenting with trigeminal neuralgia-like symptoms. PMID:25865026

  14. TREATMENT OF 25 CASES OF TRIGEMINAL NEURALGIA WITH ABDOMINAL ACUPUNCTURE THERAPY

    Institute of Scientific and Technical Information of China (English)

    MA Xue-qing; YE Shu-ping

    2006-01-01

    @@ Trigeminal Neuralgia is often found in female between 40 - 60 years old, marked by sudden severe pain on the face (a feeling of knife cutting, electric shock), and it is characterized by sudden, paroxysmal and periodical attack and triggered by touch). The attack usually lasts for 1 to 2 minutes with different intervals. The patient's life quality can be seriously affected. It is mainly treated with orally taken drugs in western internal department but without satisfactory result, and with local closing therapy in surgical department. The problem may reoccur half a year later in most patients complicated with facial paralysis, so western medicine is not likely to be accepted by the patients. The author has tried to apply abdominal acupuncture in the treatment of 25 cases of trigeminal neuralgia with good effect. The result is as follows.

  15. Clinical Characteristics of Trigeminal Neuralgia Patients at Dr. Hasan Sadikin General Hospital Bandung Indonesia in 2010–2012

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    Sri Hudaya Widihastha

    2017-03-01

    Full Text Available Background: Trigeminal neuralgia is a frequently found craniofacial neuralgia. The clinical characteristics of trigeminal neuralgia patients at Dr. HasanSadikin General Hospital, Bandung, Indonesia has never been described before. This study conducted an overview of clinical characteristics of trigeminal neuralgia to determine the characteristic features of trigeminal neuralgia. Methods: This was a non-experimental study using secondary data with a retrospective descriptive method. Data related to medical records of 76 patients with trigeminal neuralgia was collected over a period of 2010 to 2012, treated at Dr.HasanSadikin General Hospital Bandung, Indonesia. Results: Mean age was 57.6 years (range 11 to 84 years, no significant difference in gender (male:females 51.3%:48.7%. Chewing and swallowing was reported as triggering stimuli to 42 (55% patients. Two patients (2.7% had suffered pain on bilateral side of the face, 46 (60.5% patients the right side, and 28 patients (36.8% on the left side. Pain on maxillary nerve division was found in 58 (76.3% patients. Sixty one of the patients (80% received Carbamazepine. Conclusions: The peak age was between the fifth and sixth decades of life with equal representation of male to female incidence. Right side and the maxillary division was found to be the most frequently site of pain. Chewing and swallowing was reported to be the most frequent triggering stimuli and most of patients received Carbamazepine as therapy. [AMJ.2017;4(1:47–51

  16. Large-diameter compression arteries as a possible facilitating factor for trigeminal neuralgia: analysis of axial and radial diffusivity

    OpenAIRE

    2016-01-01

    Background Neurovascular compression (NVC) of the trigeminal nerve is associated with trigeminal neuralgia (TN). Some arteries that compress the trigeminal nerve are large, while others are small. This study evaluated the influence of diameter of compression arteries (DCA) on NVC with and without TN using axial diffusivity (AD) and radial diffusivity (RD) of magnetic resonance (MR) imaging. Methods Fifty TN patients with unilateral NVC, 50 asymptomatic patients with unilateral NVC, and 50 hea...

  17. Dose Verification of Stereotactic Radiosurgery Treatment for Trigeminal Neuralgia with Presage 3D Dosimetry System

    OpenAIRE

    2010-01-01

    Achieving adequate verification and quality-assurance (QA) for radiosurgery treatment of trigeminal-neuralgia (TGN) is particularly challenging because of the combination of very small fields, very high doses, and complex irradiation geometries (multiple gantry and couch combinations). TGN treatments have extreme requirements for dosimetry tools and QA techniques, to ensure adequate verification. In this work we evaluate the potential of Presage/Optical-CT dosimetry system as a tool for the v...

  18. Trigeminal Neuralgia Caused by Cerebellopontine Angle Arteriovenous Malformation Treated With Gamma Knife Radiosurgery.

    Science.gov (United States)

    Işik, Semra; Ekşi, Murat Şakir; Yilmaz, Baran; Toktaş, Zafer Orkun; Akakin, Akin; Kiliç, Türker

    2016-01-01

    Trigeminal neuralgia is a facial pain syndrome characterized as sudden onset and lightening-like sensation over somatosensorial branch(es) of fifth cranial nerve. Rarely, some underlying diseases or disorders could be diagnosed, such as multiple sclerosis, brain tumors, and vascular malformations. The authors present a 47-year-old man with trigeminal neuralgia over left V2 and V3 dermatomes. He had a previous transarterial embolization and long use of carbamazepine with partial response to treatment. Gamma knife radiosurgery (GKR) was planned. A marginal dose of 15 Gy was given to 50% isodose line. His pain was relieved by GKR in 1.5 years. Treatment of posterior fossa arteriovenous malformations causing trigeminal neuralgia, with GKR has a very limited use in the literature. It, however, is obvious that success rate as pain relief, in a very challenging field of functional neurosurgery, is satisfactory. Large series, however, are in need to make a more comprehensive statement about efficacy and safety of the procedure in these pathologies.

  19. Microvascular Decompression Versus Stereotactic Radiosurgery for Trigeminal Neuralgia: A Decision Analysis

    Science.gov (United States)

    Berger, Ian; Nayak, Nikhil; Schuster, James; Lee, John; Stein, Sherman

    2017-01-01

    Introduction: Both microvascular decompression (MVD) and stereotactic radiosurgery (SRS) have been demonstrated to be effective in treating medically refractory trigeminal neuralgia. However, there is controversy over which one offers more durable pain relief and the patient selection for each treatment. We used a decision analysis model to calculate the health-related quality of life (QOL) for each treatment. Methods: We searched PubMed and the Cochrane Database of Systematic Reviews for relevant articles on MVD or SRS for trigeminal neuralgia published between 2000 and 2015. Using data from these studies, we modeled pain relief and complication outcomes and assigned QOL values. A sensitivity analysis using a Monte Carlo simulation determined which procedure led to the greatest QOL. Results: MVD produced a significantly higher QOL than SRS at a seven-year follow-up. Additionally, MVD patients had a significantly higher rate of complete pain relief and a significantly lower rate of complications and recurrence. Conclusions: With a decision-analytic model, we calculated that MVD provides more favorable outcomes than SRS for the treatment of trigeminal neuralgia. PMID:28280653

  20. Clinical Observation on Treatment of Primary Trigeminal Neuralgia by Point Penetrating Injection plus Ear Pressing

    Institute of Scientific and Technical Information of China (English)

    乔光文; 孙培华

    2007-01-01

    To investigate the therapeutic effect of primary refractory trigeminal neuralgia. Methods: Twenty-eight cases of primary trigeminal neuralgia were treated by point penetrating injection plus ear pressing, controlled by 28 cases treated only by acupuncture.Results: The total effective rate was 96.43% in observation group and 78.57% in control group.There wasa significant difference in the total effective rate between the two groups (P<0.05).Results: Point penetrating injection plus ear pressing is the effective method in treating primary trigeminal neuralgia.%目的:探讨顽固性三叉神经痛的有效治法.方法:采用透穴注射配合耳压治疗原发顽固性三叉神经痛28例,并与单纯针刺28例对照.结果:观察组总有效率为96.4%,对照组总有效率为78.6%,透穴注射配合耳压治疗原发顽固性三叉神经痛总有效率与单纯针刺组差异明显(P<0.05).结论:运用透穴注射配合耳压是治疗原发顽固性三叉神经痛的有效方法.

  1. Ultrasound-Guided Pulsed Radiofrequency Application via the Pterygopalatine Fossa: A Practical Approach to Treat Refractory Trigeminal Neuralgia.

    Science.gov (United States)

    Nader, Antoun; Bendok, Bernard R; Prine, Jeremy J; Kendall, Mark C

    2015-01-01

    Although pharmacological therapy is the primary treatment modality for trigeminal neuralgia associated pain, ineffective analgesia and dose limiting side effects often prompt patients to seek alternative pharmacological solutions such as interventional nerve blockade. Blockade of the Gasserian ganglion or its branches is an effective analgesic procedure for trigeminal neuralgia, traditionally performed using fluoroscopy or CT imaging. Ultrasonography allows point of care and real time visualization of needle placement within the surrounding anatomical structures. The use of ultrasonography with pulsed radiofrequency therapy for trigeminal neuralgia has not been reported. Our case is a 66-year-old male suffering from trigeminal neuralgia for 4 years that was refractory to pharmacologic therapy. Neurological examination was normal with no sensory deficit. Imaging showed no vascular compression or mass involving the trigeminal nerve. A diagnostic ultrasound-guided trigeminal nerve block via the pterygopalatine fossa with 4 mL of bupivacaine 0.25% and 4 mg dexamethasone provided immediate pain relief (100%) with sustained analgesia >50% at 2 weeks. Pain relief was not sustained at one month, with return to pretreatment symptoms. A series of injections were performed with similar intermittent analgesic effectiveness. The decision was made that the patient was a suitable candidate for pulsed radiofrequency application in the pterygopalatine fossa. We successfully used an alternative approach through the pterygopalatine fossa to treat trigeminal neuralgia using ultrasound guidance in an office setting. Our case demonstrates the utility of ultrasound-guidance pulsed radiofrequency treatment in the pterygopalatine fossa as a potential alternative to other percutaneous techniques for patients with medical refractory trigeminal neuralgia.

  2. Ultrasound-guided trigeminal nerve block via the pterygopalatine fossa: an effective treatment for trigeminal neuralgia and atypical facial pain.

    Science.gov (United States)

    Nader, Antoun; Kendall, Mark C; De Oliveria, Gildasio S; Chen, Jeffry Q; Vanderby, Brooke; Rosenow, Joshua M; Bendok, Bernard R

    2013-01-01

    Patients presenting with facial pain often have ineffective pain relief with medical therapy. Cases refractory to medical management are frequently treated with surgical or minimally invasive procedures with variable success rates. We report on the use of ultrasound-guided trigeminal nerve block via the pterygopalatine fossa in patients following refractory medical and surgical treatment. To present the immediate and long-term efficacy of ultrasound-guided injections of local anesthetic and steroids in the pterygopalatine fossa in patients with unilateral facial pain that failed pharmacological and surgical interventions. Academic pain management center. Prospective case series. Fifteen patients were treated with ultrasound-guided trigeminal nerve block with local anesthetic and steroids placed into the pterygopalatine fossa. All patients achieved complete sensory analgesia to pin prick in the distribution of the V2 branch of the trigeminal nerve and 80% (12 out of 15) achieved complete sensory analgesia in V1, V2, V3 distribution within 15 minutes of the injection. All patients reported pain relief within 5 minutes of the injection. The majority of patients maintained pain relief throughout the 15 month study period. No patients experienced symptoms of local anesthetic toxicity or onset of new neurological sequelae. Prospective case series. We conclude that the use of ultrasound guidance for injectate delivery in the pterygopalatine fossa is a simple, free of radiation or magnetization, safe, and effective percutaneous procedure that provides sustained pain relief in trigeminal neuralgia or atypical facial pain patients who have failed previous medical interventions.

  3. Microvascular decompression as a surgical management for trigeminal neuralgia: A critical review of the literature

    Directory of Open Access Journals (Sweden)

    Kabatas Serdar

    2009-01-01

    Full Text Available Trigeminal neuralgia (TN is a common pain syndrome and is characterized by recurrent episodes of intense lancinating pain in one or more divisions of the trigeminal nerve. Neurovascular compression (NVC has been considered as the main cause of TN in the root entry zone (REZ of the trigeminal nerve in the cerebellopontine angle cistern. Microvascular decompression (MVD is the surgical procedure of choice for the treatment of medically refractory TN. MVD has also been shown to provide pain relief even in patients without visible neurovascular compression. Additionally, it has been accepted that MVD can provide the highest rate of long-term patient satisfaction with the lowest rate of pain recurrence. We did, systematic review of the subject and also our own experiences.

  4. A SURVEY TO OBSERVE THE COMMONLY USED TREATMENT PROTOCOL FOR TRIGEMINAL NEURALGIA BY PHYSIOTHERAPIST

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    Reeta

    2016-10-01

    Full Text Available Background: Trigeminal neuralgia (TN is also known as prosoplasia it is also termed as a Suicidal disease or Fothergill disease. The neuropathic condition is characterized by recurrent episodes of facial pains which are triggered by touch, chewing and shaving. The pain initiates from the 5th cranial nerve which is known as trigeminal nerve. The objective of this study was to evaluate treatment protocol used by physiotherapist for trigeminal neuralgia patients. Methods: It was cross-sectional descriptive study in which data was collected from certified physiotherapists working in private/ government hospitals for more than 1 year in Karachi. The sample size was 60 and Purposive random sampling technique was used. The data collection procedure was questionnaire based that was filled by physiotherapists. Results: In this study 77% physiotherapist’s answered that physiotherapy is helpful in patients with T.N and, 23% said that it is not beneficial.13.3% patients reported that they were taking medicines other than steroid and analgesics like (carbamezipine, gabapentine, 50% were taking steroids, 33.3% were taking NSAIDs, and 3.3% were taking antibiotics. Regarding Modality prescribed by physiotherapists in Trigeminal Neuralgia 68% physiotherapists used TENS to treat the disease, 30% used electrical stimulation and only 2% used ultrasound. Conclusions: Physiotherapy treatment is effective in the patients of T.N. Awareness needs to be generated amongst general public concern in the role of physiotherapy relating to the disease. The symptoms of some patients are not eased by the medicines, they should move toward electrical stimulation.

  5. Modeling and commissioner of a set of cones brain lab for trigeminal neuralgia; Modelado y comisionado de un sistema de conos brainlab para la neuralgia de trigemino

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-07-01

    Radiosurgery is an effective treatment for trigeminal neuralgia. The use of LINAC with cone system is an alternative front other procedures. As the fields to measure are very small we prefer not to use camera type pinpoint due to lack of lateral balance and the use of diodes implies fixes to correct the over-estimation of his reading. (Author)

  6. A Comparative Study between Oxcarbazepine and Gabapentin Regarding Therapeutic Efficiency and Tolerability in the Treatment of Trigeminal Neuralgia

    Directory of Open Access Journals (Sweden)

    Fakir Mohan Debta

    2010-01-01

    Recently two newer anticonvulsant oxcarbazepine (OXC a ketoderivative of carbamazepine and gabapentin (GBP has been trailed in trigeminal neuralgia in different open clinical trial as monotherapy with encouraging results. These drugs have convenient dosage and surprisingly fewer side effects. These facts that trigeminal neuralgia responds to newer anticonvulsant (oxcarbazepine, gabapentin in a better perspective, enabled me to conduct the present clinical trial on 54 patients (both in newly diagnosed TN patient and refractive patient of trigeminal neuralgia who were made two randomized group for separate monotherapy study for a period of six months. The therapeutic effect of OXC and gabapentin (GBP in relation to reduction in number of attacks of pain and severity of pain were evaluated. All the scoring data showed OXC is more therapeutic efficacious cost-effective and well-tolerated profile than gabapentin and an emerging as a drug for treatment of TN in both new and refractive patients.

  7. Subtle Sensory Abnormalities Detected by Quantitative Sensory Testing in Patients with Trigeminal Neuralgia.

    Science.gov (United States)

    Flor, Herta; Rasche, Dirk; Islamian, Ariyan Pirayesh; Rolko, Claudia; Yilmaz, Pinar; Ruppolt, Marc; Capelle, H Holger; Tronnier, Volker; Krauss, Joachim K

    2016-01-01

    Trigeminal neuralgia (TN) is characterized by paroxysmal pain attacks affecting the somatosensory distributions of the trigeminal nerve. It is thought to be associated with a neurovascular conflict most frequently, but pathomechanisms have not been fully elucidated. In general, no sensory deficit is found in routine clinical examination. There is limited data available, however, showing subtle subclinical sensory deficits upon extensive testing. We used quantitative sensory testing (QST) to detect abnormalities in sensory processing in patients with TN by comparing the affected and non-affected nerve branches with their contralateral counterparts and by comparing the results of the patients with those of controls. Observational study. University Hospital, Departments of Neurosurgery, Institute for Cognitive and Clinical Neuroscience. QST was conducted on 48 patients with idiopathic TN and 27 controls matched for age and gender using the standardized protocol of the German Neuropathic Pain Network. Stimulations were performed bilaterally in the distribution of the trigeminal branches. The patients had no prior invasive treatment, and medications at the time of examination were noted. In patients with TN deficits in warm and cold sensory detection thresholds in the affected and also the non-affected nerve branches were found. Tactile sensation thresholds were elevated in the involved nerve branches compared to the contralateral side. More data are needed on the correlation of such findings with the length of history of TN and with changes of the morphology of the trigeminal nerve. QST shows subtle sensory abnormalities in patients with TN despite not being detected in routine clinical examination. Our data may provide a basis for further research on the development of TN and also on improvement after treatment. Quantitative sensory testing, trigeminal neuralgia, facial pain, neuropathic pain, microvascular decompression, cranial nerve.

  8. Surgical treatment of primary trigeminal neuralgia through small incision behind the ear

    Directory of Open Access Journals (Sweden)

    Yun-jie XIE

    2014-12-01

    Full Text Available A total of 3000 cases with primary trigeminal neuralgia were treated in our department from October 2005 to November 2013 by microvascular decompression or partial amputation of the sensory branch of trigeminal nerve. The clinical cure rate reached 98.66% (2863 cases, and the effective rate was 0.55% (16 cases, ineffective rate 0.45% (13 cases. The recurrence rate was about 0.35% (10 cases. The main postoperative complication was intracranial hypotension syndrome (40.50% , 1215 cases, which disappeared 2 or 3 d later. The other serious complications included encephaledema (1.40%, 42 cases, cerebral hemorrhage (0.20%, 6 cases and ischemic stroke (0.07%, 2 cases. In conclusion, microvascular decompression is an effective and safe operation method in the treatment of primary trigeminal neuralgia, and most patients' pain can be eliminated or alleviated after surgery. doi: 10.3969/j.issn.1672-6731.2014.12.016

  9. Neuropatía sensitiva trigeminal secundaria a granuloma de colesterol de la punta del peñasco del temporal Trigeminal neuralgia secondary to cholesterol granuloma of the petrous bone apex

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    M.A. Pons García

    2009-10-01

    Full Text Available La neuropatía aislada de la rama sensitiva del trigémino es una entidad poco habitual. Los pacientes suelen referir hipoestesia y /o disestesia generalmente a nivel de la segunda y tercera rama del trigémino, mientras que la neuralgia es muy infrecuente.¹ Su asociación con enfermedades sistémicas del tejido conectivo es bien conocida.² Se ha descrito asociada a distintas lesiones del SNC sobre todo tumores de fosa posterior o base de cráneo, así como neoplasias mandibulares.3,4 Presentamos una paciente con hipoestesia en el territorio V2-V3 asociada a dolor hemifacial paroxístico secundario a una lesión del peñasco del temporal.Trigeminal Neuralgia is an uncommon entity. The patients report hypoesthesia and/or dysesthesia of the second and third ramus of trigeminal nerve, while neuralgia is very rare.¹ Its association with systemic diseases of connective tissue is well know.² It has been described as being associated with different lesions of the central nervous system, especially with the posterior cavity or cranial base tumors, as well as jaw neoplasias.3,4 We presented a patient with hypoesthesia V2-V3 and hemi facial paroxysmal pain secondary to lesion of petrous apex of temporal bone.

  10. Withdrawal reaction of carbamazepine after neurovascular decompression for trigeminal neuralgia: a preliminary study.

    Science.gov (United States)

    Chen, Min-Jie; Zhang, Wei-Jie; Guo, Zhi-Lin; Zhang, Wen-Hao; Chai, Ying; Li, Yun-Wu

    2014-03-15

    To evaluate the representations and the relevant factors of carbamazepine-associated withdrawal reaction (CAWR) after microvascular decompression (MVD) to treat trigeminal neuralgia (TN). The present series included 90 patients who were referred from September 2010 to January 2013 and diagnosed with classical TN. The carbamazepine (CBZ) serum level was tested twice at 24h pre- and 24h post-operation by using HPLC analysis. The analysis of correlating selected factors and CAWR was performed. Among 90 patients, 26 (28.9%) suffered from post-operative CAWR for 3 days after MVD. The symptoms of CAWR include overexcitement, e.g. insomnia, dysphoria, hand fremitus, hallucination and severe headache. The history of CBZ therapy before MVD, pre-operative dosage of CBZ, and the D-value of CBZ blood concentrations demonstrated statistic differences between the patients with CAWR and those without CAWR. Patient characteristics such as gender, age, and duration of neuralgia, neuralgia-related factors including neuralgia extent and neurovascular compression severity, and operation conditions including duration of MVD procedure, effect of MVD and complication of MVD had no influence on the occurrence of CAWR. It is strongly suggested that CAWR is dependent on the pre-operative dosage and the changing rate of pre- and post-operative CBZ blood concentrations. Copyright © 2013 Elsevier B.V. All rights reserved.

  11. Atypical Trigeminal Neuralgia: A Rare Neurological Manifestation of Systemic Lupus Erythematosus

    Science.gov (United States)

    Kumar, Viki; Kaur, Jaspinder; Pothuri, Pallavi; Bandagi, Sabiha

    2017-01-01

    Patient: Female, 53 Final Diagnosis: Atypical trigerminal neuralgia Symptoms: Right sided facial pain Medication: — Clinical Procedure: None Specialty: Rheumatology Objective: Unusual clinical course Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder of unknown etiology which can present at any age with symptoms of mucocutaneous, musculoskeletal, renal, central nervous system, and non-specific clinical pictures making the disease a “master of mimicry”. Case Report: A 53-year-old female, who was recently diagnosed with SLE, presented with right-sided sharp and electric shock-like facial pain starting at the side of her right nostril and traveling down the naso-labial fold and then back to the angle of the jaw, mostly in the region of V2–V3 distribution with no radiation beyond trigeminal distribution. Her pain had been going for the last 2 years and was regarded as “pretrigeminal neuralgia”; however, it progressed in frequency over the last 2 weeks, with no clear identifying triggering factors. Her laboratory test results showed positive anti-nuclear antibodies (ANA) with raised titer, anti-double-stranded DNA, anti-ribonucleoprotein, anti-Sjögren’s syndrome-related antigen A, anti-Sjögren’s syndrome-related antigen B, and anti-smooth muscle antibodies. Other possibilities of migraine, postherpetic neuralgia, Bell’s palsy, and brain tumor were ruled out. A diagnosis of SLE with trigeminal neuralgia (TN) was made and carbamazepine 100 mg 2 times a day was prescribed. Conclusions: TN is seldom mentioned as a neurological manifestation of SLE; hence, we recommend further studies to investigate the SLE-mediated injury to trigeminal fibers to make a timely diagnosis of TN and to prevent progressive autoimmune process-related vasculitic and demyelinating changes. PMID:28077839

  12. Atypical Trigeminal Neuralgia: A Rare Neurological Manifestation of Systemic Lupus Erythematosus.

    Science.gov (United States)

    Kumar, Viki; Kaur, Jaspinder; Pothuri, Pallavi; Bandagi, Sahiba

    2017-01-12

    BACKGROUND Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder of unknown etiology which can present at any age with symptoms of mucocutaneous, musculoskeletal, renal, central nervous system, and nonspecific clinical pictures making the disease a "master of mimicry". CASE REPORT A 53-year-old female, who was recently diagnosed with SLE, presented with right-sided sharp and electric shock-like facial pain starting at the side of her right nostril and traveling down the naso-labial fold and then back to the angle of the jaw, mostly in the region of V2-V3 distribution with no radiation beyond trigeminal distribution. Her pain had been going for the last 2 years and was regarded as "pretrigeminal neuralgia"; however, it progressed in frequency over the last 2 weeks, with no clear identifying triggering factors. Her laboratory test results showed positive anti-nuclear antibodies (ANA) with raised titer, anti-double-stranded DNA, anti-ribonucleoprotein, anti-Sjögren's syndrome-related antigen A, anti-Sjögren's syndrome-related antigen B, and anti-smooth muscle antibodies. Other possibilities of migraine, postherpetic neuralgia, Bell's palsy, and brain tumor were ruled out. A diagnosis of SLE with trigeminal neuralgia (TN) was made and carbamazepine 100 mg 2 times a day was prescribed. CONCLUSIONS TN is seldom mentioned as a neurological manifestation of SLE; hence, we recommend further studies to investigate the SLE-mediated injury to trigeminal fibers to make a timely diagnosis of TN and to prevent progressive autoimmune process-related vasculitic and demyelinating changes.

  13. Comparison of nerve combing and percutaneous radiofrequency thermocoagulation in the treatment for idiopathic trigeminal neuralgia.

    Science.gov (United States)

    Zhou, Xuanchen; Liu, Yiqing; Yue, Zhiyong; Luan, Deheng; Zhang, Hong; Han, Jie

    2016-01-01

    Idiopathic trigeminal neuralgia (ITN) is a common pain disease in elderly people. Many methods have been used to alleviate the pain of patients, but few studies in the literature have compared the effect of nerve combing and percutaneous radiofrequency thermocoagulation. The purpose of this study was to describe and evaluate the clinical outcome of idiopathic trigeminal neuralgia after nerve combing (NC) and compare them with those obtained using percutaneous radiofrequency thermocoagulation (RF). The study included 105 idiopathic trigeminal neuralgia patients with similar symptom, age and underlying disease, which were divided into two groups. One group was treated by nerve combing (50 patients), the other by RF (55 cases). All patients were considered medical failures prior to the surgeries. A questionnaire was used to assess the long-term outcomes: pain relief, recurrence, complication and need for additional treatment. The median duration of follow-up in both groups was 90 months. Satisfactory relief was noted in 41 patients (82%), 5 patients (10%) initially experienced pain relief, then recurred, and four patients (8%) were designated poor among the group NC. In the group RF, satisfactory relief was noted in 42 patients (76.4%). There were eight "pain free with recurrence patients (14.5%) and 5 poor cases (9.1%). No statistically significant differences existed in the outcomes between both groups (p>0.05). Postoperative morbidity included dysesthesia, diplopia, partial facial nerve palsy, hearing loss, tinnitus, cerebrospinal fluid leak, meningitis and mortality. Nerve combing and RF are both satisfactory treatment strategies for patients with ITN. Because of the higher risk of sensory morbidity and surgical risk as open surgery, RF is preferred as the recommended procedure for patients with ITN. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  14. Comparison of nerve combing and percutaneous radiofrequency thermocoagulation in the treatment for idiopathic trigeminal neuralgia

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    Xuanchen Zhou

    Full Text Available ABSTRACT INTRODUCTION: Idiopathic trigeminal neuralgia (ITN is a common pain disease in elderly people. Many methods have been used to alleviate the pain of patients, but few studies in the literature have compared the effect of nerve combing and percutaneous radiofrequency thermocoagulation. OBJECTIVE: The purpose of this study was to describe and evaluate the clinical outcome of idiopathic trigeminal neuralgia after nerve combing (NC and compare them with those obtained using percutaneous radiofrequency thermocoagulation (RF. METHODS: The study included 105 idiopathic trigeminal neuralgia patients with similar symptom, age and underlying disease, which were divided into two groups. One group was treated by nerve combing (50 patients, the other by RF (55 cases. All patients were considered medical failures prior to the surgeries. A questionnaire was used to assess the long-term outcomes: pain relief, recurrence, complication and need for additional treatment. RESULTS: The median duration of follow-up in both groups was 90 months. Satisfactory relief was noted in 41 patients (82%, 5 patients (10% initially experienced pain relief, then recurred, and four patients (8% were designated poor among the group NC. In the group RF, satisfactory relief was noted in 42 patients (76.4%. There were eight "pain free with recurrence patients (14.5% and 5 poor cases (9.1%. No statistically significant differences existed in the outcomes between both groups (p > 0.05. Postoperative morbidity included dysesthesia, diplopia, partial facial nerve palsy, hearing loss, tinnitus, cerebrospinal fluid leak, meningitis and mortality. CONCLUSION: Nerve combing and RF are both satisfactory treatment strategies for patients with ITN. Because of the higher risk of sensory morbidity and surgical risk as open surgery, RF is preferred as the recommended procedure for patients with ITN.

  15. Action at a distance: a lumbar spine tumor presenting as trigeminal neuralgia.

    Science.gov (United States)

    Schwartz, Neil E; Rosenberg, Sidney; So, Yuen T

    2006-12-01

    Trigeminal neuralgia (TN) is often secondary to an underlying structural cause, frequently compression of the fifth nerve root by an ectatic artery. Here we describe a case of a 36-year-old woman with symptoms of TN who was found to have severe communicating hydrocephalus. Further investigation revealed a lumbar myxopapillary ependymoma, which in turn was responsible for the communicating hydrocephalus. An argument connecting these seemingly disparate findings is made. This unusual set of circumstances is an example of "action at a distance" in the nervous system, and reminds clinicians to think broadly about the various pathophysiologic mechanisms that can potentially underlie common disorders.

  16. Prolonged vertigo and ataxia after mandibular nerve block for treatment of trigeminal neuralgia

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    Arvind Chaturvedi

    2011-01-01

    Full Text Available Common complications of neurolytic mandibular nerve block are hypoesthesia, dysesthesia, and chemical neuritis. We report a rare complication, prolonged severe vertigo and ataxia, after neurolytic mandibular blockade in a patient suffering from trigeminal neuralgia. Coronoid approach was used for right sided mandibular block. After successful test injection with local anesthetic, absolute alcohol was given for neurolytic block. Immediately after alcohol injection, patient developed nausea and vomiting along with severe vertigo, ataxia and hypertension. Neurological evaluation was normal except for the presence of vertigo and ataxia. Computerised tomography scan brain was also normal. Patient was admitted for observation and symptomatic treatment was given. Vertigo and ataxia gradually improved over 24 hours.

  17. Mind-refreshing acupuncture therapy for facial spasm, trigeminal neuralgia and stubborn facial paralysis.

    Science.gov (United States)

    Liu, Zheng; Fang, Guimei

    2004-09-01

    It has been proved by clinical experiment that needling at Fengchi (GB 20), Wangu (GB 12) and Tianzhu (BL 10) can markedly improve the blood supply to the vertebral basilar artery, increase the cerebral blood flow, and relax the spasm of the vascular smooth muscles. The combined use of Shangxing (GV 23) and Yintang (EX-HN3) can give the effects of resuscitating and tranquilizing the mind, dispelling wind, dredging the channels, and relieving spasm and pain. In short, the above therapy may turn the pathological state into a normal physiological state, and bring a quicker recovery for patients with facial spasm, trigeminal neuralgia and stubborn facial paralysis.

  18. Selective percutaneous radiofrequency thermocoagulation in the treatment of trigeminal neuralgia:report on 1860 cases

    Institute of Scientific and Technical Information of China (English)

    吴承远; 孟凡刚; 徐淑军; 刘玉光; 王宏伟

    2004-01-01

    @@Trigeminal neuralgia (TN) is defined by the International Association for the Study of Pain as "a sudden, usually unilateral, severe, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve".1 The incidence rate is about three to five cases per year per 100000 persons and increases with age.2 In our hospital, percutaneous radiofrequency therapy was performed on 1860 patients with TN from June 1986 to April 2003, and percutaneous trigeminal ganglion radiofrequency therapy on 579 cases. Among this group of patients, X-ray, 3-D CT, and navigational localization of the oval foramen were performed on 42 cases. The indications, techniques, and results are reported here.

  19. Combination of pharmacotherapy and lidocaine analgesic block of the peripheral trigeminal branches for trigeminal neuralgia: a pilot study.

    Science.gov (United States)

    Di Stani, Fabrizio; Ojango, Christine; Dugoni, Demo; Di Lorenzo, Luigi; Masala, Salvatore; Delfini, Roberto; Bruti, Gianluca; Simonetti, Giovanni; Piovesan, Elcio Juliato; Ruggeri, Andrea Gennaro

    2015-08-01

    Classical trigeminal neuralgia (CTN) is treated predominantly by pharmacotherapy but side effects and unsuccessful occurs. The current study was carried out to evaluate the therapeutic effect of combination of pharmacotherapy and lidocaine block. Thirteen patients with CTN managed with pharmacotherapy were recruited and assigned either to no additional treatment (Group I) or to additional analgesic block (Group II). The primary endpoint was the reduction in the frequency of pain episodes in a month assessed at 30 and 90 days. Comparisons of measurements of pain, general health and depression scales were secondary endpoints. The results from the follow-up visits at 30 and 90 days showed the Group II to have larger reduction in the frequency of pain and exhibited a bigger improvement in the scores of the pain, general health and depression scales. The results from this preliminary study suggest a clinical benefit of the combination of pharmacotherapy and lidocaine block.

  20. Combination of pharmacotherapy and lidocaine analgesic block of the peripheral trigeminal branches for trigeminal neuralgia: a pilot study

    Directory of Open Access Journals (Sweden)

    Fabrizio Di Stani

    2015-08-01

    Full Text Available Classical trigeminal neuralgia (CTN is treated predominantly by pharmacotherapy but side effects and unsuccessful occurs. The current study was carried out to evaluate the therapeutic effect of combination of pharmacotherapy and lidocaine block. Thirteen patients with CTN managed with pharmacotherapy were recruited and assigned either to no additional treatment (Group I or to additional analgesic block (Group II. The primary endpoint was the reduction in the frequency of pain episodes in a month assessed at 30 and 90 days. Comparisons of measurements of pain, general health and depression scales were secondary endpoints. The results from the follow-up visits at 30 and 90 days showed the Group II to have larger reduction in the frequency of pain and exhibited a bigger improvement in the scores of the pain, general health and depression scales. The results from this preliminary study suggest a clinical benefit of the combination of pharmacotherapy and lidocaine block.

  1. Keyhole craniotomy through retrosigmoid approach followed by microvascular decompression for primary trigeminal neuralgia:a report of 23 cases

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    Gang-ge CHENG

    2011-03-01

    Full Text Available Objective To explore the surgical technique,effects,and complications of keyhole craniotomy through retrosigmoid approach followed by microvascular decompression for primary trigeminal neuralgia.Methods The craniotomy with a keyhole incision above postauricular hairline followed by microvascular decompression was performed in 23 patients with primary trigeminal neuralgia.Dissection of intracranial part of trigeminal nerve under microscope was done to search for the offending vessels,which were thereby freed and between which and the root entry zone(REZ of trigeminal nerve the Teflon grafts were placed.Effects and complications were observed in follow-up,ranging from 1 month to 2 years.Results Out of 23 patients who were all found compression in REZ of trigeminal nerves by the offending vessels in operation,disappearance of symptoms post-surgery was found in 22 cases,face numbness on the surgical side in 3 cases and no effects in 1 case.Recurrence of pain was not observed in patients who had initially benefited from the surgery at the follow-up.Conclusion The keyhole craniotomy through retrosigmoid approach followed by microvascular decompression is safe and effective for primary trigeminal neuralgia,in which accurate technique during operation plays a vital role in the decrease of complications and the outcome post-surgery.

  2. Trigeminal neuralgia: the diagnosis and management of this excruciating and poorly understood facial pain.

    Science.gov (United States)

    Zakrzewska, Joanna M; McMillan, Roddy

    2011-06-01

    Trigeminal neuralgia is defined as sudden, usually unilateral, severe, brief, stabbing recurrent episodes of pain within the distribution of one or more branches of the trigeminal nerve, which has a profound effect on quality of life. The diagnosis is made on history alone, and time needs to be taken to elicit the key features and differentiate from toothache or one of the trigeminal autonomic cephalalgias. Most trigeminal neuralgia is idiopathic, but a small percentage is due to secondary causes-for example, tumours or multiple sclerosis-which can be picked up on CT or MRI. Recently published international guidelines suggest that carbamazepine and oxcarbazepine are the first-line drugs. There is limited evidence for the use of lamotrigine and baclofen. If there is a decrease in efficacy or tolerability of medication, surgery needs to be considered. A neurosurgical opinion should be sought early. There are several ablative, destructive procedures that can be carried out either at the level of the Gasserian ganglion or in the posterior fossa. The only non-destructive procedure is microvascular decompression (MVD). The ablative procedures give a 50% chance of patients being pain free for 4 years, compared with 70% of patients at 10 years after MVD. Ablative procedures result in sensory loss, and MVD carries a 0.2-0.4% risk of mortality with a 2-4% chance of ipsilateral hearing loss. Surgical procedures result in markedly improved quality of life. Patient support groups provide information and support to those in pain and play a crucial role.

  3. [Treatment of trigeminal neuralgia: an update and future prospects of percutaneous techniques].

    Science.gov (United States)

    Bescós, Agustín; Pascual, Vicenç; Escosa-Bage, Marcos; Malaga, Xavier

    2015-08-01

    Introduccion. La neuralgia del trigemino es uno de los sindromes de dolor facial mas graves. La incidencia anual varia entre el 4-13% y altera de forma significativa la calidad de vida de los afectados. Cuando el dolor no puede controlarse con tratamiento farmacologico, existen diferentes opciones quirurgicas. La seleccion de la tecnica esta basada en estudios observacionales y su aplicacion depende de la experiencia de cada centro. Objetivos. Evaluar la efectividad y el nivel de evidencia del tratamiento farmacologico y quirurgico en la neuralgia del trigemino, y analizar el papel actual de las tecnicas percutaneas en el tratamiento de esta patologia. Desarrollo. El tratamiento inicial de la neuralgia del trigemino es el farmacologico y la carbamacepina es el unico farmaco con suficiente nivel de evidencia. Las tecnicas quirurgicas percutaneas son efectivas y de facil aplicacion, pero la tendencia a la recidiva conduce a la preferencia por la microdescompresion vascular. Sin embargo, no hay estudios comparativos que determinen la superioridad de alguna tecnica con buen nivel de evidencia. Se han revisado las tres tecnicas percutaneas mas utilizadas, la compresion con balon, la rizotomia con glicerol y la termocoagulacion por radiofrecuencia. Esta ultima es la que ha presentado mayor desarrollo en los ultimos años, con la aparicion de tecnicas neurofisiologicas que pueden optimizar los resultados. Conclusiones. La seleccion de una tecnica quirurgica en la neuralgia del trigemino no esta bien apoyada por ensayos clinicos aleatorizados. Los nuevos procedimientos en la aplicacion de la radiofrecuencia pueden mejorar las perspectivas del tratamiento de esta patologia.

  4. The role of sensory fiber demography in trigeminal and postherpetic neuralgias.

    Science.gov (United States)

    DaSilva, A F; DosSantos, M F

    2012-01-01

    In this study, we systematically investigated fiber demography, based on function and distribution, from the periphery to their destinations in the various central (sub) nuclei in the trigeminal brainstem nuclear sensory complex. Conventional and novel compelling information is provided, demonstrating that the ratio and somatotopy of types A and C sensory fibers at the site of a lesion can elucidate important puzzles in TNP disorders. For instance, we explain how of a major shift in the fibers' direction and ratio at the level of the trigeminal root entry zone (REZ) influences the pathophysiology of pre- and typical trigeminal neuralgia. As a result, there is a high A/C ratio of oral and peri-oral fibers in the supero-medial region of the REZ, which is mostly susceptible to vascular compression. However, this A/C ratio varies considerably at lower proportions in other areas along the peripheral trigeminal pathway, where an injury (viral, vessel compression, or trauma) can lead to a broader spectrum of fiber involvement and, consequently, pain outcome. In summary, we explain how fiber demography can influence pain quality, location, temporal features, progress, and treatment prognosis of TNP in those patients who develop it.

  5. Preoperative demonstration of neurovascular relationship in trigeminal neuralgia by using 3D FIESTA sequence.

    Science.gov (United States)

    Zhou, Qin; Liu, Zhi-Ling; Qu, Chun-Cheng; Ni, Shi-Lei; Xue, Feng; Zeng, Qing-Shi

    2012-06-01

    The purpose of the study was to evaluate the value of high-resolution three-dimensional fast imaging employing steady-state acquisition (3D FIESTA) imaging in the visualization of neurovascular relationship in patients with trigeminal neuralgia (TN). Thirty-seven patients with unilateral typical TN underwent 3D FIESTA imaging. Neurovascular relationship at the trigeminal root entry zone was reviewed by an experienced neuroradiologist, who was blinded to the clinical details. The imaging results were compared with the operative findings in all patients. In 37 patients with TN, 3D FIESTA imaging identified surgically verified neurovascular contact in 35 of 36 symptomatic nerves. Based on surgical findings, the sensitivity and specificity of magnetic resonance (MR) imaging were 97.2% and 100%, respectively. Agreement between the position (medial, lateral, superior and inferior) of the compressing vessel relative to the trigeminal nerve identified by MR imaging and surgery was excellent (K=0.81; 95% confidence interval, 0.56-1.00). A statistically significant difference was found between the site of neurovascular contact and the clinical symptom related to the trigeminal branch (Fisher's Exact Test, PFIESTA sequence enables accurate visualization of neurovascular contact in patients with TN. Anatomic relationships defined by this method can be useful in surgical planning and predicting surgical findings. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. Usefulness of three-dimensional display for microvascular decompression surgery in patients with hemifacial spasm and trigeminal neuralgia

    Energy Technology Data Exchange (ETDEWEB)

    Kumon, Yoshiaki; Sakaki, Saburo; Ohue, Shiroh; Ohta, Shinsuke; Kohno, Kanehisa; Ishimaru, Yoshihiro [Ehime Univ., Shigenobu (Japan). Shool of Medicine

    1997-03-01

    This report deals with the usefulness of three-dimensional (3D) display for microvascular decompression surgery in patients with hemifacial spasm and trigeminal neuralgia. Twenty-two patients with hemifacial spasm and six with trigeminal neuralgia were studied by magnetic resonance (MR) imaging using three-dimensional spoiled gradient recalled acquisition in the steady state (3D-SPGR), MR angiography and 3D display. The 3D displayed images were roconstructed at a work station from the 3D-SPGR MR data by the surface rendering method. In all patients, the preoperative 3D-SPGR MR images demonstrated the causative vessels that had been compressed or were attached to the root exit or root entry zone (REZ) of the facial or trigeminal nerve. The causative vessels were identified on MR angiography. The 3D display provided clear information regarding the anatomical relationship between the causative vessels and the REZ of the nerves. Among the 22 patients with hemifacial spasm, the causative vessels were the posterior inferior cerebellar arteries (PICA) in 11, and the anterior inferior cerebellar arteries in the other 11. In the six patients with trigeminal neuralgia, the causative vessels were identified as the superior cerebellar arteries in five, and PICA in the remaining one. The surgical findings were compatible with those demonstrated by 3D displayed images. The symptoms were completely relieved after surgery in 20 patients with hemifacial spasm and in all six patients with trigeminal neuralgia. In conclusion, 3D-SPGR MR imaging and MR angiography are useful for the detection of the causative vessels in patients with hemifacial spasm and trigeminal neuralgia. Moreover, 3D display is especially useful for the presentation of the anatomical relationship and the simulation of surgical procedures. (author)

  7. The diagnostic value of MR examination in trigeminal neuralgia; Przydatnosc badania MR w ocenie konfliktu naczyniowo-nerwowego w neuralgii nerwu 5. czaszkowego

    Energy Technology Data Exchange (ETDEWEB)

    Bobek-Billewicz, B.; Hermann, M. [Instytut Radiologii, Akademia Medyczna, Gdansk (Poland); Sloniewski, P. [Klinika Neurochirurgii, Akademia Medyczna, Gdansk (Poland)

    1996-12-31

    Microneurovascular compression may produce symptoms of trigeminal neuralgia. MR examination in T-1 weighted SE, sagittal and coronal images, in slice thickness less than 3 mm, is a valuable method to demonstrate neurovascular compression in trigeminal neuralgia. Authors defined microneurovascular compression syndrome when the 5. nerve was in contact with a vessel in root entry zone. 13 patients with clinical symptoms of trigeminal neuralgia were examined, 6 of them presented MR symptoms of neurovascular compression. The operative treatment was evaluated in 2 patients (with absence of pre-operative symptoms was achieved following microvascular decompression all patients who had surgery. (author) 7 refs, 2 figs, 2 tabs

  8. Differential Diagnostics of Pain in the Course of Trigeminal Neuralgia and Temporomandibular Joint Dysfunction

    Science.gov (United States)

    Pihut, M.; Szuta, M.; Ferendiuk, E.; Zeńczak-Więckiewicz, D.

    2014-01-01

    Chronic oral and facial pain syndromes are an indication for intervention of physicians of numerous medical specialties, while the complex nature of these complaints warrants interdisciplinary diagnostic and therapeutic approach. Oftentimes, lack of proper differentiation of pain associated with pathological changes of the surrounding tissues, neurogenic pain, vascular pain, or radiating pain from idiopathic facial pain leads to improper treatment. The objective of the paper is to provide detailed characterization of pain developing in the natural history of trigeminal neuralgia and temporomandibular joint dysfunction, with particular focus on similarities accounting for the difficulties in diagnosis and treatment as well as on differences between both types of pain. It might seem that trigeminal neuralgia can be easily differentiated from temporomandibular joint dysfunction due to the acute, piercing, and stabbing nature of neuralgic pain occurring at a single facial location to spread along the course of the nerve on one side, sometimes a dozen or so times a day, without forewarning periods. Both forms differ significantly in the character and intensity of pain. The exact analysis of the nature, intensity, and duration of pain may be crucial for the differential diagnostics of the disorders of our interest. PMID:24995309

  9. SU-E-T-420: Failure Effects Mode Analysis for Trigeminal Neuralgia Frameless Radiosurgery

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    Howe, J [Associates In Medical Physics, Louisville, KY (United States)

    2015-06-15

    Purpose: Functional radiosurgery has been used successfully in the treatment of trigeminal neuralgia but presents significant challenges to ensuring the high prescription dose is delivered accurately. A review of existing practice should help direct the focus of quality improvement for this treatment regime. Method: Failure modes and effects analysis was used to identify the processes in preparing radiosurgery treatment for TN. The map was developed by a multidisciplinary team including: neurosurgeon, radiation oncology, physicist and therapist. Potential failure modes were identified for each step in the process map as well as potential causes and end effect. A risk priority number was assigned to each cause. Results: The process map identified 66 individual steps (see attached supporting document). Corrective actions were developed for areas of high risk priority number. Wrong site treatment is at higher risk for trigeminal neuralgia treatment due to the lack of site specific pathologic imaging on MR and CT – additional site specific checks were implemented to minimize the risk of wrong site treatment. Failed collision checks resulted from an insufficient collision model in the treatment planning system and a plan template was developed to address this problem. Conclusion: Failure modes and effects analysis is an effective tool for developing quality improvement in high risk radiotherapy procedures such as functional radiosurgery.

  10. Outcome of radiosurgery treatment with a linear accelerator in patients with trigeminal neuralgia.

    Science.gov (United States)

    Cordero Tous, N; Cruz Sabido, J de la; Román Cutillas, A M; Saura Rojas, E J; Jorques Infante, A M; Olivares Granados, G

    2017-04-01

    An overview of the effectiveness of radiosurgery in patients diagnosed with trigeminal neuralgia with an analysis of potential predictors of good outcome. All patients treated with linear accelerator radiosurgery between 2004 and 2011 were analysed. A dose of 60Gy dose was administered 1 to 2mm from the root entry zone with a maximum isodose of 20% delivered to the brainstem. Clinical results for pain control and any side effects were analysed at 12 and 36 months (BNI score). The study included 71 patients (mean follow-up 50.5 months). Pain improvement at 12 months was observed in 68.11% of the total (28.98% with BNI score i-ii; 39.12% with BNI score iii) and at 36 months in 58.21% (23.88% BNI score i-ii; 34.32% BNI score iii). Average recovery time was 3.69 months and the relapse rate was 44.68%. Patients with typical pain displayed statistically significant differences in improvement rates at 12 and at 36 months (Pfacial numbness (13.43%); only 2 cases were clinically relevant (2.98%). According to our results, radiosurgery is an effective treatment for trigeminal neuralgia, with few side effects. Typical pain seems to be a good predictor of pain relief. Copyright © 2015 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Botulinum neurotoxin type A for the treatment of pain: not just in migraine and trigeminal neuralgia.

    Science.gov (United States)

    Sandrini, Giorgio; De Icco, Roberto; Tassorelli, Cristina; Smania, Nicola; Tamburin, Stefano

    2017-12-01

    Despite their huge epidemiological impact, primary headaches, trigeminal neuralgia and other chronic pain conditions still receive suboptimal medical approach, even in developed countries. The limited efficacy of current pain-killers and prophylactic treatments stands among the main reasons for this phenomenon. Botulinum neurotoxin (BoNT) represents a well-established and licensed treatment for chronic migraine, but also an emerging treatment for other types of primary headache, trigeminal neuralgia, neuropathic pain, and an increasing number of pain conditions. We searched and critically reviewed evidence for the efficacy of BoNT for the treatment of chronic pain. Meta-analyses and randomized controlled trials (RCTs) suggest that BoNT potentially represents a multi-purpose drug for the treatment of pain in several disorders due to a favorable safety profile and a long-lasting relief after a single injection. BoNT is an emerging treatment in different pain conditions. Future RCTs should explore the use of BoNT injection therapy combined with systemic drugs and/or physical therapies as new pain treatment strategies.

  12. Differential Diagnostics of Pain in the Course of Trigeminal Neuralgia and Temporomandibular Joint Dysfunction

    Directory of Open Access Journals (Sweden)

    M. Pihut

    2014-01-01

    Full Text Available Chronic oral and facial pain syndromes are an indication for intervention of physicians of numerous medical specialties, while the complex nature of these complaints warrants interdisciplinary diagnostic and therapeutic approach. Oftentimes, lack of proper differentiation of pain associated with pathological changes of the surrounding tissues, neurogenic pain, vascular pain, or radiating pain from idiopathic facial pain leads to improper treatment. The objective of the paper is to provide detailed characterization of pain developing in the natural history of trigeminal neuralgia and temporomandibular joint dysfunction, with particular focus on similarities accounting for the difficulties in diagnosis and treatment as well as on differences between both types of pain. It might seem that trigeminal neuralgia can be easily differentiated from temporomandibular joint dysfunction due to the acute, piercing, and stabbing nature of neuralgic pain occurring at a single facial location to spread along the course of the nerve on one side, sometimes a dozen or so times a day, without forewarning periods. Both forms differ significantly in the character and intensity of pain. The exact analysis of the nature, intensity, and duration of pain may be crucial for the differential diagnostics of the disorders of our interest.

  13. Differential diagnostics of pain in the course of trigeminal neuralgia and temporomandibular joint dysfunction.

    Science.gov (United States)

    Pihut, M; Szuta, M; Ferendiuk, E; Zeńczak-Więckiewicz, D

    2014-01-01

    Chronic oral and facial pain syndromes are an indication for intervention of physicians of numerous medical specialties, while the complex nature of these complaints warrants interdisciplinary diagnostic and therapeutic approach. Oftentimes, lack of proper differentiation of pain associated with pathological changes of the surrounding tissues, neurogenic pain, vascular pain, or radiating pain from idiopathic facial pain leads to improper treatment. The objective of the paper is to provide detailed characterization of pain developing in the natural history of trigeminal neuralgia and temporomandibular joint dysfunction, with particular focus on similarities accounting for the difficulties in diagnosis and treatment as well as on differences between both types of pain. It might seem that trigeminal neuralgia can be easily differentiated from temporomandibular joint dysfunction due to the acute, piercing, and stabbing nature of neuralgic pain occurring at a single facial location to spread along the course of the nerve on one side, sometimes a dozen or so times a day, without forewarning periods. Both forms differ significantly in the character and intensity of pain. The exact analysis of the nature, intensity, and duration of pain may be crucial for the differential diagnostics of the disorders of our interest.

  14. Ondine's curse with accompanying trigeminal and glossopharyngeal neuralgia secondary to medullary telangiectasia.

    Science.gov (United States)

    Kapnadak, Siddhartha G; Mikolaenko, Ivan; Enfield, Kyle; Gress, Daryl R; Nathan, Barnett R

    2010-06-01

    Central hypoventilation syndrome ("Ondine's Curse") is an infrequent disorder that can lead to serious acute or chronic health consequences. This syndrome, especially in adults, is rare, and even less frequent in the absence of clear pathogenic lesions on MRI. In addition, we are not aware of any previously reported cases with associated cranial nerve neuralgias. We describe a patient with baseline trigeminal and glossopharyngeal neuralgia, admitted with episodes of severe hypoventilatory failure of central origin, consistent with "Ondine's Curse". After evaluation, she was found to have a medullary capillary telangiectasia, thought to be the causative lesion, and which could explain her complete neurologic and hypoventilatory syndrome. The patient was treated with placement of a diaphragmatic pacing system, which has been effective thus far. This case illustrates the need for investigation of centrally mediated apnea, especially when co-occurring cranial nerve neuralgia is present and cardiopulmonary evaluation is negative. It provides an example of capillary telangiectasia as the causative lesion, one that to our knowledge has not been reported before. Placement of a diaphragmatic pacing system was warranted and became lifesaving as the patient was deemed to be severely incapacitated by chronic ventilatory insufficiency.

  15. Trigeminal neuralgia post-styloidectomy in Eagle syndrome: a case report

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    Blackett John

    2012-10-01

    Full Text Available Abstract Introduction Eagle syndrome is a condition characterized by an elongated (>3cm styloid process with associated symptoms of recurrent facial or throat pain. In this report we present a case of Eagle syndrome exhibiting the typical findings of glossopharyngeal nerve involvement, as well as unusual involvement of the trigeminal nerve. Notably, this patient developed a classical trigeminal neuralgia post-styloidectomy. Case presentation A 68-year-old Caucasian woman presented with a 25-year history of dull pain along the right side of her throat, lateral neck, and jaw. Her symptoms were poorly controlled with medication until 15 years ago when she was diagnosed with Eagle syndrome, and underwent a manual fracture of her styloid process. This provided symptomatic relief until 5 years ago when the pain recurred and progressed. She underwent a styloidectomy via a lateral neck approach, which resolved the pain once again. However, 6 months ago a new onset of triggerable, electric shock-like facial pain began within the right V1 and V2 distributions. Conclusions Eagle syndrome is distressing to patients and often difficult to diagnose due to its wide variability in symptoms. It is easily confused with dental pain or temporomandibular joint disorder, leading to missed diagnoses and unnecessary procedures. Pain along the jaw and temple is an unusual but possible consequence of Eagle syndrome. An elongated styloid process should be considered a possible etiology of dull facial pain in the trigeminal distributions, in particular V3.

  16. An Open Study of Botulinum-A Toxin Treatment of Idiopathic Trigeminal Neuralgia

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    Karim Nikkhah

    2015-07-01

    Full Text Available Introduction: Trigeminal Neuralgia (TN is a unilateral, recurrent, sharp facial pain disorder that is limited to the distribution of divisions of the trigeminal nerve. The aim of this study was to evaluate the efficacy of Botulinum neurotoxin type A (BTX-A for alleviating the frequency and severity of TN pain. Materials and Methods: This trial was performed as a before and after study. We treated 31 patients (15 male and 16 female with mean age of 52 year old that their diagnosis was made at least 4.5 years before. We injected BTX-A in various parts of face and particularly in the origin of mandibular and maxillary branches of trigeminal nerve. Injection volume was determined by the necessity and pain intensity measured with visual analog scale up to 100U. Patients were evaluated before and after the injection and were followed after week, and each month, for a three months period. Other related variables were recorded such as: toxin complications, pain status variations by brushing, chewing, cold weather and patient’s satisfaction with their therapy. Results: showed that after injection, pain intensity and frequency decreased after tooth brushing, chewing and cold weather (P

  17. Evaluation of the sensation in patients with trigeminal post-herpetic neuralgia.

    Science.gov (United States)

    Alvarez, Fábio Kurogi; de Siqueira, Silvia Regina Dowgan Tesseroli; Okada, Massako; Teixeira, Manoel Jacobsen; de Siqueira, José Tadeu Tesseroli

    2007-07-01

    Post-herpetic neuralgia (PHN) is one complication after herpes zoster infection, which may affect the facial superficial sensitivity. Eighteen patients with PHN were interviewed and evaluated according to a systematized sensitivity approach, including mechanical, thermal and pain. The pain location was V1 in 15 patients. All trigeminal branches from both facial sides were evaluated; we compared the affected with the opposite side. There was a significant difference at V1 with cold (P=0.038), vonFrey (P=0.008) and pinpricks (P=0.022); at V2, the statistical difference occurred with cold (P=0.034), heat (P=0.019) and pinpricks (P=0.037); at V3, differences occurred with cold (P=0.042) and heat (P=0.036). Only V1 and oral mucosa (V2-3) presented pain threshold differences between both sides (P=0.001, P=0.021). Age, predominance of trigeminal PHN in V1 and continuous burning pain was common and similar to literature. Sensation was hampered with evident deficits of all sensory modalities in the affected trigeminal areas, especially V1.

  18. Effect of 5% lidocaine medicated plaster on pain intensity and paroxysms in classical trigeminal neuralgia.

    Science.gov (United States)

    Tamburin, Stefano; Schweiger, Vittorio; Magrinelli, Francesca; Brugnoli, Maria Paola; Zanette, Giampietro; Polati, Enrico

    2014-11-01

    Trigeminal neuralgia (TN) is a neuropathic pain condition affecting one or more branches of the trigeminal nerve. It is characterized by unilateral, sudden, shock-like, and brief painful attacks, which follow the distribution of trigeminal nerve branches, and with no other accompanying sensorimotor or autonomic signs and symptoms. Current guidelines stipulate which therapies represent first-, second-, and third-line treatments for TN, but there is a consistent mismatch between the therapeutic guidelines and the patient's preferences and expectations. We report on 2 patients with classical TN in whom conventional drugs for TN were not tolerated. In these patients, treatment with 5% lidocaine medicated plaster (LMP) resulted in reduction of pain intensity and the number of pain paroxysms. LMP is known to block the sodium channels on peripheral nerves and may cause a selective and partial block of Aδ and C fibers. According to the TN ignition hypothesis, blockage of peripheral afferents by LMP may reduce pain paroxysms. The effect of LMP may outlast the pharmacokinetics of the drug by reducing pain amplification mechanisms in the central nervous system. LMP has limited or no systemic side effects. LMP may be an effective and well-tolerated treatment option for TN in those patients who do not tolerate or who refuse other therapies. Future randomized controlled studies should better address this issue. © The Author(s) 2014.

  19. Beneficial effects of botulinum toxin type A in trigeminal neuralgia Beneficio de la toxina botulínica tipo A en neuralgia del trigemino

    OpenAIRE

    Carlos Zúñiga; Sergio Díaz; Fabián Piedimonte; Federico Micheli

    2008-01-01

    Botulinum toxin has been thoroughly studied as a potential tool in the treatment of several pain syndromes. Therefore, we assessed the clinical effects of botulinum toxin type A injections in 12 patients with otherwise unresponsive idiopathic trigeminal neuralgia. Patients were infiltrated with 20-50 units of botulinum toxin in trigger zones. Those who presented with mandibular involvement were also infiltrated in the masseter muscle. The patients were assessed on a weekly basis using the Vis...

  20. Clinical observation on treating primary trigeminal neuralgia by acupuncture%针刺治疗原发性三叉神经痛的疗效观察

    Institute of Scientific and Technical Information of China (English)

    夏兆新

    2014-01-01

    Objective:To observe clinical therapeutic effect of acupuncture for primary trigeminal neuralgia. Methods:136 primary trigeminal neuralgia patients were randomly divided into control group and acupuncture group. Results: TCM acupuncture for primary trigeminal neuralgia achieved a good clinical effect. Conclusion: Acupuncture for primary trigeminal neuralgia is simple and convenient, worthy of promotion.%目的:观察原发性三叉神经痛针灸治疗的临床疗效。方法:136例均为原发性三叉神经痛患者,分为对照组、针刺治疗组。结果:祖国医学针灸治疗原发性三叉神经痛效果明显。结论:针灸治疗原发性三叉神经痛简便易行,值得推广。

  1. Treatment of trigeminal neuralgia with low doses of topiramate Tratamento da neuralgia do trigêmeo com baixas doses de topiramato

    Directory of Open Access Journals (Sweden)

    Renan Barros Domingues

    2007-09-01

    Full Text Available Topiramate was administered to eight patients with classical trigeminal neuralgia with or without previous symptomatic therapy with other antiepileptic drugs. The topiramate doses ranged from 50 to 100 mg a day, according to the clinical response and the reported side effects. Three patients had complete symptoms remission, three reported moderate improvement, and the treatment was not effective in two. The most frequently registered side effects were dizziness, somnolence and weight loss. Topiramate can be considered an alternative treatment for patients with trigeminal neuralgia.Oito pacientes com neuralgia do trigêmeo, com ou sem tratamentos prévios com anticonvulsivantes, foram submetidos a tratamento com topiramato. As doses de topiramato variaram de 50 a 100 mg ao dia, de acordo com a resposta clínica e com os efeitos colaterais relatados. Três pacientes obtiveram remissão completa, três relataram melhora parcial e o tratamento com topiramato foi ineficaz em dois pacientes. Os efeitos colaterais mais frequentemente citados foram tontura, sonolência e perda de peso. O topiramato pode ser considerado uma alternativa potencialmente eficaz para o tratamento de pacientes com neuralgia do trigêmeo.

  2. Research Progress in Animal Models of Trigeminal Neuralgia%三叉神经痛动物模型研究进展

    Institute of Scientific and Technical Information of China (English)

    郑福庆; 柯文海; 苏联彬; 许培均(综述); 罗道枢(审校)

    2015-01-01

    目前三叉神经痛的病因和发病机制尚未明确,导致临床上缺乏有效的治疗措施来解除三叉神经痛患者的口面部剧烈疼痛。理想的三叉神经痛动物模型是其发病机制研究的重要基础。近年来,基于三叉神经痛在临床治疗和基础研究中的重要发现,更多新颖实用的三叉神经痛动物模型被相继提出。这些动物模型具有各自的特点和优势,并分别适用于三叉神经痛发病机制的不同研究方向,从而有力推进了三叉神经痛病因及发病机制的研究进展。%The etiology and pathogenesis of trigeminal neuralgia is unclear, which causes the lack of effective therapeutic measures for the relief of the severe orofacial pain of patients with trigeminal neuralgia. Ideal animal models of trigeminal neuralgia are the important basis for studying of the pathogenesis of trigemi-nal neuralgia. Based on the key discoveries in clinical treatment and basic scientific research of trigeminal neuralgia,more novel and practical animal models of trigeminal neuralgia are put forward consecutively. With their own characteristics and superiorities,these animal models apply to different research aspects of the path-ogenesis for trigeminal neuralgia,boosting the development in the etiology and pathogenesis of trigeminal neu-ralgia.

  3. Pharmacological versus microvascular decompression approaches for the treatment of trigeminal neuralgia: clinical outcomes and direct costs

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    Almeida A

    2011-08-01

    Full Text Available Laurinda Lemos1,2, Carlos Alegria3, Joana Oliveira3, Ana Machado2, Pedro Oliveira4, Armando Almeida11Life and Health Sciences Research Institute (ICVS, School of Health Sciences, Campus de Gualtar, University of Minho, Braga, Portugal; 2Hospital Center of Alto Ave, Unit of Fafe, Fafe, Portugal; 3Department of Neurosurgery, Hospital São Marcos; 4Products and Systems Engineering, Campus de Azurém, University of Minho, Guimarães, PortugalAbstract: In idiopathic trigeminal neuralgia (TN the neuroimaging evaluation is usually normal, but in some cases a vascular compression of trigeminal nerve root is present. Although the latter condition may be referred to surgery, drug therapy is usually the first approach to control pain. This study compared the clinical outcome and direct costs of (1 a traditional treatment (carbamazepine [CBZ] in monotherapy [CBZ protocol], (2 the association of gabapentin (GBP and analgesic block of trigger-points with ropivacaine (ROP (GBP+ROP protocol, and (3 a common TN surgery, microvascular decompression of the trigeminal nerve (MVD protocol. Sixty-two TN patients were randomly treated during 4 weeks (CBZ [n = 23] and GBP+ROP [n = 17] protocols from cases of idiopathic TN, or selected for MVD surgery (n = 22 due to intractable pain. Direct medical cost estimates were determined by the price of drugs in 2008 and the hospital costs. Pain was evaluated using the Numerical Rating Scale (NRS and number of pain crises; the Hospital Anxiety and Depression Scale, Sickness Impact Profile, and satisfaction with treatment and hospital team were evaluated. Assessments were performed at day 0 and 6 months after the beginning of treatment. All protocols showed a clinical improvement of pain control at month 6. The GBP+ROP protocol was the least expensive treatment, whereas surgery was the most expensive. With time, however, GBP+ROP tended to be the most and MVD the least expensive. No sequelae resulted in any patient after drug

  4. Rizotomia trigeminal por radiofrequência para tratamento da neuralgia do trigêmeo: resultados e modificação técnica Trigeminal radiofrequency rhizotomy for the treatment of trigeminal neuralgia: results and technical modification

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    Sebastião Gusmão

    2003-06-01

    Full Text Available O objetivo deste estudo é avaliar a eficácia da rizotomia trigeminal por radiofrequência no tratamento da neuralgia essencial do trigêmeo em 135 pacientes e propor modificação da técnica para guiar a punção do forame oval. Cento e um (74,8% pacientes foram tratados com apenas um procedimento cirúrgico e os 34 (25,2% restantes necessitaram dois procedimentos. O tempo de avaliação pós-operatória variou de 6 meses a 15 anos. O alívio das crises de dor no pós-operatório imediato ocorreu em 131 (97,0% pacientes. Após a realização do primeiro procedimento, houve recorrência em 33 (24,5% pacientes. As complicações incluíram diminuição do reflexo corneano (4,4%, paresia do masseter (2,2%, disestesia dolorosa (1,5% e anestesia dolorosa (0,7%. A rizotomia trigeminal por radiofrequência constitui procedimento minimamente invasivo, de baixo risco e com alta eficácia. O uso da fluoroscopia por tomografia computadorizada torna a punção do forame oval mais fácil, rápida e precisa.The purpose of this study was to evaluate the efficacy of radiofrequency trigeminal rhizotomy in treating 135 patients harboring trigeminal neuralgia, and to introduce a technical modification to guide the puncture of the foramen ovale. A hundred and one (74.8% patients were treated with a single surgical procedure whereas the 34 (25.2% remaining patients required two procedures. Follow-up ranges from 6 months to 15 years. Pain relief in the immediate postoperative was achieved in 131 (97.0% patients. After the initial procedure, recurrence happened in 33 (24.5% patients. The complications included decrease corneal reflex (4.4%, masseter paresis (2.2%, painful dysesthesia (1.5% and anesthesia dolorosa (0.7%. The radiofrequency trigeminal rizhotomy is a low risk, highly effective and minimally invasive procedure. The use of the computerized tomography guided fluoroscopy turns foramen ovale's puncture easier, fast and precise.

  5. MRI 3D CISS– A Novel Imaging Modality in Diagnosing Trigeminal Neuralgia – A Review

    Science.gov (United States)

    Besta, Radhika; Shankar, Y. Uday; Kumar, Ashwini; Prakash, S. Bhanu

    2016-01-01

    Trigeminal Neuralgia (TN) is considered as one of the most painful neurologic disorders affecting oro-facial region. TN is often diagnosed clinically based on the patients complete history of pain (severity, duration, episodes etc), relief of pain on test dose of Carbamazepine, regional block of long acting anaesthetic. However, Magnetic Resonance Imaging (MRI) plays an important and confirmatory role in showing Neuro Vascular Conflict (NVC) which is the commonest causative factor for TN. This article reviews the effectiveness of three-dimensional constructive interference in steady-state (3D-CISS) MRI in diagnosing the exact location, degree of neurovascular conflict responsible for classical as well as atypical TN and possible pre-treatment evaluation and treatment outcome. PMID:27135019

  6. CLINICAL STUDY ON TREATMENT OF TRIGEMINAL NEURALGIA BY NEEDLING MENTAL AND MANDIBULAR FORAMINA

    Institute of Scientific and Technical Information of China (English)

    董宇翔; 韩春霞; 张二力

    2001-01-01

    In the present paper, 126 patients with neuralgia involving the mandibular branch of trigeminal nerve were treated mainly by puncturing the mental foramen and the mandibular foramen. The two foramina are both located in the focus through which the Stomach Channel of Foot-Yangming passes. Among the 126 patients, 42 were attributed to the light type, 61 to the moderate type one and the other 23 to serious type. Acupuncture treatment was given once daily, 30 min every time, with 10 days being a therapeutic course. After 3 courses of treatment, results showed that 29 (69.1%) light-type cases, 35(57.4%) moderate-type cases and 6 (26.1%) serious-type cases were cured. It displays that the less serious the symptom, the higher is the cure rate, and the shorter the duration of disease, the better is the therapeutic effect.

  7. Drug-Induced Hypersensitivity Syndrome Caused by Carbamazepine Used for the Treatment of Trigeminal Neuralgia

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    Yuko Ono

    2016-01-01

    Full Text Available An 88-year-old man was diagnosed with trigeminal neuralgia, and treatment of carbamazepine 200 mg/day was initiated. About 6 weeks later, the patient developed a skin rash accompanied by fever. He was admitted to hospital and diagnosed with drug-induced hypersensitivity syndrome (DIHS caused by carbamazepine. Oral carbamazepine treatment was stopped, but blood tests showed acute liver and acute renal failure. Drug-induced lymphocyte stimulation test (DLST for carbamazepine, human herpes virus-6 (HHV-6 IgG, and CMV-HRP were negative. Oral prednisolone therapy was begun 18 days later. The titer of HHV-6 IgG antibodies was then detected (640 times. Following treatment, liver and renal function improved and the erythema disappeared.

  8. Computed tomography-guided percutaneous radiofrequency thermocoagulation for primary trigeminal neuralgia in older and younger patients

    Institute of Scientific and Technical Information of China (English)

    Guanghui Lai; Jiaxiang Ni; Baishan Wu; Mingwei He; Liqiang Yang; Jianning Yue; Yuna Guo

    2011-01-01

    We evaluated the immediate and long-term clinical efficacy of computed tomography (CT)-guided radiofrequency thermocoagulation for primary trigeminal neuralgia (RTPTN) in 852 patients includ-ing 502 patients aged ≥ 60 years and 350 patients aged < 60 years. After discharge, the incidence of complications was 1.0% and 0.9% in patients aged ≥ 60 years and patients aged < 60 years, respectively. Over 3-year follow-up after CT-guided RTPTN, 96.8% of the patients aged ≥ 60 years and 98.6% of the patients aged < 60 years were completely pain-free, and there was no significant difference between these two age brackets. In addition, there were no significant differences in quality of life scores and numbness scores between these two age brackets. These findings suggest that CT-guided RTPTN is a safe and effective method and is recommended for older and poor-risk patients.

  9. 继发于脑积水的三叉神经痛%Trigeminal neuralgia secondary to hydrocephalus

    Institute of Scientific and Technical Information of China (English)

    刘江; 于炎冰; 赵曙虹; 张黎; 赵奎明; 徐晓利; 刘红举; 张哲; 袁越

    2015-01-01

    Objective To explore the clinical characteristics,pathogenesis,surgical treatment and efficacy of rare trigeminal neuralgia secondary to hydrocephalus.Methods Five patients with trigeminal neuralgia secondary to hydrocephalus were analyzed retrospectively from January 2009 to July 2013.The MRI of brain showed hydrocephalus with Chiari's malformation in 1 case,and significant expansion of the lateral ventricle accompanying with normal morphology of the fourth ventricle in the other four cases.All patients underwent ventriculoperitoneal shunting (VPs).Results Trigeminal neuralgia was completely disappeared in these five patients:the facial pain disappeared immediately in 2 patients and disappeared after 3 days with VPs in 3 patients.There was no surgical complication.During follow-up,the ventricular system returned to normal,without recurrence of trigeminal neuralgia.Conclusions Trigeminal neuralgia secondary to hydrocephalus was rare.Surgical treatment of hydrocephalus might be the first choice of treatment for trigeminal neuralgia with hydrocephalus.%目的 探讨临床少见的继发于幕上脑积水的三叉神经痛的发病机制、临床特点、治疗方式和疗效.方法 回顾性分析2009年1月2013年7月中日友好医院收治的5例继发于脑积水的三叉神经痛患者,其中1例脑积水合并Chiari's畸形,另4例头颅MRI示幕上脑室系统明显扩张而第四脑室形态基本正常,均行脑室-腹腔分流术.结果 本组5例患者术后三叉神经痛症状完全消失,2例患者脑室腹腔分流术后面部疼痛立即消失,另3例患者面部疼痛均在3d之内消失,无手术并发症.随访期间所有患者脑室系统均恢复正常,三叉神经痛症状无复发.结论 继发于脑积水的三叉神经痛临床上罕见,对于合并脑积水的三叉神经痛患者可首先进行脑积水的外科治疗.

  10. Treatments’ Outcomes of Patients Suffered from Trigeminal Neuralgia in Kerman, Iran

    Directory of Open Access Journals (Sweden)

    Javad Faryabi

    2014-09-01

    Full Text Available Statement of the Problem: Trigeminal neuralgia (TN presents with a shooting pain in maxillofacial region which compels the involved patients to visit many medical and dental physicians to relieve the pain. Hence, assessing the outcomes of different treatment modalities may help the patients and their clinicians choose a suitable practical method of treatment. Purpose: The study was aimed to evaluate the outcomes of different treatments of TN and to determine which surgical or non-surgical treatment is better for controlling the pain. Materials and Method: This study included 42 patients with trigeminal neuralgia. A questionnaire was completed for each patient in order to evaluate the pain control status of patients’ treatment with non-surgical (pharmaceutical and surgical modalities. The questionnaire consisted of questions on an datasheet, concerning the duration of involvement with the condition, type and dose of the medication(s used, the surgical technique administrated, patient satisfaction with the treatment modality and the intensity and frequency of the pain if present. The purpose of the study and the necessary information regarding the questions of the data sheet was given in detail to the patients for a careful completion of the ques-tionnaires. Data was analyzed by adopting t-test using SPSS software. Results: The results showed that the patients treated with pharmaceutical modalities had relatively lower improvement rate than those treated with surgery combined with medication (p< 0.035. Carbamazepine was the most consumed medication for pain control and the microvascular decompression was the most performed surgical method in patients. Conclusion: Although medication therapy alone was less effective than surgery combined with medication, both treatment modalities were significantly effective in controlling the pain of patients.

  11. Percutaneous balloon compression for primary trigeminal neuralgia in patients older than 80 years

    Institute of Scientific and Technical Information of China (English)

    Yuanfeng Du; Qiao Gu; Dingbo Yang; Xiaoqiao Dong; Quan Du; Hao Wang; Wenhua Yu

    2015-01-01

    Background: It has been demonstrated that the incidence of trigeminal neuralgia in elderly patients is higher and thus, neurosurgeons often encounter elderly patients with this disorder.However, for those with poor basic condition, the optimal surgical treatment remains controversial.In this study, the authors aimed to evaluate the safety and efficacy of percutaneous balloon compression (PBC) for primary trigeminal neuralgia in elderly patients older than 80 years.Methods: From September 2009 to March 2013, a total of 68 patients older than 80 years underwent PBC, and a retrospective study of the clinical data of these patients was performed.Results: After PBC, pain relief was immediate in 66 (97.0 %) patients, 1 (1.5 %) patient had no pain relief, and 1 (1.5 %) patient had some pain that could be controlled with medication.With a mean length of follow-up of 40.1 months, ranging from 24 to 66 months after surgery, 55 (80.9 %) patients were still pain free.Of the 11 patients with recurrence, 9 cases had mild recurrence and 2 cases suffered severe recurrence.The mean time to recurrence was 18.9 months (1-64 months).Postoperative morbidity included common side effects such as facial numbness in 66 (97.1%) patients, masseter muscle weakness in 19 (27.9 %) patients, paresthesia in 7 (10.3 %) patients, and diplopia secondary to abducens nerve weakness in 1 (1.5 %) patient.No corneal anesthesia, subarachnoid hemorrhage, or other serious surgical complications occurred in this study.Conclusions: In this study, the authors reviewed data on a cohort of patient older than 80 years.The PBC procedure has advantages in that it is minimally invasive, safe, effective, and could be performed under general anesthesia.This makes it an optimized choice for elderly patients.

  12. Quantitative assessment of sensory functions after 3 surgical approaches for trigeminal neuralgia by current perception threshold measurement

    Institute of Scientific and Technical Information of China (English)

    Chen Ruoping; Ouyang Huoniu; Wang Bingyu; Ding Meixiu; Charles J. Hodge Jr.

    2008-01-01

    Objective: To quantitatively identify and grade trigeminal sensory functions after 3 major surgical procedures of trigeminal neuralgia using a newly developed quantitative sensory testing technique, current perception threshold measurement (CPTM). Methods: In the current study, there were 48 trigeminal neuralgia patients without history of prior surgical treatment. These patients received one of the following 3 surgical procedures, microvascular decompression (MVD), peripheral nerve block with alcohol (PNB), or percutaneous radiofrequency thermocoagulation (PRFT). The quantitative sensory testing measurement, CPTM, and conventional qualitative sensory testing measurements were performed preoperatively and postoperatively to evaluate and grade the trigeminal sensory functions.All 3 major cutaneous sensory fiber types, large myelinated fibers (A beta), small myelinated fibers (A delta) and unmyelinated fibers(C) were allowed to quantitatively evaluate and grade by CPTM. The results of the measurements were statistically analyzed using a one-way analysis of variance (single factor). Each subject was his/her own control for comparison of the preoperative to postoperative state on the asymptomatic and symptomatic sides. Subjects were tested 48 h preoperatively and 4 weeks postoperatively. Results: PNB with alcohol and PRFT caused significant sensory dysfunction postoperatively in every fiber type, indicating damage to all fibers. On the contrary, the sensory function in all 3 fiber types was unchanged after MVD management. Conclusion: Among the 3 major surgical procedures tested,only MVD preserves sensory function in trigeminal system. CPTM is of quantitative nature on the evaluation of sensory functions of nerve fibers

  13. Association between neurovascular contact on MRI and response to gamma knife radiosurgery in trigeminal neuralgia.

    Science.gov (United States)

    Erbay, Sami H; Bhadelia, Rafeeque A; Riesenburger, Ron; Gupta, Punita; O'Callaghan, Mark; Yun, Eric; Oljeski, Steven

    2006-01-01

    Treatment with gamma knife radiosurgery (GKRS) provides adequate short-term pain control in about 70% of the patients with intractable trigeminal neuralgia (TN). The purpose of our study was to evaluate whether the presence of neurovascular contact (NVC) at the root entry zone of the trigeminal nerve on pre-gamma knife MR imaging predicts an increased likelihood of an adequate response to GKRS. We studied 40 consecutive patients who underwent GKRS for treatment of intractable TN. Two neuroradiologists blinded to the side of symptoms analyzed pre-treatment constructive interference in steady state (CISS) images to determine the presence of NVC by consensus. An adequate response was defined as freedom from pain with or without reduced need for medical therapy. Adequate short-term response to GKRS was seen in 29 (72.5%) of 40 patients. NVC was seen in 30 of the 40 patients. Twenty-five (83.3%) of 30 patients with NVC had adequate short-term response to GKRS. Only four (40%) of the 10 patients without NVC had adequate response to GKRS (X2=7.06; PNVC were seven times more likely to have an adequate response to GKRS than those without NVC (odds ratio =7.5).The presence of NVC on pre-treatment MR imaging predicts an increased likelihood of an adequate response to GKRS.

  14. ANALYSIS ON THE THERAPEUTIC EFFECT OF ACUPUNCTURE TREATMENT OF 2656CASES OF PRIMARY TRIGEMINAL NEURALGIA

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    In the present paper,the clinical therapeutic effect of acupuncture therapy for treat-ment of primary prosopalgia was observed and its influencing factors were analyzed in 2656 patients.Yuyao(EX-HN4),Touwei(ST8),Sibai(ST2),Quanliao(SI18),Xiaguan(ST7)and Ji-achengjiang were punctured selectively according to the involvement of different branches of the trigeminal nerve.After treatment,of the 2656cases,the trigeminal neuralgia disappeared in 1469(55.31),727(27.37%)had marked improvement,430(16.19%)had improvement and 30(1.13%)had no any significant effect.The three years'follow-up visit in 245cases showed a relapse in 187cases(76.3%).We think that the therapeutic effect is closely related to the needling manipula-tions.Only when an electric shock-like needing sensation appeared(i.e.“qi reaching th affected area”)after inserting the acupuncture needle into the chief acupoints,a better therapeutic effect would be achived.

  15. Progressive Intracranial Vertebral Artery Dissection Presenting with Isolated Trigeminal Neuralgia-Like Facial Pain.

    Science.gov (United States)

    Nakamizo, Tomoki; Koide, Takashi; Miyazaki, Hiromichi

    2015-01-01

    Intracranial vertebral artery dissection (IVAD) is a potentially life-threatening disease, which usually presents with ischemic stroke or subarachnoid hemorrhage. IVAD presenting with isolated facial pain is rare, and no case with isolated trigeminal neuralgia- (TN-) like facial pain has been reported. Here, we report the case of a 57-year-old male with IVAD who presented with acute isolated TN-like facial pain that extended from his left cheek to his left forehead and auricle. He felt a brief stabbing pain when his face was touched in the territory of the first and second divisions of the left trigeminal nerve. There were no other neurological signs. Magnetic resonance imaging (MRI) of the brain 7 days after onset revealed dissection of the left intracranial vertebral artery without brain infarction. The pain gradually disappeared in approximately 6 weeks, and the patient remained asymptomatic thereafter, except for a brief episode of vertigo. Follow-up MRI revealed progressive narrowing of the artery without brain infarction. This case indicates that IVAD can present with isolated facial pain that mimics TN. IVAD should be considered in the differential diagnosis of acute facial pain or TN.

  16. The optimal radiofrequency temperature in radiofrequency thermocoagulation for idiopathic trigeminal neuralgia

    Science.gov (United States)

    Tang, Yuan-Zhang; Yang, Li-Qiang; Yue, Jian-Ning; Wang, Xiao-Ping; HE, Liang-Liang; NI, Jia-Xiang

    2016-01-01

    Abstract Objective: Our previous study evaluated the effectiveness and safety of radiofrequency thermocoagulation (RFT) of trigeminal gasserian ganglion for idiopathic trigeminal neuralgia (ITN). The aim of this study was to evaluate the optimal radiofrequency temperature of computed tomography (CT)-guided RFT for treatment of ITN. Methods: A retrospective study of patients with ITN treated with a single CT-guided RFT procedure between January 2002 and December 2013. Patients were divided into ≤75 °C, 75 °C, and ≥80 °C groups according to the highest radiofrequency temperature used. Pain relief was graded from poor to excellent, and facial numbness/dysesthesia from I (absent) to IV (most severe). Results: A total of 1161 RFT procedures were undertaken in the 1137 patients. The mean follow-up time was 46 ± 31 months. There were no significant differences in the rate of excellent pain relief according to the radiofrequency temperature used. However, more patients experienced with no facial numbness or facial numbness gradually resolved and those patients treated at 75 °C had a lower rate of grade IV facial numbness/dysesthesia than other groups. Conclusions: The optimal radiofrequency temperature to maximize pain relief and minimize facial numbness or dysesthesia may be 75 °C, but this requires confirmation. PMID:27428194

  17. Progressive Intracranial Vertebral Artery Dissection Presenting with Isolated Trigeminal Neuralgia-Like Facial Pain

    Directory of Open Access Journals (Sweden)

    Tomoki Nakamizo

    2015-01-01

    Full Text Available Intracranial vertebral artery dissection (IVAD is a potentially life-threatening disease, which usually presents with ischemic stroke or subarachnoid hemorrhage. IVAD presenting with isolated facial pain is rare, and no case with isolated trigeminal neuralgia- (TN- like facial pain has been reported. Here, we report the case of a 57-year-old male with IVAD who presented with acute isolated TN-like facial pain that extended from his left cheek to his left forehead and auricle. He felt a brief stabbing pain when his face was touched in the territory of the first and second divisions of the left trigeminal nerve. There were no other neurological signs. Magnetic resonance imaging (MRI of the brain 7 days after onset revealed dissection of the left intracranial vertebral artery without brain infarction. The pain gradually disappeared in approximately 6 weeks, and the patient remained asymptomatic thereafter, except for a brief episode of vertigo. Follow-up MRI revealed progressive narrowing of the artery without brain infarction. This case indicates that IVAD can present with isolated facial pain that mimics TN. IVAD should be considered in the differential diagnosis of acute facial pain or TN.

  18. A prospective study of 39 patients with trigeminal neuralgia treated with percutaneous balloon compression

    Directory of Open Access Journals (Sweden)

    Wuilker Knoner Campos

    2011-04-01

    Full Text Available OBJECTIVE: Trigeminal neuralgia is the most common facial pain. It may be treated with percutaneous balloon compression (PBC, which is considered to be a safe and efficient procedure. The purpose of this study was to review our results with PBC and to assess the factors influencing the outcome. METHOD: A multivariate analysis was used to study 39 patients during a 50-month postoperative period. RESULTS: There was predominance of the female gender (54%, the right side of the face (84% and V2V3 roots of trigeminal nerve (33%. The mean age was 62.3 years. No major complications or deaths occurred. Among all variables, postoperative hypoesthesia was the single prognostic factor capable of positively influencing the results (p=0.02. Most patients (80% were pain-free after 50 months with a 90% satisfaction rate. CONCLUSION: PBC was a safe procedure with low morbidity, no mortality, high approval ratings, and was an important improving on patients' quality of life.

  19. Association between neurovascular contact on MRI and response to gamma knife radiosurgery in trigeminal neuralgia

    Energy Technology Data Exchange (ETDEWEB)

    Erbay, Sami H.; Bhadelia, Rafeeque A.; Gupta, Punita; O' Callaghan, Mark; Yun, Eric; Oljeski, Steven [Tufts-New England Medical Center, Department of Radiology, Boston, MA (United States); Riesenburger, Ron [Tufts-New England Medical Center, Department of Neurosurgery, Boston, MA (United States)

    2006-01-01

    Treatment with gamma knife radiosurgery (GKRS) provides adequate short-term pain control in about 70% of the patients with intractable trigeminal neuralgia (TN). The purpose of our study was to evaluate whether the presence of neurovascular contact (NVC) at the root entry zone of the trigeminal nerve on pre-gamma knife MR imaging predicts an increased likelihood of an adequate response to GKRS.We studied 40 consecutive patients who underwent GKRS for treatment of intractable TN. Two neuroradiologists blinded to the side of symptoms analyzed pre-treatment constructive interference in steady state (CISS) images to determine the presence of NVC by consensus. An adequate response was defined as freedom from pain with or without reduced need for medical therapy. Adequate short-term response to GKRS was seen in 29 (72.5%) of 40 patients. NVC was seen in 30 of the 40 patients. Twenty-five (83.3%) of 30 patients with NVC had adequate short-term response to GKRS. Only four (40%) of the 10 patients without NVC had adequate response to GKRS (X{sup 2}=7.06; P<0.01). Patients with NVC were seven times more likely to have an adequate response to GKRS than those without NVC (odds ratio =7.5).The presence of NVC on pre-treatment MR imaging predicts an increased likelihood of an adequate response to GKRS. (orig.)

  20. Quantitative sensory testing in classical trigeminal neuralgia-a blinded study in patients with and without concomitant persistent pain

    DEFF Research Database (Denmark)

    Younis, Samaira; Maarbjerg, Stine; Reimer, Maren

    2016-01-01

    The diagnostic criteria of the third International Classification of Headache Disorders state that there should be no neurological deficits in patients with classical trigeminal neuralgia (TN) at clinical examination. However, studies demonstrating sensory abnormalities at bedside examination in TN...... scores were calculated to process frequency analyses and Z-profiles. We found increased mechanical detection threshold on the symptomatic side (47.2% vs 0%, P = 0.008), asymptomatic side (33.3% vs 0%, P = 0.011), and hand (36% vs 0%, P ... increased mechanical detection threshold on the symptomatic side compared with the asymptomatic side (-2.980 vs -2.166, P = 0.040). Thermal and mechanical hyperalgesia was detected bilaterally in the face and the hand. Trigeminal neuralgia patients with concomitant persistent pain tended to have higher mean...

  1. 针刺阳明经治疗三叉神经痛探微%Analysis of acupuncture for treatment of trigeminal neuralgia Yangming Meridian

    Institute of Scientific and Technical Information of China (English)

    高洁; 刘欢; 宋卓原; 江学勤

    2015-01-01

    三叉神经痛是最常见的面部神经痛,其发病机制尚不明确,治疗方式复杂多样。近年来针灸治疗三叉神经痛是临床关注的热点之一,且有着不可忽视的作用。但目前有取穴原则杂乱不规律的现象。文章从三叉神经痛的含义、病机及机制来分析针刺阳明经在治疗三叉神经痛的重要作用,以期针灸治疗三叉神经痛更加合理,从而提高临床疗效。%Trigeminal neuralgia is the most common facial neuralgia,its pathogenesis is not clear,and the complex and varied treatments.Acupuncture treatment of trigeminal neuralgia in recent years,having the effect that cannot ignore,but find out the princi-ple of irregular mixed and disorderly.This article from the meaning of trigeminal neuralgia,pathogenesis and mechanism to analyze ac-upuncture the Yangming Meridian play the important role in the treatment of trigeminal neuralgia.In the hope of acupuncture treatment of trigeminal neuralgia is more reasonable,improve the clinical curative effect.

  2. Proposal for evaluating the quality of reports of surgical interventions in the treatment of trigeminal neuralgia: the Surgical Trigeminal Neuralgia Score.

    Science.gov (United States)

    Akram, Harith; Mirza, Bilal; Kitchen, Neil; Zakrzewska, Joanna M

    2013-09-01

    The aim of this study was to design a checklist with a scoring system for reporting on studies of surgical interventions for trigeminal neuralgia (TN) and to validate it by a review of the recent literature. A checklist with a scoring system, the Surgical Trigeminal Neuralgia Score (STNS), was devised partially based on the validated STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) criteria and customized for TN after a literature review and then applied to a series of articles. These articles were identified using a prespecified MEDLINE and Embase search covering the period from 2008 to 2010. Of the 584 articles found, 59 were studies of interventional procedures for TN that fulfilled the inclusion criteria and 56 could be obtained in full. The STNS was then applied independently by 3 of the authors. The maximum STNS came to 30, and was reliable and reproducible when used by the 3 authors who performed the scoring. The range of scores was 6-23.5, with a mean of 14 for all the journals. The impact factor scores of the journals in which the papers were published ranged from 0 to 4.8. Twenty-four of the studies were published in the Journal of Neurosurgery or in Neurosurgery. Studies published in neurosurgical journals ranked higher on the STNS scale than those published in nonneurosurgical journals. There was no statistically significant correlation between STNS and impact factors. Stereotactic radiosurgery (n = 25) and microvascular decompression (n = 15) were the most commonly reported procedures. The diagnostic criteria were stated in 35% of the studies, and 4 studies reported subtypes of TN. An increasing number of studies (46%) used the recommended Kaplan-Meier methodology for pain survival outcomes. The follow-up period was unclear in 8 studies, and 26 reported follow-ups of more than 5 years. Complications were reported fairly consistently but the temporal course was not always indicated. Direct interview, telephone conversation

  3. 三叉神经痛微创治疗进展%Advances in minimally invasive treatment of trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    贺轲渝

    2014-01-01

    三叉神经痛(trigeminal neuralgia,TN)是临床上最常见的神经病理性疼痛.为进一步了解当前可能有效的治疗措施,促进患者预后的改善,为临床提供可参考的研究证据,本文综述了各种微创手段治疗TN的研究进展.

  4. To Discuss Treatment Experience of Trigeminal Neuralgia%浅析三叉神经痛的治疗体会

    Institute of Scientific and Technical Information of China (English)

    马洪梅

    2015-01-01

    目的:探讨三叉神经痛的治疗体会。方法对2011年~2012年我院收治的54例三叉神经痛患者进行回顾性资料分析。结果54例患者中得到缓解的53例,无效的有1例。结论目前尚无治疗三叉神经痛的特效药,临床上采用多种药物联合治疗。%Objective To investigate the treatment of trigeminal neuralgia. Methods Data of 54 cases of trigeminal neuralgia patients in our hospital from 2011 to 2012 were retrospectively analyzed.Results 53 cases got remission and one case was invalid. Conclusion There is no cure for the treatment of trigeminal neuralgia and a variety of drug combination therapy is used in clinical practice.

  5. Do Carbamazepine, Gabapentin, or Other Anticonvulsants Exert Sufficient Radioprotective Effects to Alter Responses From Trigeminal Neuralgia Radiosurgery?

    Energy Technology Data Exchange (ETDEWEB)

    Flickinger, John C. [Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States); College of Arts and Sciences, University of Pittsburgh, Pittsburgh, PA (United States); Kim, Hyun [Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States); Kano, Hideyuki [Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States); Greenberger, Joel S.; Arai, Yoshio [Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States); Pittsburgh Cancer Institute, Pittsburgh, PA (United States); Niranjan, Ajay [Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States); Lunsford, L. Dade; Kondziolka, Douglas [Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States); Pittsburgh Cancer Institute, Pittsburgh, PA (United States); Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States); Flickinger, John C., E-mail: flickingerjc@upmc.edu [Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States); Pittsburgh Cancer Institute, Pittsburgh, PA (United States); Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States)

    2012-07-15

    Purpose: Laboratory studies have documented radioprotective effects with carbamazepine. We sought to determine whether carbamazepine or other anticonvulsant/neuroleptic drugs would show significant radioprotective effects in patients undergoing high-dose small-volume radiosurgery for trigeminal neuralgia. Methods and Materials: We conducted a retrospective review of 200 patients undergoing Gamma Knife (Elekta Instrument AB, Stockholm, Sweden) stereotactic radiosurgery for trigeminal neuralgia between February 1995 and May 2008. We selected patients treated with a maximum dose of 80 Gy with 4-mm diameter collimators, with no previous microvascular decompression, and follow-up {>=}6 months (median, 24 months; range, 6-153 months). At the time of radiosurgery, 28 patients were taking no anticonvulsants, 62 only carbamazepine, 35 only gabapentin, 21 carbamazepine plus gabapentin, 17 carbamazepine plus other anticonvulsants, and 9 gabapentin plus other anticonvulsants, and 28 were taking other anticonvulsants or combinations. Results: Pain improvement developed post-radiosurgery in 187 of 200 patients (93.5%). Initial complete pain relief developed in 84 of 200 patients (42%). Post-radiosurgery trigeminal neuropathy developed in 27 of 200 patients (13.5%). We could not significantly correlate pain improvement or initial complete pain relief with use of carbamazepine, gabapentin, or use of any anticonvulsants/neuroleptic drugs or other factors in univariate or multivariate analysis. Post-radiosurgery numbness/paresthesias correlated with the use of gabapentin (1 of 36 patients with gabapentin vs. 7 of 28 without, p = 0.017). In multivariate analysis, decreasing age, purely typical pain, and use of gabapentin correlated (p = 0.008, p = 0.005, and p = 0.021) with lower risks of developing post-radiosurgery trigeminal neuropathy. New post-radiosurgery numbness/paresthesias developed in 3% (1 of 36), 5% (4 of 81), and 13% (23 of 187) of patients on gabapentin alone, with age

  6. Do carbamazepine, gabapentin, or other anticonvulsants exert sufficient radioprotective effects to alter responses from trigeminal neuralgia radiosurgery?

    Science.gov (United States)

    Flickinger, John C; Kim, Hyun; Kano, Hideyuki; Greenberger, Joel S; Arai, Yoshio; Niranjan, Ajay; Lunsford, L Dade; Kondziolka, Douglas; Flickinger, John C

    2012-07-15

    Laboratory studies have documented radioprotective effects with carbamazepine. We sought to determine whether carbamazepine or other anticonvulsant/neuroleptic drugs would show significant radioprotective effects in patients undergoing high-dose small-volume radiosurgery for trigeminal neuralgia. We conducted a retrospective review of 200 patients undergoing Gamma Knife (Elekta Instrument AB, Stockholm, Sweden) stereotactic radiosurgery for trigeminal neuralgia between February 1995 and May 2008. We selected patients treated with a maximum dose of 80 Gy with 4-mm diameter collimators, with no previous microvascular decompression, and follow-up ≥6 months (median, 24 months; range, 6-153 months). At the time of radiosurgery, 28 patients were taking no anticonvulsants, 62 only carbamazepine, 35 only gabapentin, 21 carbamazepine plus gabapentin, 17 carbamazepine plus other anticonvulsants, and 9 gabapentin plus other anticonvulsants, and 28 were taking other anticonvulsants or combinations. Pain improvement developed post-radiosurgery in 187 of 200 patients (93.5%). Initial complete pain relief developed in 84 of 200 patients (42%). Post-radiosurgery trigeminal neuropathy developed in 27 of 200 patients (13.5%). We could not significantly correlate pain improvement or initial complete pain relief with use of carbamazepine, gabapentin, or use of any anticonvulsants/neuroleptic drugs or other factors in univariate or multivariate analysis. Post-radiosurgery numbness/paresthesias correlated with the use of gabapentin (1 of 36 patients with gabapentin vs. 7 of 28 without, p = 0.017). In multivariate analysis, decreasing age, purely typical pain, and use of gabapentin correlated (p = 0.008, p = 0.005, and p = 0.021) with lower risks of developing post-radiosurgery trigeminal neuropathy. New post-radiosurgery numbness/paresthesias developed in 3% (1 of 36), 5% (4 of 81), and 13% (23 of 187) of patients on gabapentin alone, with age ≤70 years, and Type 1 typical

  7. Trigeminal nerve block with alcohol for medically intractable classic trigeminal neuralgia: long-term clinical effectiveness on pain

    Science.gov (United States)

    Han, Kyung Ream; Chae, Yun Jeong; Lee, Jung Dong; Kim, Chan

    2017-01-01

    Background: Trigeminal nerve block (Tnb) with alcohol for trigeminal neuralgia (TN) may not be used widely as a percutaneous procedure for medically intractable TN in recent clinical work, because it has been considered having a limited duration of pain relief, a decrease in success rate and increase in complications on repeated blocks. Objectives: To evaluate the clinical outcome of the Tnb with alcohol in the treatment of medically intractable TN. Methods: Six hundred thirty-two patients were diagnosed with TN between March 2000 and February 2010. Four hundred sixty-five out of 632 underwent Tnb with alcohol under a fluoroscope. Pain relief duration were analyzed and compared in the individual branch blocks. Outcomes were compared between patients with and without a previous Tnb with alcohol. Results: Tnb with alcohol were performed in a total 710 (1st-465, 2nd-155, 3rd-55, 4th-23, 5th-8, 6th-4) cases for a series of consecutive 465 patients during the study period. Forty hundred sixty two out of the 465 patients experienced immediate complete pain relief (99%) at the first Tnb. Of the 465 patients, 218 patients (46.9%) did not require any further treatment after the first Tnb with alcohol during an entire study period. One hundred fifty nine (34.2 %) out of the 465 patients experienced recurring pain after the first block, among whom 155 patients received subsequent blocks, and the remaining 4 patients decided to take medication. According to the Kaplan-Meier analysis, the probabilities of remaining pain relief for 1, 2, 3, and 5 years after the procedures were 86.2%, 65.5%, 52.5%, and 33.4%, respectively. There was no significant difference in the probability of pain relief duration between patients with and without previous Tnb with alcohol. Median (95% CI) pain relief durations of the first and repeated blocks were 39 (36-51) and 37 (28-54) months, respectively. There was no significant difference in occurrence of complications between patients with and

  8. Early response to medical treatment of trigeminal neuralgia in a Nigerian population

    Directory of Open Access Journals (Sweden)

    Osawe Felix Omoregie

    2015-01-01

    Full Text Available Background: This study evaluates the clinical profile of patients suffering from trigeminal neuralgia (TN and correlates the findings with early response of the patients to medical treatment. Patients and Methods: A 4-year prospective study in which patients diagnosed of TN were treated medically and followed up weekly for 8 weeks to determine early treatment outcome, in the University of Benin Teaching Hospital, Benin City, Nigeria. Results: Of the 287 patients seen during the study period, a total of 14 (4.9% patients were diagnosed of TN. Thirteen (4.5% of the cases were selected based on compliance to the 8-week follow-up visits, consisting of 8 (61.5% males and 5 (38.5% females, giving a ratio of 1.6:1. The mean age of the patients was 50±1.5 years. The mandibular (n = 6, 46.2% and maxillary (n = 5, 38.5% divisions of the trigeminal nerve were mostly affected. The lesion was slightly more common on the right side of the face (n = 7, 53.8% than the left side (n = 6, 46.2%. Talking (n=4, 30.8% and chewing (n = 3, 23.1% were the most frequent trigger factors. The patients mostly described the pain as severe, spontaneous, and sharp (n = 5, 38.2%. Most patients became stable on tablets carbamazepine 200 mg 12 hourly, folic acid 5 mg daily, and phenytoin 100 mg daily. Good response was observed in most patients within 2 weeks (n = 6, 46.2% of medical treatment, especially in patients at the seventh decade of age (n = 3, 23.1% and those with lesions involving the mandibular division of the trigeminal nerve (n = 3, 23.1%. Conclusion: This study shows early response of TN to medical treatment. We recommend combination therapy of carbamazepine and folic acid in the treatment of patients, especially elderly patients with lesions involving the mandibular division of the trigeminal nerve.

  9. Neural interconnections between portio minor and portio major at the porus trigeminus: application to failed surgical treatment of trigeminal neuralgia.

    Science.gov (United States)

    Tubbs, R Shane; Griessenauer, Christoph J; Hogan, Elizabeth; Loukas, Marios; Cohen-Gadol, Aaron A

    2014-01-01

    Recalcitrant trigeminal neuralgia following surgical treatment can be a life-altering condition. To explore alternative anatomic reasons for such a complication, the authors examined the potential for nerve connections between the sensory and motor roots of the trigeminal nerve at the opening of Meckel's cave (porus trigeminus). In 15 embalmed adult cadavers (30 sides), the authors performed microdissection of the skull base and specifically at the opening of Meckel's cave. Two sides (6.67%) were found to have interneural connections between the sensory and motor roots at Meckel's cave. These occurred in one male and one female cadaver, both on right sides. Both connections were histologically verified to be neural and were 0.5 mm in diameter and 2.2 and 3.2 mm in length, respectively. Both connections traveled in an oblique fashion from the portio major to the portio minor. On the basis of authors' findings, the sensory and motor components of the trigeminal nerve at the opening of Meckel's cave may be interconnected with a neural anastomosis. Such findings may be of use during the surgical treatment of trigeminal neuralgia or other surgery of the posterior fossa so that inadvertent transection or traction does not occur.

  10. Repeat Gamma-Knife Radiosurgery for Refractory or Recurrent Trigeminal Neuralgia with Consideration About the Optimal Second Dose.

    Science.gov (United States)

    Park, Seong-Cheol; Kwon, Do Hoon; Lee, Do Hee; Lee, Jung Kyo

    2016-02-01

    To investigate adequate radiation doses for repeat Gamma Knife radiosurgery (GKS) for trigeminal neuralgia in our series and meta-analysis. Fourteen patients treated by ipsilateral repeat GKS for trigeminal neuralgia were included. Median age of patients was 65 years (range, 28-78), the median target dose, 140-180). Patients were followed a median of 10.8 months (range, 1-151) after the second gamma-knife surgery. Brainstem dose analysis and vote-counting meta-analysis of 19 studies were performed. After the second gamma-knife radiosurgeries, pain was relieved effectively in 12 patients (86%; Barrow Neurological Institute Pain Intensity Score I-III). Post-gamma-knife radiosurgery trigeminal nerve deficits were mild in 5 patients. No serious anesthesia dolorosa was occurred. The second GKS radiation dose ≤ 60 Gy was significantly associated with worse pain control outcome (P = 0.018 in our series, permutation analysis of variance, and P = 0.009 in the meta-analysis, 2-tailed Fisher's exact test). Cumulative dose ≤ 140-150 Gy was significantly associated with poor pain control outcome (P = 0.033 in our series and P = 0.013 in the meta-analysis, 2-tailed Fisher's exact test). A cumulative brainstem edge dose >12 Gy tended to be associated with trigeminal nerve deficit (P = 0.077). Our study suggests that the second GKS dose is a potentially important factor. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Sensorimotor and Pain Modulation Brain Abnormalities in Trigeminal Neuralgia: A Paroxysmal, Sensory-Triggered Neuropathic Pain.

    Directory of Open Access Journals (Sweden)

    Danielle D Desouza

    Full Text Available Idiopathic trigeminal neuralgia (TN is characterized by paroxysms of severe facial pain but without the major sensory loss that commonly accompanies neuropathic pain. Since neurovascular compression of the trigeminal nerve root entry zone does not fully explain the pathogenesis of TN, we determined whether there were brain gray matter abnormalities in a cohort of idiopathic TN patients. We used structural MRI to test the hypothesis that TN is associated with altered gray matter (GM in brain areas involved in the sensory and affective aspects of pain, pain modulation, and motor function. We further determined the contribution of long-term TN on GM plasticity.Cortical thickness and subcortical GM volume were measured from high-resolution 3T T1-weighted MRI scans in 24 patients with right-sided TN and 24 healthy control participants.TN patients had increased GM volume in the sensory thalamus, amygdala, periaqueductal gray, and basal ganglia (putamen, caudate, nucleus accumbens compared to healthy controls. The patients also had greater cortical thickness in the contralateral primary somatosensory cortex and frontal pole compared to controls. In contrast, patients had thinner cortex in the pregenual anterior cingulate cortex, the insula and the orbitofrontal cortex. No relationship was observed between GM abnormalities and TN pain duration.TN is associated with GM abnormalities in areas involved in pain perception, pain modulation and motor function. These findings may reflect increased nociceptive input to the brain, an impaired descending modulation system that does not adequately inhibit pain, and increased motor output to control facial movements to limit pain attacks.

  12. Outcomes after microvascular decompression for patients with trigeminal neuralgia and suspected multiple sclerosis.

    Science.gov (United States)

    Ariai, M Shafie; Mallory, Grant W; Pollock, Bruce E

    2014-01-01

    Microvascular decompression (MVD) is an established surgical therapy for patients with idiopathic trigeminal neuralgia (TN). The role of MVD in patients with definite or suspected multiple sclerosis (MS) remains controversial. During the period 2000-2012, 10 patients with medically refractory TN and ipsilateral brainstem T2 hyperintensity underwent MVD. In 5 patients, additional clinical features suspicious for MS were present, including prior optic neuritis (n = 2), multiple disseminated lesions (n = 3), and elevated immunoglobulin G index (n = 2). One patient had failed prior percutaneous surgery; 1 patient had Burchiel type 2 TN. Follow-up (median, 14 months) was censored at the time of additional surgery (n = 6) or last clinic visit (n = 4). Neurovascular compression was confirmed at surgery from the superior cerebellar artery (SCA) plus adjacent vein (n = 4), vein alone (n = 3), SCA alone (n = 2), and SCA plus anterior inferior cerebellar artery (n = 1). Initially after MVD, 8 patients (80%) were pain-free and subsequently tapered off medications for their facial pain. Pain recurred in 6 patients at a median of 4 months (range, 1-23 months). Actuarial rates of being pain-free off medications were 50% at 3 months and 15% at 2 years. In 6 patients, additional treatments were performed, including glycerol rhizotomy (n = 4), radiosurgery (n = 2), balloon compression (n = 2), and repeat MVD (n = 1). At last contact, 5 of the 6 patients who were retreated were pain-free. Facial pain outcomes after MVD in patients with suspected MS-related TN are poor compared with outcomes for patients with idiopathic TN. This study provides further support that many patients with MS-related TN have pain that is centrally mediated, reducing the effectiveness of procedures performed on the trigeminal root, ganglion, or divisions. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. [Linear accelerator-based stereotactic radiosurgery for the treatment of trigeminal neuralgia. Nine years' experience in a single institution].

    Science.gov (United States)

    Serrano-Rubio, A A; Martinez-Manrique, J J; Revuelta-Gutierrez, R; Gomez-Amador, J L; Martinez-Anda, J J; Ponce-Gomez, J A; Moreno-Jimenez, S

    2014-09-16

    INTRODUCTION. Pharmacological treatment is the first therapeutic step towards controlling pain in trigeminal neuralgia, but 25-50% of patients become medication resistant. There are currently several surgical alternatives for treating these patients. AIM. To evaluate the effectiveness and safety of stereotactic radiosurgery for the treatment of patients with trigeminal neuralgia. PATIENTS AND METHODS. A follow-up study was conducted on 30 patients who underwent radiosurgery using a Novalis linear accelerator. Eighty per cent of the dosage was calculated at the isocentre, the entry zone of the root of the trigeminal nerve. The mean follow-up time was 27.5 months (range: 1-65 months). RESULTS. The mean age was 66 years (range: 36-87 years), with a time to progression of 7.1 years (range: 4-27 years). The distribution of the pain was from the right side (63.3%). Of the 30 patients, 27 experienced an improvement (90%) 1.6 months (range: 1 week-4 months) after the treatment; 10 patients (33.3%) scored grade I, and 17 patients (56.6%) obtained a score of grade II. During the follow-up, four patients (14.2%) suffered a relapse; two underwent re-irradiation. Time without recurrence was 62.7 months (range: 54.6-70.8 months). The rate of side effects was 76.7% and only three patients developed facial anaesthesia with loss of the corneal reflex. CONCLUSIONS. The use of the linear accelerator is an effective therapeutic option in the treatment of trigeminal neuralgia, since it provides adequate long-term control of the pain, reduces the use of medication and improves the quality of life.

  14. Dose Verification of Stereotactic Radiosurgery Treatment for Trigeminal Neuralgia with Presage 3D Dosimetry System

    Science.gov (United States)

    Wang, Z.; Thomas, A.; Newton, J.; Ibbott, G.; Deasy, J.; Oldham, M.

    2010-11-01

    Achieving adequate verification and quality-assurance (QA) for radiosurgery treatment of trigeminal-neuralgia (TGN) is particularly challenging because of the combination of very small fields, very high doses, and complex irradiation geometries (multiple gantry and couch combinations). TGN treatments have extreme requirements for dosimetry tools and QA techniques, to ensure adequate verification. In this work we evaluate the potential of Presage/Optical-CT dosimetry system as a tool for the verification of TGN distributions in high-resolution and in 3D. A TGN treatment was planned and delivered to a Presage 3D dosimeter positioned inside the Radiological-Physics-Center (RPC) head and neck IMRT credentialing phantom. A 6-arc treatment plan was created using the iPlan system, and a maximum dose of 80Gy was delivered with a Varian Trilogy machine. The delivered dose to Presage was determined by optical-CT scanning using the Duke Large field-of-view Optical-CT Scanner (DLOS) in 3D, with isotropic resolution of 0.7mm3. DLOS scanning and reconstruction took about 20minutes. 3D dose comparisons were made with the planning system. Good agreement was observed between the planned and measured 3D dose distributions, and this work provides strong support for the viability of Presage/Optical-CT as a highly useful new approach for verification of this complex technique.

  15. OnabotulinumtoxinA for trigeminal neuralgia: a review of the available data

    Directory of Open Access Journals (Sweden)

    Pedro A. Kowacs

    2015-01-01

    Full Text Available Trigeminal neuralgia (TN patients may develop side effects from centrally acting drugs, have contraindications for neurosurgical procedures, or experience relapse during conventional therapies. OnabotulinumtoxinA (BoNT/A has been reported to be effective for TN, although this finding has been challenged. An overview of the available evidence based on a narrative/qualitative analysis of the literature is presented. About 90% of patients who receive BoNT/A show an improvement, a higher figure than that reported for the placebo effect of BoNT/A for other headaches. Tolerability of BoNT/A is good, and its few side-effects are transient. The articles reviewed were mainly case reports, case series and open-label trials; however, randomized controlled trials have endorsed the efficacy of BoNT/A for TN. This evidence, together with a better understanding of the analgesic mechanisms of BoNT/A and its proven efficacy in treating other pain syndromes, supports the use of this toxin as a therapeutic option for TN.

  16. Trigeminal neuralgia: Assessment with T2 VISTA and FLAIR VISTA fusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Cha, Jihoon; Kim, Sung Tae; Kim, Hyung-Jin; Choi, Jin Wook; Kim, Hye Jeong; Jeon, Pyoung; Kim, Keon Ha; Byun, Hong Sik [Sungkyunkwan University School of Medicine, Samsung Medical Center, Department of Radiology and Center for Imaging Science, Seoul (Korea, Republic of); Park, Kwan [Sungkyunkwan University School of Medicine, Samsung Medical Center, Department of Neurosurgery, Seoul (Korea, Republic of)

    2011-12-15

    To evaluate the neurovascular compression (NVC) in patients with trigeminal neuralgia (TN) using T2 VISTA and FLAIR VISTA fusion imaging. Sixty-six consecutive patients with TN who underwent MR imaging at 3-T between April 2008 and December 2010 were retrospectively reviewed. Multiplanar reconstructions (MPR) of T2 VISTA and FLAIR VISTA fusion imaging were used for image interpretation. The frequency of vascular contact, the segment of compression and the type of vessel were compared between the ipsilateral symptomatic side and the contralateral asymptomatic side. The frequency of vascular contact on the ipsilateral side and the contralateral side were 95.5% (63/66) and 74.2% (49/66), respectively. The frequency of indentation on the ipsilateral side and contralateral side were 74.2% (49/66) and 21.2% (14/66), and showed a statistically significant difference (p < 0.05). The sensitivity, specificity and odds ratio were 77.8%, 71.4% and 10.7, respectively. There were no significant differences in the involved segment or type of vessel between the ipsilateral side and contralateral side. MPR of T2 VISTA and FLAIR VISTA fusion imaging is useful in the detection of NVC in patients with TN. Vascular indentation can predict the presence of symptoms in patients with TN. (orig.)

  17. Prevalence of trigeminal neuralgia and persistent idiopathic facial pain: a population-based study.

    Science.gov (United States)

    Mueller, Daniel; Obermann, Mark; Yoon, Min-Suk; Poitz, Franziska; Hansen, Niels; Slomke, Marc-Andre; Dommes, Peter; Gizewski, Elke; Diener, Hans-Christoph; Katsarava, Zaza

    2011-11-01

    To estimate the lifetime prevalence of trigeminal neuralgia (TN) and persistent idiopathic facial pain (PIFP) in a population-based sample in Germany. A total of 3336 responders of 6000 contacted inhabitants of the city of Essen in Germany were screened using a self-assessment questionnaire. 327 individuals, who reported recurrent facial pain and randomly selected 150 (5% of 3009) screening negative subjects, received a phone interview by one of six neurologists and if necessary a face-to-face examination. Those with suspected TN or PIFP following the phone interview underwent neurological examination by two neurologists who were unaware of the presumed diagnosis. A random group of 25 (10% of 247) phone interview negative subjects was examined face-to-face. All suspected cases of PIFP received otorhinolaryngological examination and diagnostic cranial magnetic resonance imaging (MRI). In TN patients the number of vessel-nerve contacts was determined by thin-slice cranial MRI. Lifetime prevalence of TN was estimated to be 0.3% [10 of 3336; 95% CI 0.1-0.5%], of PIFP 0.03% [1 of 3336; 95% CI facial pain disorders.

  18. Clinical Outcomes of Gamma Knife Radiosurgery in the Treatment of Patients with Trigeminal Neuralgia

    Science.gov (United States)

    Elaimy, Ameer L.; Hanson, Peter W.; Lamoreaux, Wayne T.; Mackay, Alexander R.; Demakas, John J.; Fairbanks, Robert K.; Cooke, Barton S.; Thumma, Sudheer R.; Lee, Christopher M.

    2012-01-01

    Since its introduction by Leksell, Gamma Knife radiosurgery (GKRS) has become increasingly popular as a management approach for patients diagnosed with trigeminal neuralgia (TN). For this reason, we performed a modern review of the literature analyzing the efficacy of GKRS in the treatment of patients who suffer from TN. For patients with medically refractory forms of the condition, GKRS has proven to be an effective initial and repeat treatment option. Cumulative research suggests that patients treated a single time with GKRS exhibit similar levels of facial pain control when compared to patients treated multiple times with GKRS. However, patients treated on multiple occasions with GKRS are more likely to experience facial numbness and other facial sensory changes when compared to patients treated once with GKRS. Although numerous articles have reported MVD to be superior to GKRS in achieving facial pain relief, the findings of these comparison studies are weakened by the vast differences in patient age and comorbidities between the two studied groups and cannot be considered conclusive. Questions remain regarding optimal GKRS dosing and targeting strategies, which warrants further investigation into this controversial matter. PMID:22229034

  19. Dose Verification of Stereotactic Radiosurgery Treatment for Trigeminal Neuralgia with Presage 3D Dosimetry System

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Z; Thomas, A; Newton, J; Ibbott, G; Deasy, J; Oldham, M, E-mail: Zhiheng.wang@duke.ed

    2010-11-01

    Achieving adequate verification and quality-assurance (QA) for radiosurgery treatment of trigeminal-neuralgia (TGN) is particularly challenging because of the combination of very small fields, very high doses, and complex irradiation geometries (multiple gantry and couch combinations). TGN treatments have extreme requirements for dosimetry tools and QA techniques, to ensure adequate verification. In this work we evaluate the potential of Presage/Optical-CT dosimetry system as a tool for the verification of TGN distributions in high-resolution and in 3D. A TGN treatment was planned and delivered to a Presage 3D dosimeter positioned inside the Radiological-Physics-Center (RPC) head and neck IMRT credentialing phantom. A 6-arc treatment plan was created using the iPlan system, and a maximum dose of 80Gy was delivered with a Varian Trilogy machine. The delivered dose to Presage was determined by optical-CT scanning using the Duke Large field-of-view Optical-CT Scanner (DLOS) in 3D, with isotropic resolution of 0.7mm{sup 3}. DLOS scanning and reconstruction took about 20minutes. 3D dose comparisons were made with the planning system. Good agreement was observed between the planned and measured 3D dose distributions, and this work provides strong support for the viability of Presage/Optical-CT as a highly useful new approach for verification of this complex technique.

  20. Comparison of the Efficacy of Reoperation, Percutaneous Radiofrequency Thermocoagulation When Microvascular Decompression of Trigeminal Neuralgia Is Invalid.

    Science.gov (United States)

    Zhang, Xin; Zhao, Hua; Tang, Yinda; Zhu, Jin; Wang, Xuhui; Li, Shiting

    2016-10-01

    To compare the curative effect of reoperation in short-term and percutaneous radiofrequency thermocoagulation (PRT) when trigeminal neuralgia patient after microvascular decompression (MVD) is invalid. Follow-up of 54 patients (30 patients with reoperation in the short term, 24 patients with PRT of primitive trigeminal neuralgia) when MVD is invalid between January 2008 and December 2014. To evaluate the degree of pain relief and facial numbness of patients after the treatment in short-term (1 month), in long-term (1 year). One month after surgery, the authors compared the reoperation group with PRT group. The ratio of cure rate P = 0.02, the ratio of effective rate P = 0.04, the ratio of facial numbness P = 0.01; 1 year after surgery, the authors compared the reoperation group with PRT group. The ratio of cure rate P = 0.004, the ratio of effective rate P = 0.006, the ratio of facial numbness P = 0.02, the ratio of recurrence P = 0.04. The short-term and long-term clinical efficacy in reoperation group was better than PRT group (P neuralgia when first MVD is invalid, reoperation is better than PRT, and a significantly lower incidence of facial numbness and recurrence than PRT.

  1. 针药结合治疗三叉神经痛经验初探%Combination of Acupuncture with Medicine Experience in Treatment of Trigeminal Neuralgia

    Institute of Scientific and Technical Information of China (English)

    高丽; 刘智斌; 李彬锋

    2015-01-01

    Objective: The curative effect of combined acupuncture and medicine treatment of trigeminal neuralgia. Methods: Patients with trigeminal neuralgia with acupuncture fengchi, xiaguan, taichong ,and this Powder for clearing away stomach-heat and Shengyangsanhuo decoction is given priority to.Conclusion: give priority to with traditional Chinese medicine with western medicine curative effect on treating trigeminal neuralgia, is worth popularizing in clinical.%目的:观察针药结合治疗三叉神经痛的疗效。方法给三叉神经痛患者以针刺风池、下关、太冲等穴,内服清胃散合升阳散火汤加减治疗为主治疗。结论以针药结合西医治疗三叉神经痛疗效肯定,值得在临床推广。

  2. Image Registration Strategy of T1-Weighted and FIESTA MRI Sequences in Trigeminal Neuralgia Gamma Knife Radiosurgery

    Science.gov (United States)

    Wang, Tony J.C.; Brisman, Ronald; Lu, Zheng Feng; Li, Xiang; Isaacson, Steven R.; Shah, Jinesh N.; Yoshida, Emi J.; Liu, Tian

    2010-01-01

    Background/Aims In Gamma Knife radiosurgery, T1 MRI is most commonly used and is generally sufficient for targeting the trigeminal nerve. For patients whose trigeminal nerves are unclear on T1 MRI, FIESTA MRI supplements anatomical structure visualization and may improve trigeminal nerve delineation. The purpose of this study was to develop a registration strategy for T1 and FIESTA MRIs. Methods We conducted a retrospective study on 54 trigeminal neuralgia patients. All patients were scanned with T1 and FIESTA MRIs. We evaluated 4 methods of registration: automatic image definition, superior-slice definition, middle-slice definition and inferior-slice definition. Target discrepancies were measured by deviations from an intracranial landmark on T1 and FIESTA MR images. Results The overall range in registration error was 0.10–5.19 mm using superior-, 0.10–1.56 mm using middle- and 0.14–2.89 mm using inferior-slice definition. Registration error >2 mm was observed in 11% of the patients using superior-, 4% using middle- and 7% using inferior-slice FIESTA MRI definition. Conclusions Among patients for whom FIESTA and T1 MRI are used, registration based on middle-slice definition reduces registration error and improves targeting of the trigeminal nerve. PMID:20530977

  3. Image registration strategy of T(1)-weighted and FIESTA MRI sequences in trigeminal neuralgia gamma knife radiosurgery.

    Science.gov (United States)

    Wang, Tony J C; Brisman, Ronald; Lu, Zheng Feng; Li, Xiang; Isaacson, Steven R; Shah, Jinesh N; Yoshida, Emi J; Liu, Tian

    2010-01-01

    In Gamma Knife radiosurgery, T(1) MRI is most commonly used and is generally sufficient for targeting the trigeminal nerve. For patients whose trigeminal nerves are unclear on T(1) MRI, FIESTA MRI supplements anatomical structure visualization and may improve trigeminal nerve delineation. The purpose of this study was to develop a registration strategy for T(1) and FIESTA MRIs. We conducted a retrospective study on 54 trigeminal neuralgia patients. All patients were scanned with T(1) and FIESTA MRIs. We evaluated 4 methods of registration: automatic image definition, superior-slice definition, middle-slice definition and inferior-slice definition. Target discrepancies were measured by deviations from an intracranial landmark on T(1) and FIESTA MR images. The overall range in registration error was 0.10-5.19 mm using superior-, 0.10-1.56 mm using middle- and 0.14-2.89 mm using inferior-slice definition. Registration error >2 mm was observed in 11% of the patients using superior-, 4% using middle- and 7% using inferior-slice FIESTA MRI definition. Among patients for whom FIESTA and T(1) MRI are used, registration based on middle-slice definition reduces registration error and improves targeting of the trigeminal nerve. 2010 S. Karger AG, Basel.

  4. End-to-end test of spatial accuracy in Gamma Knife treatments for trigeminal neuralgia

    Energy Technology Data Exchange (ETDEWEB)

    Brezovich, Ivan A., E-mail: ibrezovich@uabmc.edu; Wu, Xingen; Duan, Jun; Popple, Richard A.; Shen, Sui; Benhabib, Sidi; Huang, Mi; Christian Dobelbower, M. [Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama 35249 (United States); Fisher III, Winfield S. [Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama 35249 (United States)

    2014-11-01

    Purpose: Spatial accuracy is most crucial when small targets like the trigeminal nerve are treated. Although current quality assurance procedures typically verify that individual apparatus, like the MRI scanner, CT scanner, Gamma Knife, etc., are meeting specifications, the cumulative error of all equipment and procedures combined may exceed safe margins. This study uses an end-to-end approach to assess the overall targeting errors that may have occurred in individual patients previously treated for trigeminal neuralgia. Methods: The trigeminal nerve is simulated by a 3 mm long, 3.175 mm (1/8 in.) diameter MRI-contrast filled cavity embedded within a PMMA plastic capsule. The capsule is positioned within the head frame such that the location of the cavity matches the Gamma Knife coordinates of an arbitrarily chosen, previously treated patient. Gafchromic EBT2 film is placed at the center of the cavity in coronal and sagittal orientations. The films are marked with a pinprick to identify the cavity center. Treatments are planned for radiation delivery with 4 mm collimators according to MRI and CT scans using the clinical localizer boxes and acquisition protocols. Shots are planned so that the 50% isodose surface encompasses the cavity. Following irradiation, the films are scanned and analyzed. Targeting errors are defined as the distance between the pinprick, which represents the intended target, and the centroid of the 50% isodose line, which is the center of the radiation field that was actually delivered. Results: Averaged over ten patient simulations, targeting errors along the x, y, and z coordinates (patient’s left-to-right, posterior-to-anterior, and head-to-foot) were, respectively, −0.060 ± 0.363, −0.350 ± 0.253, and 0.348 ± 0.204 mm when MRI was used for treatment planning. Planning according to CT exhibited generally smaller errors, namely, 0.109 ± 0.167, −0.191 ± 0.144, and 0.211 ± 0.094 mm. The largest errors along individual axes in MRI

  5. Peripheral neurectomies: A treatment option for trigeminal neuralgia in rural practice

    Directory of Open Access Journals (Sweden)

    Fareedi Mukram Ali

    2012-01-01

    Full Text Available Background: Trigeminal neuralgia is a commonly diagnosed neurosensory disease of head, neck and face region, involving 5 th cranial nerve. Carbamazepine is the first line drug if there is decrease in efficacy or tolerability of medication, surgery needs to be considered. Factors such as pain relief, recurrence rates, morbidity and mortality rates should be taken in to account while considering which technique to use. Peripheral neurectomy is a safe and effective procedure for elderly patients and in rural and remote centers where neurosurgical facilities are not available. It is also effective in those patients who are reluctant for major neurosurgical procedures. Although loss of sensation along the branches of trigeminal nerve and recurrence rate are associated with peripheral neurectomy, we consider it as the safe and effective procedure in rural practice, which can be done under local anesthesia. Aims: The aim of this prospective study is to evaluate the long term efficacy of peripheral neurectomy with and without the placement of stainless steel screws in the foramina and to calculate the mean remission period after peripheral neurectomies for different branches of trigeminal nerve. Setting and Design: The sample was divided into 2 groups by selecting randomly the patients, satisfying inclusion criteria. Both groups were operated under local anesthesia by regional nerve blocks. In one group of patients after peripheral neurectomy, the proximal nerve stump was left alone in the foramina, and in another group of patients, obturation of foramina was done with stainless steel screws after peripheral neurectomy. Materials and Methods: Peripheral neurectomy was done on the terminal branches of trigeminal nerve in 14 patients. We selected only those cases that were experiencing pain after Carbamazepine therapy, all our patients were from rural and remote areas where facilities to neurosurgical centers are limited. Elderly patients who were unfit

  6. Tratamento famacológico da neuralgia do trigêmeo: revisão sistemática e metanálise Tratamiento famacológico de la neuralgia del trigémino: revisión sistemática y metanálisis Pharmacological treatment of trigeminal neuralgia: systematic review and metanalysis

    Directory of Open Access Journals (Sweden)

    Túlio César Azevedo Alves

    2004-12-01

    medicamentosa sistémica es considerada como el tratamiento de primera línea para esta enfermedad. El objetivo de este estudio fue de evaluar la eficacia, la seguridad y la tolerabilidad de los diversos tratamientos farmacológicos ofrecidos a los pacientes con neuralgia del trigémino, con la finalidad de suministrar evidencias para las recomendaciones de la práctica clínica e identificar las necesidades de pesquisas adicionales. MÉTODO: Fueron analizados ensayos clínicos aleatorios y controlados, publicados hasta julio de 2003, sobre el efecto analgésico de las drogas prescritas en el tratamiento de la neuralgia del trigémino. El análisis estadístico fue realizado con el auxilio del programa Review Manager 4.2.2 (Colaboración Cochrane, 2003. RESULTADOS: Los resultados de la metanálisis sugieren que la carbamazepina es más eficaz que el placebo. En tres estudios controlados comparando la lamotrigina, el topiramato y el cloridrato de proparacaína al placebo, solamente la lamotrigina se mostró superior a él. El dextrometafano fue comparado al lorazepam en dosis bajas, habiendo aumento del dolor con el uso de aquel fármaco. Tres estudios compararon la carbamazepina con la tizanidina, la tocainida y la pimozida, mostrándose apenas la pimozida superior a la carbamazepina. CONCLUSIONES: La carbamazepina continúa como droga de elección para el tratamiento de la neuralgia del trigémino, estando la lamotrigina y la pimozida indicadas en casos refractarios a la terapia convencional. Además, estudios adicionales son necesarios para que se establezcan futuras opciones terapéuticas.BACKGROUND AND OBJECTIVES: Trigeminal neuralgia is a syndrome of chronic pain, characterized by paroxysms of excruciating pain which dramatically affect patients' quality of life. Systemic drug therapy is the first line treatment for this disease. This study aimed at evaluating efficacy, safety and tolerability of several pharmacologic treatments offered to trigeminal neuralgia patients

  7. Neuronavigator-guided percutaneous radiofrequency thermocoagulation in the treatment of intractable trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    XU Shu-jun; ZHANG Wen-hua; CHEN Teng; WU Cheng-yuan; ZHOU Mao-de

    2006-01-01

    Background Percutaneous radiofrequency thermocoagulation of the trigeminal ganglion (PRTTG) is regarded as the first choice for most patients with trigeminal neuralgia (TN) because of its safety and feasibility. However,neuronavigator-guided PRTTG has been seldom reported. The purpose of this study was to assess the safety and efficacy of neuronavigator-guided PRTTG for the treatment of intractable TN.Methods Between January 2000 and December 2004, 54 patients with intractable TN were enrolled into this study and were randomly divided into two groups. The patients in navigation group (n=26) underwent PRTTG with frameless neuronavigation, and those in control group (n=28) received PRTTG without neuronavigation.Three months after the operation, the efficacy, side effects, and complications of the surgery were recorded. The patients in the control group were followed up for 10 to 54 months (mean, 34±5), and those in the navigation group were followed up for 13 to 58 months (mean, 36±7). Kaplan-Meier analyses of the pain-free survival curves were used for the censored survival data, and the log-rank test was used to compare survival curves of the two groups.Results The immediate complete pain-relief rate of the navigation group was 100%, whereas it was 95% in the control. The proportion of sustained pain-relief rates at 12, 24 and 36 months after the procedure were 85%, 77%,and 62% in the navigation group, and 54%, 40%, and 35% in the control. Recurrences in the control group were more common than that in the navigation group. Annual recurrence rate in the first and second years were 15% and 23% in the navigation group, and 46%, 60% in the control group. No side-effect and complication was noted in the navigation group except minimal facial hypesthesia.Conclusion Neuronavigator-guided PRTTG is a safe and promising method for treatment of intractable TN with better short- and long-term outcomes and lower complication rate than PRTTG without neuronavigation.

  8. Stereotactic radiosurgery for trigeminal neuralgia utilizing the BrainLAB Novalis system.

    Science.gov (United States)

    Zahra, Hadi; Teh, Bin S; Paulino, Arnold C; Yoshor, Daniel; Trask, Todd; Baskin, David; Butler, E Brian

    2009-12-01

    Stereotactic radiosurgery (SRS) is one of the least invasive treatments for trigeminal neuralgia (TN). To date, most reports have been about Cobalt-based treatments (i.e., Gamma Knife) with limited data on image-guided stereotactic linear accelerator treatments. We describe our initial experience of using BrainLAB Novalis stereotactic system for the radiosurgical treatment of TN. A total of 20 patients were treated between July 2004 and February 2007. Each SRS procedure was performed using the BrainLAB Novalis System. Thin cuts MRI images of 1.5 mm thickness were acquired and fused with the simulation CT of each patient. Majority of the patients received a maximum dose of 90 Gy. The median brainstem dose to 1.0 cc and 0.1 cc was 2.3 Gy and 13.5 Gy, respectively. In addition, specially acquired three-dimensional fast imaging sequence employing steady-state acquisition (FIESTA) MRI was utilized to improve target delineation of the trigeminal proximal nerve root entry zone. Barrow Neurological Index (BNI) pain scale for TN was used for assessing treatment outcome. At a median follow-up time of 14.2 months, 19 patients (95%) reported at least some improvement in pain. Eight (40%) patients were completely pain-free and stopped all medications (BNI Grade I) while another 2 (10%) patients also stopped medications but reported occasional pain (BNI Grade II). Another 2 (10%) patients reported no pain and 7 (35%) patients only occasional pain while continuing medications, BNI Grade IIIA and IIIB, respectively. Median time to pain control was 8.5 days (range: 1-70 days). No patient reported severe pain, worsening pain or any pain not controlled on their previously taken medication. Intermittent or persistent facial numbness following treatments occurred in 35% of patients. No other complications were reported. Stereotactic radiosurgery using the BrainLAB Novalis system is a safe and effective treatment for TN. This information is important as more centers are obtaining image

  9. Epidermoid cyst in the cerebellopontine angle cistern presenting as trigeminal neuralgia. Diagnostic values of the orbicularis oculi reflex and metrizamide CT cisternography - case report -

    Energy Technology Data Exchange (ETDEWEB)

    Ueda, Takashi; Goya, Tomokazu; Kinoshita, Kazuo (Miyazaki Medical College, Miyazaki (Japan)); Fukui, Masashi

    1983-05-01

    This 29-year-old male had been suffering from left trigeminal neuralgia one year prior to admission. Admission was prompted by the development of pain in the third division of the left trigeminal nerve. Physical and neurological examinations were not remarkable except for the facial pain. The orbicularis oculi reflex showed delayed latency of R/sub 1/ on the affected side. CT scans performed pre- and post-contrast enhancement revealed a low density area in the left cerebellopontine angle cistern. Metrizamide CT cisternography clearly revealed the margin of the lesion as the contrast media did not enter into the low density area. A left suboccipital craniectomy was performed. The trigeminal nerve was surrounded by a thin-capsulated mass and cholesteatoma materials. Histological diagnosis was epidermoid cyst. Since this surgical procedure, the trigeminal neuralgia has not recurred for one year. Without objective neurological deficits, it is difficult to distinguish symptomatic trigeminal from idiopathic neuralgia. Therefore, minor change of the orbicularis oculi reflex should help in objectively detecting dysfunction of the trigeminal nerve. Metrizamide CT cisternography is also useful in diagnosis of cystic lesions.

  10. Other facial neuralgias.

    Science.gov (United States)

    O'Neill, Francis; Nurmikko, Turo; Sommer, Claudia

    2017-01-01

    Premise In this article we review some lesser known cranial neuralgias that are distinct from trigeminal neuralgia, trigeminal autonomic cephalalgias, or trigeminal neuropathies. Included are occipital neuralgia, superior laryngeal neuralgia, auriculotemporal neuralgia, glossopharyngeal and nervus intermedius neuralgia, and pain from acute herpes zoster and postherpetic neuralgia of the trigeminal and intermedius nerves. Problem Facial neuralgias are rare and many physicians do not see such cases in their lifetime, so patients with a suspected diagnosis within this group should be referred to a specialized center where multidisciplinary team diagnosis may be available. Potential solution Each facial neuralgia can be identified on the basis of clinical presentation, allowing for precision diagnosis and planning of treatment. Treatment remains conservative with oral or topical medication recommended for neuropathic pain to be tried before more invasive procedures are undertaken. However, evidence for efficacy of current treatments remains weak.

  11. Three-dimensional time-of-flight MR angiography in trigeminal neuralgia on a 0.5-T system

    Energy Technology Data Exchange (ETDEWEB)

    Voeroes, E.; Palko, A.; Horvath, K. [Dept. of Radiology, University of Szeged (Hungary); Barzo, P. [Dept. of Neurosurgery, Univ. of Szeged (Hungary); Kardos, L.; Kuncz, A.

    2001-04-01

    The goal of this study was to analyze the diagnostic value of three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA), performed on a 0.5-T system in the detection of neurovascular compression in patients with trigeminal neuralgia (TN). One hundred seventy-two TN patients were examined using plain and contrast-enhanced 3D TOF MRA on a 0.5-T system. Maximum intensity projection (MIP) reconstruction was performed in three standard planes. Both the original and the reconstructed images were studied to search for vascular compression shown by close neurovascular contact and/or dislocation of the trigeminal nerve. Forty-two TN patients underwent surgical exploration of the posterior fossa. Results of MRA were compared with clinical data in all cases and to results of surgery in the surgically treated cases. Neurovascular contact at the root entry zone of the trigeminal nerve was detected on the symptomatic side in 94 patients, and on the asymptomatic side in 12 patients. Sensitivity, specificity, accuracy, as well as positive and negative predictive value of 3D TOF MRA in the detection of neurovascular compression in the patient group undergoing surgery, were 97.6, 92.5, 95.0, 93.0, and 97.4 %, respectively. Three-dimensional TOF MRA performed on a 0.5-T system appears to be not less effective than similar examinations by higher field strength devices in the detection of neurovascular contact. This sequence accurately demonstrates the presence of neurovascular compression, and in this way valuable information may be achieved for the planning of surgical therapy of patients with trigeminal neuralgia. (orig.)

  12. Comparative analyses of linac and Gamma Knife radiosurgery for trigeminal neuralgia treatments

    Science.gov (United States)

    Ma, L.; Kwok, Y.; Chin, L. S.; Yu, C.; Regine, W. F.

    2005-11-01

    Dedicated linac-based radiosurgery has been reported for trigeminal neuralgia treatments. In this study, we investigated the dose fall-off characteristics and setup error tolerance of linac-based radiosurgery as compared with standard Gamma Knife radiosurgery. In order to minimize the errors from different treatment planning calculations, consistent imaging registration, dose calculation and dose volume analysis methods were developed and implemented for both Gamma Knife and linac-based treatments. Intra-arc setup errors were incorporated into the treatment planning process of linac-based deliveries. The effects of intra-arc setup errors with increasing number of arcs were studied and benchmarked against Gamma Knife deliveries with and without plugging patterns. Our studies found equivalent dose fall-off properties between Gamma Knife and linac-based radiosurgery given a sufficient number of arcs (>7) and small intra-arc errors (<0.5 mm) were satisfied for linac-based deliveries. Increasing the number of arcs significantly decreased the variations in the dose fall-off curve at the low isodose region (e.g. from 40% to 10%) and also improved dose uniformity at the high isodose region (e.g. from 70% to 90%). As the number of arcs increased, the effects of intra-arc setup errors on the dose fall-off curves decreased. Increasing the number of arcs also reduced the integral dose to the distal normal brain tissues. In conclusion, linac-based radiosurgery produces equivalent dose fall-off characteristics to Gamma Knife radiosurgery with a high number of arcs. However, one must note the increased treatment time for a large number of arcs and isocentre accuracies.

  13. Thalamic metabolic alterations with cognitive dysfunction in idiopathic trigeminal neuralgia: a multivoxel spectroscopy study

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Yuan; Bao, Faxiu; Ma, Shaohui; Guo, Chenguang; Jin, Chenwang; Zhang, Ming [First Affiliated Hospital of Xi' an Jiaotong University, Department of Medical Imaging, Xi' an, Shaanxi (China); Li, Dan [First Affiliated Hospital of Xi' an Jiaotong University, Department of Respiratory and Critical Care Medicine, Xi' an, Shaanxi (China)

    2014-08-15

    Although abnormalities in metabolite compositions in the thalamus are well described in patients with idiopathic trigeminal neuralgia (ITN), differences in distinct thalamic subregions have not been measured with proton magnetic resonance spectroscopy ({sup 1}H-MRS), and whether there are correlations between thalamic metabolites and cognitive function still remain unknown. Multivoxel MRS was recorded to investigate the metabolic alterations in the thalamic subregions of patients with ITN. The regions of interest were localized in the anterior thalamus (A-Th), intralaminar portion of the thalamus (IL-Th), posterior lateral thalamus (PL-Th), posterior medial thalamus (PM-Th), and medial and lateral pulvinar of the thalamus (PuM-Th and PuL-Th). The N-acetylaspartate to creatine (NAA/Cr) and choline to creatine (Cho/Cr) ratios were measured in the ITN and control groups. Scores of the visual analogue scale (VAS) and the Montreal Cognitive Assessment (MoCA) were analyzed to correlate with the neuroradiological findings. The NAA/Cr ratio in the affected side of PM-Th and PL-Th in ITN patients was statistically lower than that in the corresponding regions of the thalamus in controls. The NAA/Cr ratio in the affected PM-Th was negatively associated with VAS and disease duration. Furthermore, decreases of NAA/Cr and Cho/Cr were detected in the affected side of IL-Th, and lower Cho/Cr was positively correlated with MoCA values in the ITN group. Our result of low level of NAA/Cr in the affected PM-Th probably serves as a marker of the pain-rating index, and decreased Cho/Cr in IL-Th may be an indicator of cognitive disorder in patients with ITN. (orig.)

  14. Comparative analyses of linac and Gamma Knife radiosurgery for trigeminal neuralgia treatments

    Energy Technology Data Exchange (ETDEWEB)

    Ma, L; Kwok, Y; Chin, L S; Yu, C; Regine, W F [University of Maryland School of Medicine, Baltimore, MD 21201 (United States)

    2005-11-21

    Dedicated linac-based radiosurgery has been reported for trigeminal neuralgia treatments. In this study, we investigated the dose fall-off characteristics and setup error tolerance of linac-based radiosurgery as compared with standard Gamma Knife radiosurgery. In order to minimize the errors from different treatment planning calculations, consistent imaging registration, dose calculation and dose volume analysis methods were developed and implemented for both Gamma Knife and linac-based treatments. Intra-arc setup errors were incorporated into the treatment planning process of linac-based deliveries. The effects of intra-arc setup errors with increasing number of arcs were studied and benchmarked against Gamma Knife deliveries with and without plugging patterns. Our studies found equivalent dose fall-off properties between Gamma Knife and linac-based radiosurgery given a sufficient number of arcs (>7) and small intra-arc errors (<0.5 mm) were satisfied for linac-based deliveries. Increasing the number of arcs significantly decreased the variations in the dose fall-off curve at the low isodose region (e.g. from 40% to 10%) and also improved dose uniformity at the high isodose region (e.g. from 70% to 90%). As the number of arcs increased, the effects of intra-arc setup errors on the dose fall-off curves decreased. Increasing the number of arcs also reduced the integral dose to the distal normal brain tissues. In conclusion, linac-based radiosurgery produces equivalent dose fall-off characteristics to Gamma Knife radiosurgery with a high number of arcs. However, one must note the increased treatment time for a large number of arcs and isocentre accuracies.

  15. Gamma knife radiosurgery for typical trigeminal neuralgia: An institutional review of 108 patients

    Science.gov (United States)

    Elaimy, Ameer L.; Lamm, Andrew F.; Demakas, John J.; Mackay, Alexander R.; Lamoreaux, Wayne T.; Fairbanks, Robert K.; Pfeffer, Robert D.; Cooke, Barton S.; Peressini, Benjamin J.; Lee, Christopher M.

    2013-01-01

    Background: In this study, we present the previously unreported pain relief outcomes of 108 patients treated at Gamma Knife of Spokane for typical trigeminal neuralgia (TN) between 2002 and 2011. Methods: Pain relief outcomes were measured using the Barrow Neurological Institute (BNI) pain intensity scale. In addition, the effects gender, age at treatment, pain laterality, previous surgical treatment, repeat Gamma Knife radiosurgery (GKRS), and maximum radiosurgery dose have on patient pain relief outcomes were retrospectively analyzed. Statistical analysis was performed using Andersen 95% confidence intervals, approximate confidence intervals for log hazard ratios, and multivariate Cox proportional hazard models. Results: All 108 patients included in this study were grouped into BNI class IV or V prior to GKRS. The median clinical follow-up time was determined to be 15 months. Following the first GKRS procedure, 71% of patients were grouped into BNI class I-IIIb (I = 31%; II = 3%; IIIa = 19%; IIIb = 18%) and the median duration of pain relief for those patients was determined to be 11.8 months. New facial numbness was reported in 19% of patients and new facial paresthesias were reported in 7% of patients after the first GKRS procedure. A total of 19 repeat procedures were performed on the 108 patients included in this study. Following the second GKRS procedure, 73% of patients were grouped into BNI class I-IIIb (I = 44%; II = 6%; IIIa = 17%, IIIb = 6%) and the median duration of pain relief for those patients was determined to be 4.9 months. For repeat procedures, new facial numbness was reported in 22% of patients and new facial paresthesias were reported in 6% of patients. Conclusions: GKRS is a safe and effective management approach for patients diagnosed with typical TN. However, further studies and supporting research is needed on the effects previous surgical treatment, number of radiosurgery procedures, and maximum radiosurgery dose have on GKRS clinical

  16. Hyperbaric oxygen therapy attenuates neuropathic hyperalgesia in rats and idiopathic trigeminal neuralgia in patients.

    Science.gov (United States)

    Gu, N; Niu, J-Y; Liu, W-T; Sun, Y-Y; Liu, S; Lv, Y; Dong, H-L; Song, X-J; Xiong, L-Z

    2012-09-01

    Neuropathic pain after nerve injury is severe and intractable, and current drug and non-drug therapies offer very limited pain relief. Hyperbaric oxygen (HBO 2) has been clinically used for protection of the nervous system after acute injury. We investigated whether HBO 2 treatment could prevent and/or attenuate neuropathic pain in animals and in patients. Mechanical allodynia and thermal hyperalgesia and neurochemical alterations of neuropathic pain were analysed in male, adult, Sprague-Dawley rats with sciatic nerve injury. Clinical trials were conducted in patients with idiopathic trigeminal neuralgia. Repetitive HBO 2 treatment [a combination of pressure at 3 atmosphere absolute (ATA) and pure oxygen] greatly inhibited behavioural signs of neuropathic pain manifested as thermal hyperalgesia and mechanical allodynia. Such an HBO 2 treatment also inhibited nerve injury-induced induction of c-Fos and activation of astrocytes and increased phosphorylation of NR2B receptor and the subsequent Ca 2+-dependent signals in rats. Neither high pressure (up to 3 ATA) nor pure oxygen alone resulted in analgesic effect. In clinical trials, one course of HBO 2 therapy (10 consecutive days) produced a rapid-onset, dose-dependent and long-lasting analgesic effects evidenced by the decreased doses of carbamazepine required for keeping patient pain at a minimum and decreased scores of visual analogue scales, which was used for patient's self-evaluation. These findings support that HBO 2 therapy is an effective approach for treating neuropathic pain in both animals and human beings and suggest that neural protection, anti-inflammation and inhibition of nerve injury-induced altered neural activity may contribute to the analgesic effect of HBO 2 therapy. © 2012 European Federation of International Association for the Study of Pain Chapters.

  17. Microsurgical treatment of trigeminal neuralgia in patients older than 70 years: An efficacy and safety study.

    Science.gov (United States)

    Ruiz-Juretschke, F; Vargas, A J; Gonzalez-Quarante, L H; Gil de Sagredo, O L; Montalvo, A; Fernandez-Carballal, C

    2017-09-01

    The increasing incidence of trigeminal neuralgia (TN) with age together with population ageing call for reexamination of surgical treatment options for refractory TN in elderly patients. Retrospective review of a consecutive series of patients older than 70 who underwent microvascular decompression (MVD) for refractory TN between 1997 and 2015. Outcomes based on the Barrow Neurological Institute pain intensity score (BNI score) and surgical complications were compared to those of patients younger than 70 undergoing MVD in the same period. Forty patients older than 70 (mean = 74.8 years) underwent interventions. At a mean follow-up time of 34 months, 73% of the patients presented complete absence of pain without medication (BNI I) and 85% had good pain control with or without medication (BNI I-III). A comparison of these patients with the 85 patients younger than 70 treated surgically during the same period did not find a significant association between age and achievement of pain control (BNI I-II). However, there was a significant association between age older than 70 and complete pain relief (BNI I; P=.03). The mean hospital stay in patients over 70 was also significantly longer (P=.04), although the postsurgical complication rate was similar to that in younger patients. Elderly patients with refractory TN may benefit from treatment with MVD and the probability of success and surgical risk are comparable to those in younger patients. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Harvey Cushing's case series of trigeminal neuralgia at the Johns Hopkins Hospital: a surgeon's quest to advance the treatment of the 'suicide disease'.

    NARCIS (Netherlands)

    Adams, H.; Pendleton, C.; Latimer, K.; Cohen-Gadol, A.A.; Carson, B.S.; Quinones-Hinojosa, A.

    2011-01-01

    BACKGROUND: A review of Dr. Harvey Cushing's surgical cases at the Johns Hopkins Hospital provided insight into his early work on trigeminal neuralgia (TN). There was perhaps no other affliction that captured his attention in the way that TN did, and he built a remarkable legacy of successful treatm

  19. Percutaneous Glycerol Rhizotomy for Trigeminal Neuralgia Using a Single-Plane, Flat Panel Detector Angiography System: Technical Note

    Science.gov (United States)

    ARISHIMA, Hidetaka; KAWAJIRI, Satoshi; ARAI, Hiroshi; HIGASHINO, Yoshifumi; KODERA, Toshiaki; KIKUTA, Ken-ichiro

    2016-01-01

    Percutaneous treatments for trigeminal neuralgia (TN) including glycerol rhizotomy (GR), radiofrequency thermocoagulation (RT), and balloon compression (BC) are effective for patients with medical comorbidities and risk factors of microvascular decompression (MVD). These procedures are usually performed under fluoroscopy. Surgeons advance the needle to the trigeminal plexus through the foramen ovale while observing landmarks of fluoroscopic images; however, it is sometimes difficult to appropriately place the needle tip in Meckel’s cave. We present the technical details of percutaneous GR using a single-plane, flat panel detector angiography system to check the needle positioning. When the needle tip may be located near the trigeminal cistern, three-dimensional (3-D) bone images are taken with cone-beam computed tomography (CT). These images clearly show the position of the needle tip in Meckel’s cave. If it is difficult to place it through the foramen ovale, surgeons perform cone beam CT to observe the actual position of the needle tip at the skull base. After confirming the positional relation between the needle tip and foramen ovale, surgeons can advance it in the precise direction. In 10 procedures, we could place the nerve-block needle in about 14.5 minutes on average without complications. We think that our method is simple and convenient for percutaneous treatments for TN, and it may be helpful for surgeons to perform such treatments. PMID:27041633

  20. Subtemporal transtentorial approach for recurrent trigeminal neuralgia after microvascular decompression via the lateral suboccipital approach: case report.

    Science.gov (United States)

    Ogiwara, Toshihiro; Goto, Tetsuya; Kusano, Yoshikazu; Kuroiwa, Masafumi; Kiuchi, Takafumi; Kodama, Kunihiko; Takemae, Toshiki; Hongo, Kazuhiro

    2015-06-01

    Microvascular decompression (MVD) via lateral suboccipital craniotomy is the standard surgical intervention for trigeminal neuralgia (TN). For recurrent TN, difficulties are sometimes encountered when performing reoperation via the same approach because of adhesions and prosthetic materials used in the previous surgery. In the present case report the authors describe the efficacy of the subtemporal transtentorial approach for use in recurrent TN after MVD via the lateral suboccipital approach. An 86-year-old woman, in whom an MVD via a lateral suboccipital craniotomy had previously been performed for TN, underwent surgery for recurrent TN via the subtemporal transtentorial approach, which provided excellent visualization of the neurovascular relationships and the trigeminal nerve without adhesions due to the previous surgery. Her TN disappeared after the MVD. The present approach is ideal for visualizing the trigeminal root entry zone, and the neurovascular complex can be easily dissected using a new surgical trajectory. This approach could be another surgical option for reoperation when the previous MVD had been performed via the suboccipital approach.

  1. [Dermoid Cyst in Meckel's Cave Presenting with Oculomotor Nerve Palsy and Trigeminal Neuralgia:A Case Report].

    Science.gov (United States)

    Tanabe, Nozomu; Tomita, Takahiro; Nagai, Shoichi; Kuwayama, Naoya; Noguchi, Kyo; Kuroda, Satoshi

    2016-10-01

    The authors report a rare case of an intracranial dermoid cyst found in Meckel's cave. A 63-year-old woman developed left oculomotor nerve palsy and was referred to their hospital. Magnetic resonance imaging revealed a cystic lesion in the left Meckel's cave and prepontine cistern, but her symptoms gradually improved during conservative observation. However, three years later she complained of left facial pain in the territory of the second branch of the trigeminal nerve. The left oculomotor nerve palsy exacerbated again. Although her trigeminal neuralgia improved after carbamazepine administration, her oculomotor nerve palsy did not recover. Therefore, she underwent direct surgery through the anterior transpetrosal approach, and the fat-containing tumor cyst was completely resected. The tumor was strongly compressing the left trigeminal nerve and its ganglion in Meckel's cave. After surgery, her facial pain completely resolved and her oculomotor nerve palsy gradually improved. Histological examination revealed that the cyst wall was composed of a single layer of squamous epithelium and contained hair and keratin. A pathological diagnosis of a dermoid cyst was made.

  2. Percutaneous Glycerol Rhizotomy for Trigeminal Neuralgia Using a Single-Plane, Flat Panel Detector Angiography System: Technical Note.

    Science.gov (United States)

    Arishima, Hidetaka; Kawajiri, Satoshi; Arai, Hiroshi; Higashino, Yoshifumi; Kodera, Toshiaki; Kikuta, Ken-Ichiro

    2016-05-15

    Percutaneous treatments for trigeminal neuralgia (TN) including glycerol rhizotomy (GR), radiofrequency thermocoagulation (RT), and balloon compression (BC) are effective for patients with medical comorbidities and risk factors of microvascular decompression (MVD). These procedures are usually performed under fluoroscopy. Surgeons advance the needle to the trigeminal plexus through the foramen ovale while observing landmarks of fluoroscopic images; however, it is sometimes difficult to appropriately place the needle tip in Meckel's cave. We present the technical details of percutaneous GR using a single-plane, flat panel detector angiography system to check the needle positioning. When the needle tip may be located near the trigeminal cistern, three-dimensional (3-D) bone images are taken with cone-beam computed tomography (CT). These images clearly show the position of the needle tip in Meckel's cave. If it is difficult to place it through the foramen ovale, surgeons perform cone beam CT to observe the actual position of the needle tip at the skull base. After confirming the positional relation between the needle tip and foramen ovale, surgeons can advance it in the precise direction. In 10 procedures, we could place the nerve-block needle in about 14.5 minutes on average without complications. We think that our method is simple and convenient for percutaneous treatments for TN, and it may be helpful for surgeons to perform such treatments.

  3. The results of a third Gamma Knife procedure for recurrent trigeminal neuralgia.

    Science.gov (United States)

    Tempel, Zachary J; Chivukula, Srinivas; Monaco, Edward A; Bowden, Greg; Kano, Hideyuki; Niranjan, Ajay; Chang, Edward F; Sneed, Penny K; Kaufmann, Anthony M; Sheehan, Jason; Mathieu, David; Lunsford, L Dade

    2015-01-01

    Gamma Knife radiosurgery (GKRS) is the least invasive treatment option for medically refractory, intractable trigeminal neuralgia (TN) and is especially valuable for treating elderly, infirm patients or those on anticoagulation therapy. The authors reviewed pain outcomes and complications in TN patients who required 3 radiosurgical procedures for recurrent or persistent pain. A retrospective review of all patients who underwent 3 GKRS procedures for TN at 4 participating centers of the North American Gamma Knife Consortium from 1995 to 2012 was performed. The Barrow Neurological Institute (BNI) pain score was used to evaluate pain outcomes. Seventeen patients were identified; 7 were male and 10 were female. The mean age at the time of last GKRS was 79.6 years (range 51.2-95.6 years). The TN was Type I in 16 patients and Type II in 1 patient. No patient suffered from multiple sclerosis. Eight patients (47.1%) reported initial complete pain relief (BNI Score I) following their third GKRS and 8 others (47.1%) experienced at least partial relief (BNI Scores II-IIIb). The average time to initial response was 2.9 months following the third GKRS. Although 3 patients (17.6%) developed new facial sensory dysfunction following primary GKRS and 2 patients (11.8%) experienced new or worsening sensory disturbance following the second GKRS, no patient sustained additional sensory disturbances after the third procedure. At a mean follow-up of 22.9 months following the third GKRS, 6 patients (35.3%) reported continued Score I complete pain relief, while 7 others (41.2%) reported pain improvement (BNI Scores II-IIIb). Four patients (23.5%) suffered recurrent TN following the third procedure at a mean interval of 19.1 months. A third GKRS resulted in pain reduction with a low risk of additional complications in most patients with medically refractory and recurrent, intractable TN. In patients unsuitable for other microsurgical or percutaneous strategies, especially those receiving

  4. Stereotactic Radiosurgery for Trigeminal Neuralgia Improves Patient-Reported Quality of Life and Reduces Depression.

    Science.gov (United States)

    Kotecha, Rupesh; Miller, Jacob A; Modugula, Sujith; Barnett, Gene H; Murphy, Erin S; Reddy, Chandana A; Suh, John H; Neyman, Gennady; Machado, Andre; Nagel, Sean; Chao, Samuel T

    2017-08-01

    To characterize quality-of-life (QOL) outcomes after stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN). The EuroQOL 5 Dimensions (EQ-5D) and Patient Health Questionnaire 9 (PHQ-9) were prospectively collected before and after SRS for 50 patients with TN. Pain response and treatment-related facial numbness were classified by Barrow Neurological Institute (BNI) scales. Differences in pooled QOL outcomes were tested with paired t tests and sign tests. The Kaplan-Meier method was used to estimate time-dependent improvements in the EQ-5D index, EQ-5D perceived health status (PHS), PHQ-9 score, and freedom from pain failure (BNI class IV-V) or facial numbness (BNI class III-IV). Following SRS, the 12-month rate of freedom from pain failure was 92% (95% confidence interval [CI], 77%-97%) while the 12-month rate of freedom from facial numbness was 89% (95% CI, 66%-97%). Significant improvements in the EQ-5D index (P<.01), PHS (P=.01), and PHQ-9 (P=.03) were observed, driven by the EQ-5D subscores for self-care and for pain and/or discomfort (P=.02 and P<.01, respectively). At 12 months after SRS, the actuarial rates of improvement in the EQ-5D, PHS, and PHQ-9 were 55% (95% CI, 40%-70%), 59% (95% CI, 40%-76%), and 59% (95% CI, 39%-76%), respectively. The median time to improvement in each of the QOL measures was 9 months (95% CI, 3-36 months) for the EQ-5D index, 5 months (95% CI, 3-36 months) for PHS, and 9 months (95% CI, 3-18 months) for the PHQ-9. On multivariate analysis, only higher prescription dose (86 Gy vs ≤82 Gy) was associated with improvement in the EQ-5D index (hazard ratio, 5.73; 95% CI, 1.85-22.33; P<.01). Patients with TN treated with SRS reported significant improvements in multiple QOL measures, with the therapeutic benefit strongly driven by improvements in pain and/or discomfort and in self-care, along with lower rates of depression. In this analysis, there appears to be a correlation between prescription dose and treatment

  5. Microstructural abnormalities of the trigeminal nerve correlate with pain severity and concomitant emotional dysfunctions in idiopathic trigeminal neuralgia: A randomized, prospective, double-blind study.

    Science.gov (United States)

    Wang, Yuan; Li, Dan; Bao, Faxiu; Guo, Chenguang; Ma, Shaohui; Zhang, Ming

    2016-06-01

    To compare cross-sectional area (CSA) and volume (V) between the trigeminal nerves (TGNs) of the affected side and the unaffected side in patients with idiopathic trigeminal neuralgia (ITN), and both nerves in normal controls, and to correlate these morphological data with degree of facial pain and emotional disorder severity in ITN patients. Forty ITN patients and 40 matched healthy volunteers underwent three-dimensional fast imaging employing steady state acquisition (3D-FIESTA) and time-of-flight magnetic resonance angiography (TOF-MRA) focusing on CSA and V of the TGN cisternal segment. Correlations between the morphological results and scores of visual analogue scale (VAS), Hamilton Depression Rating Scale (HAMD), and Hamilton Anxiety Rating Scale (HAMA) were analyzed in two groups. CSA and V of the affected TGN were significantly smaller than in the unaffected TGN and both sides in controls. No statistical differences were observed between morphological data of the unaffected TGN and control TGNs. CSA and V of the affected TGN were significantly associated with VAS scores in ITN patients, and intermediate correlations were detected with HAMD and HAMA scores. Degree of atrophy in the affected TGN can be effective for evaluating facial pain and assessing emotional deficits in ITN patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Relationship of the location of nerve compression and different type of trigeminal neuralgia%不同类型三叉神经痛与神经压迫位置的关系

    Institute of Scientific and Technical Information of China (English)

    翟晓雷; 刘连松

    2015-01-01

    目的:探讨不同类型三叉神经痛与神经压迫位置的关系。方法对21例典型三叉神经痛及16例非典型三叉神经痛患者进行微血管减压术,术中探查责任血管压迫位置。结果与非典型组比较,典型组动脉进出脑干端区域(REZ)压迫率显著升高(P<0.01)。典型组责任血管为动脉的三叉神经REZ压迫率显著高于非典型组( P<0.01)。结论典型三叉神经痛责任血管大多压迫REZ,非典型三叉神经痛大多压迫非REZ,责任血管是否压迫REZ与三叉神经痛类型密切相关。%Objective To investigate the relationship of the location of nerve compression and different type of trigeminal neuralgia.Methods Twenty-one patients with typical trigeminal neuralgia and 16 patients with atypical trigeminal neuralgia were treated by micro-vascular decompression.The position of the responsible vessels was probed during operation.Results Compared with atypical trigeminal neuralgia group, the compression rate of trigeminal root entry/exit zone (REZ) in typical trigeminal neuralgia group was significantly higher(P<0.01).The compression rate of trigeminal REZ which oppressed by artery in typical trigeminal neuralgia group was significantly higher than that in atypical trigeminal neuralgia group ( P<0.01 ) .Conclusions The responsible vessels in typical trigeminal neuralgia patients is mostly located in the trigeminal REZ, and the responsible vessels is mostly not located in other location in the trigeminal REZ.The responsible vessels oppress REZ is closely related to types of trigeminal neuralgia.

  7. Patterns of neurovascular compression in patients with classic trigeminal neuralgia: A high-resolution MRI-based study

    Energy Technology Data Exchange (ETDEWEB)

    Lorenzoni, Jose, E-mail: jls@med.puc.cl [Department of Neurosurgery, School of Medicine, Pontificia Universidad Catolica de Chile (Chile); David, Philippe, E-mail: pdavid@ulb.ac.be [Department of Radiology, Hopital Erasme, Universite Libre de Bruxelles, Brussels (Belgium); Levivier, Marc, E-mail: marc.levivier@chuv.ch [Department of Neurosurgery, Centre Hopitalier Universitaire Vaudois, Universite de Lausanne (Switzerland)

    2012-08-15

    Purpose: To describe the anatomical characteristics and patterns of neurovascular compression in patients suffering classic trigeminal neuralgia (CTN), using high-resolution magnetic resonance imaging (MRI). Materials and methods: The analysis of the anatomy of the trigeminal nerve, brain stem and the vascular structures related to this nerve was made in 100 consecutive patients treated with a Gamma Knife radiosurgery for CTN between December 1999 and September 2004. MRI studies (T1, T1 enhanced and T2-SPIR) with axial, coronal and sagital simultaneous visualization were dynamically assessed using the software GammaPlan Trade-Mark-Sign . Three-dimensional reconstructions were also developed in some representative cases. Results: In 93 patients (93%), there were one or several vascular structures in contact, either, with the trigeminal nerve, or close to its origin in the pons. The superior cerebellar artery was involved in 71 cases (76%). Other vessels identified were the antero-inferior cerebellar artery, the basilar artery, the vertebral artery, and some venous structures. Vascular compression was found anywhere along the trigeminal nerve. The mean distance between the nerve compression and the origin of the nerve in the brainstem was 3.76 {+-} 2.9 mm (range 0-9.8 mm). In 39 patients (42%), the vascular compression was located proximally and in 42 (45%) the compression was located distally. Nerve dislocation or distortion by the vessel was observed in 30 cases (32%). Conclusions: The findings of this study are similar to those reported in surgical and autopsy series. This non-invasive MRI-based approach could be useful for diagnostic and therapeutic decisions in CTN, and it could help to understand its pathogenesis.

  8. A Gain-of-Function Mutation in Nav1.6 in a Case of Trigeminal Neuralgia

    Science.gov (United States)

    Tanaka, Brian S; Zhao, Peng; Dib-Hajj, Fadia B; Morisset, Valerie; Tate, Simon; Waxman, Stephen G; Dib-Hajj, Sulayman D

    2016-01-01

    Idiopathic trigeminal neuralgia (TN) is a debilitating pain disorder characterized by episodic unilateral facial pain along the territory of branches of the trigeminal nerve. Human pain disorders, but not TN, have been linked to gain-of-function mutations in peripheral voltage-gated sodium channels (NaV1.7, NaV1.8 and NaV1.9). Gain-of-function mutations in NaV1.6, which is expressed in myelinated and unmyelinated central nervous system (CNS) and peripheral nervous system neurons and supports neuronal high-frequency firing, have been linked to epilepsy but not to pain. Here, we describe an individual who presented with evoked and spontaneous paroxysmal unilateral facial pain and carried a diagnosis of TN. Magnetic resonance imaging showed unilateral neurovascular compression, consistent with pain in areas innervated by the second branch of the trigeminal nerve. Genetic analysis as part of a phase 2 clinical study in patients with TN conducted by Convergence Pharmaceuticals Ltd revealed a previously undescribed de novo missense mutation in NaV1.6 (c.A406G; p.Met136Val). Whole-cell voltage-clamp recordings show that the Met136Val mutation significantly increases peak current density (1.5-fold) and resurgent current (1.6-fold) without altering gating properties. Current-clamp studies in trigeminal ganglia (TRG) neurons showed that Met136Val increased the fraction of high-firing neurons, lowered the current threshold and increased the frequency of evoked action potentials in response to graded stimuli. Our results demonstrate a novel NaV1.6 mutation in TN, and show that this mutation potentiates transient and resurgent sodium currents and leads to increased excitability in TRG neurons. We suggest that this gain-of-function NaV1.6 mutation may exacerbate the pathophysiology of vascular compression and contribute to TN. PMID:27496104

  9. Feasibility of Multiple Repeat Gamma Knife Radiosurgeries for Trigeminal Neuralgia: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Guy C. Jones

    2011-01-01

    Full Text Available Treatment options for trigeminal neuralgia (TN must be customized for the individual patient, and physicians must be aware of the medical, surgical, and radiation treatment modalities to prescribe optimal treatment courses for specific patients. The following case illustrates the potential for gamma knife radiosurgery (GKRS to be repeated multiple times for the purpose of achieving facial pain control in cases of TN that have been refractory to other medical and surgical options, as well as prior GKRS. The patient described failed to achieve pain control with initial GKRS, as well as medical and surgical treatments, but experienced significant pain relief for a period of time with a second GKRS procedure and later underwent a third procedure. Only a small subset of patients have reportedly undergone more than two GKRS for TN; thus, further research and long-term clinical followup will be valuable in determining its usefulness in specific clinical situations.

  10. Feasibility of Multiple Repeat Gamma Knife Radiosurgeries for Trigeminal Neuralgia: A Case Report and Review of the Literature

    Science.gov (United States)

    Jones, Guy C.; Elaimy, Ameer L.; Demakas, John J.; Jiang, Hansi; Lamoreaux, Wayne T.; Fairbanks, Robert K.; Mackay, Alexander R.; Cooke, Barton S.; Lee, Christopher M.

    2011-01-01

    Treatment options for trigeminal neuralgia (TN) must be customized for the individual patient, and physicians must be aware of the medical, surgical, and radiation treatment modalities to prescribe optimal treatment courses for specific patients. The following case illustrates the potential for gamma knife radiosurgery (GKRS) to be repeated multiple times for the purpose of achieving facial pain control in cases of TN that have been refractory to other medical and surgical options, as well as prior GKRS. The patient described failed to achieve pain control with initial GKRS, as well as medical and surgical treatments, but experienced significant pain relief for a period of time with a second GKRS procedure and later underwent a third procedure. Only a small subset of patients have reportedly undergone more than two GKRS for TN; thus, further research and long-term clinical followup will be valuable in determining its usefulness in specific clinical situations. PMID:21904556

  11. Brain-stem auditory evoked responses during microvascular decompression for trigeminal neuralgia: Predicting post-operative hearing loss

    Directory of Open Access Journals (Sweden)

    Ramnarayan Ramachandran

    2006-01-01

    Full Text Available Context: The importance of brainstem auditory evoked potential monitoring in reducing hearing loss during microvascular decompression for trigeminal neuralgia is now accepted. However the extent of the changes in the pattern of these potentials and the safe limits to which these changes are relevant in reducing postoperative hearing loss have not been established. Aims: The aim of this study is to quantify these changes and relate these to the postoperative hearing loss. Settings and Design: This study was done at the Walton Centre for neurology and neurosurgery, Liverpool, United Kingdom. The study was designed to give a measure of the change in the wave pattern following microvascular decompression and relate it to postoperative hearing loss. Materials and Methods: Seventy-five patients undergoing microvascular decompression for trigeminal neuralgia had preoperative and postoperative hearing assessments and intraoperative brainstem auditory evoked potential monitoring. Statistical Analysis Used: Chi-square tests. Results: It was found that the wave V latency was increased by more than 0.9ms in nine patients, eight of whom suffered significant postoperative hearing loss as demonstrated by audiometry. It was also seen that progressive decrease in amplitude of wave V showed progressive hearing loss with 25% loss when amplitude fell by 50 and 100% loss when wave V was lost completely. However most of the patients did not have a clinically manifest hearing loss. Conclusions: A per-operative increase in the latency of wave V greater than 0.9 ms and a fall of amplitude of wave V of more than 50% indicates a risk to hearing.

  12. Hypericum perforatum (St. John's Wort) as a possible therapeutic alternative for the management of trigeminal neuralgia (TN) - A case report.

    Science.gov (United States)

    Assiri, Khalil; Alyami, Yagoub; Uyanik, James M; Romero-Reyes, Marcela

    2017-02-01

    Hypericum perforatum (St. John's Wort) is an alternative remedy used primarily for depression but also is used for rheumatism, gastroenteritis, headache and neuralgias. The mechanism of action of Hypericum perforatum comprehends a neurotransmitter inhibitory profile, and potential anti-inflammatory and anti-oxidant effects suggesting a role for pain management. In this case report, we describe a 53-year-old Hispanic female patient who came to our orofacial pain clinical service presenting with a history of trigeminal neuralgia (TN). The patient was not able to get an appointment soon enough and decided to take an over the counter homeopathic preparation of Hypericum perforatum since she found on the internet that it was effective for nerve pain. The patient responded dramatically to the Hypericum perforatum preparation. The use of this homeopathic preparation relieved completely the TN pain. The management of TN is often a challenge. Hypericum perforatum may be a promising therapeutic option for TN that deserves to be explored further to solidly support its use in the clinical setting.

  13. Gamma Knife surgery for tumor-related trigeminal neuralgia: targeting both the tumor and the trigeminal root exit zone in a single session.

    Science.gov (United States)

    Kim, Sung Kwon; Kim, Dong Gyu; Se, Young-Bem; Kim, Jin Wook; Kim, Yong Hwy; Chung, Hyun-Tai; Paek, Sun Ha

    2016-10-01

    OBJECTIVE Gamma Knife surgery (GKS) represents an alternative treatment for patients with tumor-related trigeminal neuralgia (TRTN). However, in previous studies, the primary GKS target was limited to mass lesions. The authors evaluated whether GKS could target both the tumor and the trigeminal root exit zone (REZ) in a single session while providing durable pain relief and minimizing radiation dose-related complications for TRTN patients. METHODS The authors' institutional review board approved the retrospective analysis of data from 15 consecutive patients (6 men and 9 women, median age 67 years, range 45-79 years) with TRTN who had undergone GKS. In all cases, the radiation was delivered in a single session targeting both the tumor and trigeminal REZ. The authors assessed the clinical outcomes, including the extent of pain relief, durability of the treatment response, and complications. Radiation doses to organs at risk (OARs), including the brainstem and the cranial nerve VII-VIII complex, were analyzed as doses received by 2% or 50% of the tissue volume and the tissue volume covered by a dose of 12 Gy (V12Gy). RESULTS The median length of clinical follow-up was 38 months (range 12-78 months). Pain relief with GKS was initially achieved in 14 patients (93.3%) and at the last follow-up in 13 patients (86.7%). The actuarial recurrence-free survival rates were 93%, 83%, and 69% at 1, 3, and 5 years after GKS, respectively. Persistent facial numbness was observed in 3 patients (20.0%). There were no complications such as facial weakness, altered taste function, hearing impairment, and balance difficulties indicating impaired function of the cranial nerve VII-VIII complex. The V12Gy in the brainstem was less than or equal to 0.24 cm(3) in all patients. There were no significant differences in any OAR values in the brainstem between patients with and without facial numbness after GKS. CONCLUSIONS The strategy of performing GKS for both tumor and trigeminal REZ in a

  14. Long-term efficacy and safety of internal neurolysis for trigeminal neuralgia without neurovascular compression.

    Science.gov (United States)

    Ko, Andrew L; Ozpinar, Alp; Lee, Albert; Raslan, Ahmed M; McCartney, Shirley; Burchiel, Kim J

    2015-05-01

    OBJECT Trigeminal neuralgia (TN) occurs and recurs in the absence of neurovascular compression (NVC). While microvascular decompression (MVD) is the most effective treatment for TN, it is not possible when NVC is not present. Therefore, the authors sought to evaluate the safety, efficacy, and durability of internal neurolysis (IN), or "nerve combing," as a treatment for TN without NVC. METHODS This was a retrospective review of all cases of Type 1 TN involving all patients 18 years of age or older who underwent evaluation (and surgery when appropriate) at Oregon Health & Science University between July 2006 and February 2013. Chart reviews and telephone interviews were conducted to assess patient outcomes. Pain intensity was evaluated with the Barrow Neurological Institute (BNI) Pain Intensity scale, and the Brief Pain Inventory-Facial (BPI-Facial) was used to assess general and face-specific activity. Pain-free survival and durability of successful pain relief (BNI pain scores of 1 or 2) were statistically evaluated with Kaplan-Meier analysis. Prognostic factors were identified and analyzed using Cox proportional hazards regression. RESULTS A total of 177 patients with Type 1 TN were identified. A subgroup of 27 was found to have no NVC on high-resolution MRI/MR angiography or at surgery. These patients were significantly younger than patients with classic Type 1 TN. Long-term follow-up was available for 26 of 27 patients, and 23 responded to the telephone survey. The median follow-up duration was 43.4 months. Immediate postoperative results were comparable to MVD, with 85% of patients pain free and 96% of patients with successful pain relief. At 1 year and 5 years, the rate of pain-free survival was 58% and 47%, respectively. Successful pain relief at those intervals was maintained in 77% and 72% of patients. Almost all patients experienced some degree of numbness or hypesthesia (96%), but in patients with successful pain relief, this numbness did not

  15. 三叉神经体感诱发电位监测对三叉神经痛诊断的意义%The Diagnostic Value of Trigeminal Somatosensory Evoked Potential Monitoring for Trigeminal Neuralgia

    Institute of Scientific and Technical Information of China (English)

    李俊庆; 李景义

    2014-01-01

    目的:探讨三叉神经体感诱发电位监测对三叉神经痛诊断的意义。方法2013年本院共收治三叉神经痛患者34例,对其进行三叉神经体感诱发电位的检查,并与健侧做对比,分析其特点。结果34例患者患侧与健侧各波潜伏期比较,差异有统计学意义(P ﹤0.05)。结论三叉神经体感诱发电位监测可以作为三叉神经痛辅助诊断的客观指标。%Objective To study the diagnostic value of trigeminal somatosensory evoked potential monitoring for tri-geminal neuralgia. Methods 34 patients in our hospital in 2013,which were received trigeminal somatosensory evoked poten-tial monitoring test,then compared with uninjured side. Results There were statistically significant differences in each wave incubation period between affected side and uninjured side(P ﹤ 0. 05). Conclusion Trigeminal somatosensory evoked poten-tial monitoring is an objective indicate of auxiliary diagnosis in trigeminal neuralgia.

  16. Trigeminal Neuralgia: Evaluation of the Relationship Between the Region of Neuralgic Manifestation and the Site of Neurovascular Compression Under Endoscopy.

    Science.gov (United States)

    Zhang, Wenhao; Chen, Minjie; Zhang, Weijie; Chai, Ying

    2015-07-01

    This study aimed to evaluate the relationship among the pain region, branches of trigeminal nerve, and the neurovascular compression (NVC) location. A total of 123 consecutive patients with trigeminal neuralgia (TN) underwent endoscope-assisted microvascular decompression according to positive preoperative tomographic angiography. V2 alone was in 51 cases and V3 alone was in 64 cases. The location of NVC was classified into cranial, caudal, medial, or lateral sites. Some patients with multiple regions were recorded as medial + cranial, lateral + cranial, medial + caudal, and lateral + caudal. Twenty-eight (71.8%) of 39 patients with TN (V2) had their NVC at the medial site of the nerve. Twenty-seven (64.3%) of 42 patients with TN (V3) had their NVC at the lateral site of the nerve. There was a statistically significant difference (P = 0.0011 NVC at the cranial site of the nerve. Thirty-four (69.4%) of 49 patients with TN (V3) had their NVC at the caudal site of the nerve. There was no statistical difference (P = 0.3097 > 0.01). Evaluation of the relationship between the pain region and the NVC location by endoscopic images during microvascular decompression is more accurate. The second branch is mostly distributed in the medial area, and third branch is mainly distributed in the lateral area.

  17. Is it effective to raise the irradiation dose from 80 to 85 Gy in gamma knife radiosurgery for trigeminal neuralgia?

    Science.gov (United States)

    Kim, Yong Hwy; Kim, Dong Gyu; Kim, Jin Wook; Kim, Young-Hoon; Han, Jung Ho; Chung, Hyun-Tai; Paek, Sun Ha

    2010-01-01

    In order to assess the effect of raising gamma knife radiosurgery (GKS) doses from 80 to 85 Gy for the treatment of trigeminal neuralgia (TN), the authors analyzed the outcomes of GKS in each group. The authors retrospectively collected follow-up data of 104 GKS procedures conducted for TN. Doses of 80 and 85 Gy were prescribed for 60 and 44 patients, respectively. The target was 2-4 mm anterior to the junction of the trigeminal nerve and pons. Outcomes were quantified based on facial pain levels and classified using the Barrow Neurological Institute scale. Actuarial rates of a favorable pain control outcome at 1 and 3 years after GKS were 75.0 and 61.2% for 80 Gy and 65.9 and 60.3% for 85 Gy. Post-GKS facial sensory loss developed in 20.6%. There was no statistically significant difference in pain control rate between the two groups. Time to maximal pain relief was shorter in the 85-Gy group. Protracted morbidity before GKS was a favorable prognostic factor of pain control in a multivariate analysis. According to our finding that 85 Gy brought more rapid clinical improvement without causing more complications, 85 Gy seems to be preferable to 80 Gy, but prospective randomized trials are mandatory to get a more definite conclusion on the optimal dose for GKS of TN.

  18. Neuralgia del Trigémino: Revisión del tratamiento médico y quirúrgico Trigeminal neuralgia: A Review of the medical a surgical management

    Directory of Open Access Journals (Sweden)

    Francisco Javier Robaina Padrón

    2008-05-01

    écnicas con sus ventajas e inconvenientes, teniendo muy en cuenta la experiencia previa del médico que realizará el procedimiento quirúrgico. La termocoagulación con radiofrecuencia del ganglio de Gasser posee ventajas e inconvenientes pero carece de mortalidad, consiguiéndose alivio en el 75% de los pacientes. La rizotomía retrogasseriana con glicerol consigue alivio persistente en el 55% de los casos. La microcompresión percutánea del ganglio de Gasser con balón de Fogarty precisa anestesia general obteniéndose alivio persistente en el 76% de los casos. La descompresión microvascular obtiene buenos resultados en el 77% de lo casos y un riesgo de mortalidad del 1% en manos muy expertas. La radiocirugía estereotáctica del ganglio de Gasser consigue porcentajes de alivio del dolor alrededor del 70%. La neuralgia del trigémino es una entidad de difícil manejo con porcentajes discretos de alivio del dolor mediante tratamiento farmacológico. Las técnicas intervencionistas percutáneas incluyendo la radiocirugía estreotáctica son una alternativa eficaz para el control del dolor. Salvo pacientes jóvenes o que expresamente lo soliciten, la descompresión microvascular debería ofrecerse en último lugar.Trigetninal neuralgia is defined by the International Association for the Study of Pain (IASP as a paroxistic, unilateral, severe, penetrant pain of short duration and localized in the distribution of one or several trigeminal nerve branches. It can be idiopathic or sintomatic, secundary to múltiple sclerosis or due to tumoral lesions in the cerebelo pontine angle in the posterior fossa. Is a neuropathic pain due in its idiopathic form to vascular compression of the trigeminal root. Its prevalence is rather high and posible is increasing due to the improvement of live expectancy of the polulation. The medical treatment is the first step for pain control Carbamacepine is the most used and usefull drug to treat this pain condition, although it can induce side

  19. 三叉神经痛的分子发病机制的研究进展%Progress on molecular pathogenesis of trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    吴饶平; 熊伟; 高云

    2011-01-01

    Trigeminal neuralgia( TN )is a recurrent and parox- ysmal pain in regions innervated by one or several branches oftrigeminal nerve. It has a great impact on the quality of patients life and is difficult to cure completely. Generally, TN is divided into primary and secondary TN in clinical practice. At present, the etiology and pathogenesis of TN remain unclear. With the progress of molecular biology, it has been found that a variety of nerve substances are closely linked with TN. In this paper, a review has been made on pathogenesis and researchprogress of trigeminal neuralgia from the point of molecular mechanism, hoping to find a theoretical basis for the treatment of trigeminal neuralgia.%三叉神经痛(trigeminal neuralgia,TN)是指三叉神经的一支或几支分布区的反复性、阵发性剧痛,对病人的生活质量影响较大的一种较难完全治愈的疾病,临床一般分为原发性和继发性TN.关于原发性TN的病因和发病机制目前尚不明确.现在,随着分子生物学研究的进展,已经发现多种神经类物质和TN有着密切的联系.该文从分子方面对TN的发病机制研究进展情况作一综述,旨在为TN的治疗提供理论依据.

  20. 神经干阻断治疗三叉神经痛初步分析%Preliminary Analysis of Trigeminal Neuralgia Treated by Nerve Block

    Institute of Scientific and Technical Information of China (English)

    韩贵轩

    2016-01-01

    目的:探讨神经干阻断治疗三叉神经痛临床疗效。方法选择三叉神经痛患者进行临床干预观察效果。结果治疗后半个月、1个月、3个月观察组评分明显低于对照组。结论神经干阻断治疗三叉神经痛明显优于一般疗法。%Objective To investigate the clinical efficacy of nerve block in the treatment of trigeminal neuralgia. Methods The clinical effect of the treatment of patients with trigeminal neuralgia was observed. Results The scores of the observation group were significantly lower than those in the control group after 1 months, months and 3 months after treatment. Conclusion The nerve block in the treatment of trigeminal neuralgia is better than the general treatment.

  1. [Craniofacial neuralgias].

    Science.gov (United States)

    Mikula, Ivan

    2008-05-01

    Craniofacial neuralgias are characterized by sudden paroxysmal pain along the distribution of one or more of the cranial or upper cervical spinal nerves. The most significant neuralgia of the craniofacial region is trigeminal neuralgia, while geniculate neuralgia, glossopharyngeal neuralgia and occipital neuralgia are less common. Trigeminal neuralgia may be primary or secondary. Idiopathic trigeminal neuralgia or tic douloureux has been recognized for centuries as an extremely painful disorder most commonly involving the maxillary nerve. Recurrent lancinating, shocklike unilateral pain lasting for seconds to minutes is provoked by non noxious stimulation of the skin at specific sites around the face and less frequently by movement of the tongue. The trigger zones are usually within the same dermatome as the painful sensation. After each episode, there is usually a refractive period during which stimulation of the trigger zone will not induce pain. Idiopathic trigeminal neuralgia occurs somewhat more frequently in women and usually begins in individuals 50 to 70 years of age. There is no pain between attacks, and the frequency of painful episodes can range from several per day to only a few per year. With time, the features may become more atypical, with greater areas of more enduring and dull pain and occasionally bilateral pain, rarely on both sides simultaneously. No sensory or reflex deficit is detectable by routine neurologic testing. Diagnostic local anesthetic blocks will identify the specific nerves involved and the trigger point distribution. Neurologic and neuroradiologic examination is advised in all cases to rule out diseases such as intracranical tumors, vascular malformations or multiple sclerosis.

  2. Radiofrequency thermocoagulation for V2/V3 idiopathic trigeminal neuralgia: effect of treatment temperatures on long-term clinical outcomes

    Science.gov (United States)

    Yao, Peng; Deng, Yi-yong; Hong, Tao; Wang, Zhi-bin; Ma, Jia-ming; Zhu, Yong-qiang; Li, Hong-xi; Ding, Yuan-yuan; Pan, Shi-nong

    2016-01-01

    Abstract Radiofrequency thermocoagulation (RFT) is widely used to treat trigeminal neuralgia (TN); however, the optimal temperature at which RFT is most efficacious remains under much debate. Thus, the aim of the present study was to determine the lowest temperature at which morbidity could be minimized and patient outcomes maximized. A multivariate analysis was used to study 1354 patients who underwent computed tomography (CT)-guided RFT for V2/V3 idiopathic trigeminal neuralgia (ITN) during from June 2006 to May 2015. RFT was carried out at 62, 65, and 68°C, while keeping all other RF parameters the same. This was a prospective cohort study, in which we assessed intra- and postoperative complications, pain relief, and long-term health-related quality of life (HRQoL). The intraoperative and in-hospital complications of patients were mainly facial hematoma, mouth and external auditory meatus penetration, nausea, vomiting, dizziness, and headache, which were all treated symptomatically. In long-term follow-up, patients with pain relief (defined as no pain and no required drug intervention) at 62, 65, and 68°C accounted for 94.2%, 98.3%, and 98.8% (at discharge); 83.8%, 90.1%, and 91.4% (at 1 year); 66.7%, 80.5%, and 88.2% (at 3 years); 59.0%, 64.3%, and 77.2% (at 5 years); 48.7%, 57.8%, and 72.3% (at 7 years); 40.6%, 53.7%, and 60.3% (at 9 years), respectively. The number of patients with facial numbness, masticatory atonia, or corneal hypoesthesia was increased with the elevation of temperature, but these complications were all mild. No blindness, deafness, intracranial hemorrhage, or death as a result of the surgical intervention occurred in any patients. SF-36 scores showed highest HRQoL in the group treated at 68°C, followed by the 65 and 62°C groups, respectively. Our results demonstrate that 68°C is a good choice for RFT of V2/V3 ITN. The alternative option is 65 or 62°C for RFT to minimize the occurrence of complications including facial numbness, yet

  3. Magnetic resonance imaging of vascular compression in trigeminal neuralgia and hemifacial spasms; The efficacy of oblique sagittal view

    Energy Technology Data Exchange (ETDEWEB)

    Nagaseki, Yoshishige; Horikoshi, Tohru; Omata, Tomohiro; Sugita, Masao; Nukui, Hideaki; Sakamoto, Hajime; Kumagai, Hiroshi (Yamanashi Medical College, Tamaho (Japan)); Sasaki, Hideo; Tsuji, Reizou

    1991-06-01

    We show how neurosurgical planning can benefit from the better visualization of the precise vascular compression of the nerve provided by the oblique-sagittal and gradient-echo method (OS-GR image) using magnetic resonance images (MRI). The scans of 3 patients with trigeminal neuralgia (TN) and of 15 with hemifacial spasm (HFS) were analyzed for the presence and appearance of the vascular compression of the nerves. Imaging sequences consisted of an OS-GR image (TR/TE: 200/20, 3-mm-thick slice) cut along each nerve shown by the axial view, which was scanned at the angle of 105 degrees taken between the dorsal line of the brain stem and the line corresponding to the pontomedullary junction. In the OS-GR images of the TN's, the vascular compressions of the root entry zone (REZ) of the trigeminal nerve were well visualized as high-intensity lines in the 2 cases whose vessels were confirmed intraoperatively. In the other case, with atypical facial pain, vascular compression was confirmed at the rostral distal site on the fifth nerve, apart from the REZ. In the 15 cases of HFS, twelve OS-GR images (80%) demonstrated vascular compressions at the REZ of the facial nerves from the direction of the caudoventral side. During the surgery for these 12 cases, in 11 cases (excepting the 1 case whose facial nerve was not compressed by any vessels), vascular compressions were confirmed corresponding to the findings of the OS-GR images. Among the 10 OS-GR images on the non-affected side, two false-positive findings were visualized. It is concluded that OS-GR images obtained by means of MRI may serve as a useful planning aid prior to microvascular decompression for cases of TN and HFS. (author).

  4. Identification of offending vessele in trigeminal neuralgia and hemifacial spasm using SPGR-MRI and 3D-TOF-MRA

    Energy Technology Data Exchange (ETDEWEB)

    Niwa, Yoshikazu; Shiotani, Masahiro; Karasawa, Hidetake; Ohseto, Kiyoshige; Naganuma, Yoshikazu [Kanto Teishin Hospital, Tokyo (Japan)

    1996-04-01

    We investigated 100 consecutive patients with trigeminal neuralgia (TN) and 53 patients with hemifacial spasm (HFS) concerning the anatomical relationship between the root entry (exit) zone (REZ) of cranial nerve and the offending artery, using spoiled GRASS MRI (SPGR-MRI) and three dimensional-time of fly-MRA (MRA). In 67 of 100 (67%) patients with TN, this new radiological method, SPGR-MRI and MRA demonstrated the relationship between the fifth cranial nerve root and offending artery causing neurovascular compression (NVC), and in 46 of 53 (87%) with HFS, demonstrated the similar relationship between seventh and eighth nerve complex and offending artery. Microvascular decompression (MVD) was performed in 10 with HFS, and NVC of the REZ of the facial nerve caused by the offending artery was exactly predicted by SPGR-MRI and MRA in 9 (90%). The combination of SPGR-MRI and MRA is very useful for demonstrating NVC as the cause of TN and HFS. On the other hand, we investigated asymptomatic 206 trigemimal and 253 facial nerves about the relationship between their REZ and the surrounding structures using the similar method. The contact of REZ of cranial nerve with surrounding artery is demonstrated in 31.6% of trigeminal nerves and in 22.5% of facial nerves. These results indicate that the contact of REZ of cranial nerve with surrounding artery is not rare in healthy subjects, though causing TN and HFS in particular patients. In this context, we discussed the difference between the contact which is asymptomatic and the compression which is symptomatic. (author)

  5. An investigation of eye lens dose of stereotactic radiosurgery for trigeminal neuralgia using Leksell Gamma Knife model C.

    Science.gov (United States)

    Liang, Cheng-Loong; Ho, Meng-Wei; Lu, Kang; Tsai, Yu-Duan; Liliang, Po-Chou; Wang, Kuo-Wei; Chen, Han-Jung

    2006-12-01

    The authors conducted a study to assess the eye lens dosimetry in trigeminal neuralgia (TN) treatment when using the Leksell Gamma Knife model C. Phantom studies were used to measure the maximal dose reaching the eye lens with and without eye shielding. Six consecutive patients with TN were evaluated for Gamma Knife surgery (GKS). The maximum prescribed dose of 80 Gy was delivered with a single shot using the 4-mm collimator helmet. High-sensitivity thermoluminescence dosimeter chips (TLDCs) were used to measure the dosimetry. In vitro, the Leksell GammaPlan (LGP) system predicted the mean maximal doses of 1.08 +/- 0.08 and 0.15 +/- 0.01 Gy (mean +/- standard deviation) to the lens ipsilateral to the treated trigeminal nerve without and with eye shielding, respectively. The TLDCs-measured dosimetry indicated the mean maximal doses of 1.12 +/- 0.09 and 0.17 +/- 0.01 Gy without and with eye shielding, respectively. The maximal doses to the lens contralateral to the nerve were similar. In vivo, the LGP predicted the mean maximal doses to the lens ipsilateral to the treated nerve as 1.1 +/- 0.07 and 0.16 +/- 0.02 Gy, respectively, without and with eye shielding. The dosimetry measured by TLDCs indicated the mean maximal dose to the lens ipsilateral to the treated nerve as 0.17 +/- 0.02 Gy with eye shielding. The mean maximal doses to the lens contralateral to the nerve were similar. Using the 110 and 125 degrees gamma angles, the LGP predicted the mean maximal doses of 0.32 +/- 0.04 and 0.12 +/- 0.04 Gy to the lens without and with eye shielding, respectively. Patients with TN undergoing GKS without eye shielding may develop cataracts due to the high radiation dose to the eye lenses. The authors suggest the routine use of bilateral eye shielding for the patients.

  6. Trigeminal Neuralgia as the First Clinical Manifestation of Anti-Hu Paraneoplastic Syndrome Induced by a Borderline Ovarian Mucinous Tumor

    Directory of Open Access Journals (Sweden)

    Hossein Kalanie

    2014-01-01

    Full Text Available Paraneoplastic neurologic syndrome (PNS is an uncommon manifestation of cancer that is not caused by the tumor or metastasis. Trigeminal neuralgia (TN is an initial symptom of this disease, but it has rarely been reported in the literature. Here, we report the case of a 76-year-old woman who presented with classic TN, followed by limbic encephalitis due to an underlying ovarian intestinal-type mucinous borderline tumor, with the presence of anti-Hu antibodies. She recovered quickly after removal of the tumor and was essentially free of symptoms 2 weeks after surgery. Because PNS precedes the tumor in approximately 60% of cases, its rapid detection and treatment are crucial. Therefore, we propose that PNS be considered during the management of TN when brain imaging is normal, as it is followed by other central and/or peripheral neurological manifestations as well as the presence of systemic symptoms such as anemia, fatigability, loss of appetite, or weight loss.

  7. Expression of hNav1.8 sodium channel protein in affected nerves of patients with trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    ZHU Ling-lan; JIANG Xiao-zhong; ZHAO Yun-fu; LI Yu-li; HE Jin

    2004-01-01

    Objective: To explore the pathogenesis of trigeminal neuralgia (TN) and to provide a new target for the drug treatment of TN by studying the expression of tetrodotoxin-resistant hNavl. 8 sodium channel protein in affected nerves of patients with TN. Methods: Twelve affected inferior alveolar nerves were obtained from patients with idiopathic TN, to whom the drug therapy was not effective. As negative control, one normal inferior alveolar nerve was obtained from patients who accepted the combined radical neck dissection with glossectomy and mandibulectomy. One muscle sample was obtained as normal control. One dorsal root ganglion from rat was as positive control. These tissues and prepared hNav1.8 antibody were conducted immunohistochemistry response. Results: hNavl. 8 channel protein was expresses in all the 12 specimens of the affected nerves of patients with TN, but not in the muscle sample and the normal inferior alveolar nerve. Conclusion:The abnormal expression of hNavl. 8 channel protein in the affected nerves of patients with TN may play an impo~nt role in the pathogenesis of TN.

  8. Gamma knife radiosurgery for trigeminal neuralgia: comparing the use of a 4-mm versus concentric 4- and 8-mm collimators.

    Science.gov (United States)

    Kanner, Andrew A; Neyman, Gennady; Suh, John H; Weinhous, Martin S; Lee, Shih-Yuan; Barnett, Gene H

    2004-01-01

    Gamma knife (GK) radiosurgery for trigeminal neuralgia (TN) has been effective in 50-80% of cases when using a single 4-mm collimator and a maximum dose of 60-90 Gy. Attempting to improve the response rate by increasing the dose may lead to increased risk of facial numbness or disturbed sensation. Combined use of 4- and 8-mm collimators results in a larger target volume, which would potentially treat a larger region of the nerve without increasing the maximum dose. One hundred-one patients suffering from medically refractory TN were evaluated. Fifty-four were treated with a single shot using a 4-mm helmet and 47 with concentrically aimed, equally weighted 4- and 8-mm helmets. 75 Gy were prescribed to the 100% isodose line (using a 4-mm helmet output factor of 0.80) in all cases. The outcome was assessed by interview or outpatient visit. An excellent/good response was seen in 57.8 vs. 71.4%, respectively, with a partial response of 13.3 vs. 2.3%, respectively (p > 0.05). Pain recurrence occurred in 28.6 vs. 23.2%, respectively (p > 0.05). The use of a combined concentric 4- and 8-mm collimator treatment for medically refractory TN at a maximum dose of 75 Gy does not improve outcome as compared with a single 4-mm collimator with an equivalent maximum dose. Copyright 2004 S. Karger AG, Basel

  9. Botulinum neurotoxin type A in the treatment of classical Trigeminal Neuralgia (BoTN): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Burmeister, Jan; Holle, Dagny; Bock, Eva; Ose, Claudia; Diener, Hans-Christoph; Obermann, Mark

    2015-12-03

    Trigeminal neuralgia is characterized by paroxysmal facial pain attacks. Adequate prophylactic drug therapy is often limited by the lack of efficacy and intolerance due to central nervous system side effects. Subcutaneous injections of botulinum toxin type A are a promising treatment option for patients with unsatisfactory response to drug therapy or neurosurgical intervention. Its effects are expected to last for at least 3 months, so it could be a potential long-term treatment. This is the study protocol of a prospective, placebo-controlled, double blind clinical trial investigating the add-on therapy of subcutaneous administration of botulinum toxin type A injections to standard treatment in therapy-refractory classical trigeminal neuralgia. BoTN is a prospective, double blind, placebo-controlled trial with a randomized withdrawal design in which a single blind phase is followed by a double blind phase (see also Methods and design). Eligible patients with classical trigeminal neuralgia who are otherwise refractory to medical and neurosurgical treatment will receive subcutaneous injections of botulinum toxin type A into injection sites of the affected trigeminal branch. In the first phase all patients will receive botulinum toxin type A in a single blinded intervention. Twelve weeks later therapy responders will be allocated to the verum or placebo (saline) arm in a double blind, randomized manner. These injections will be performed at the same sites as the first injections. This trial will be conducted in a tertiary outpatient clinic specialized in the treatment of headache and facial pain. There will be three investigators performing the injections who are experienced in the treatment of headache and facial pain and trained in botulinum toxin type A injections. BoTN is designed to assess the efficacy and safety of subcutaneous botulinum toxin type A injections in addition to standard prophylactic treatment in therapy-refractory trigeminal neuralgia. EU Clinical

  10. [Experience of professor FANG Jianqiao treating trigeminal neuralgia at different stages].

    Science.gov (United States)

    Sun, Jing; Fang, Jianqiao; Shao, Xiaomei; Chen, Lifang

    2016-02-01

    Trigerninal neuralgia is a common refractory disease in clinic. Professor FANG Jianqiao has rich experience through diagnosing and treating the disease for many years. In the first diagnosis, professor FANG underlines the position of damaged neuron and syndrome differentiation. He considers acupuncture should be implemented by stages,namely according to whether the patients are in the period of pain attack, different acupuocture prescriptions are made. Acupuncture manipulation and needle-retention time should be adjusted according to the condition of disease. And the appropriate application of electroacupuncture and transcutaneous electrical acupoint stimulation can strengthen the effect.

  11. Magnetic resonance imaging contribution for diagnosing symptomatic neurovascular contact in classical trigeminal neuralgia: a blinded case-control study and meta-analysis.

    Science.gov (United States)

    Antonini, Giovanni; Di Pasquale, Antonella; Cruccu, Giorgio; Truini, Andrea; Morino, Stefania; Saltelli, Giorgia; Romano, Andrea; Trasimeni, Guido; Vanacore, Nicola; Bozzao, Alessandro

    2014-08-01

    Although classical trigeminal neuralgia (CTN) is frequently caused by neurovascular contact (NVC) at the trigeminal root entry zone (REZ), both anatomical and MRI studies have shown that NVC of the trigeminal nerve frequently occurs in individuals without CTN. To assess the accuracy of MRI in distinguishing symptomatic from asymptomatic trigeminal NVC, we submitted to high-definition MRI the series of CTN patients referred to our outpatient service between June 2011 and January 2013 (n=24), and a similar number of age-matched healthy controls. Two neuroradiologists, blinded to the clinical data, evaluated whether the trigeminal nerve displayed NVC in the REZ or non-REZ, whether it was dislocated by the vessel or displayed atrophy at the contact site, and whether the offending vessel was an artery or a vein. Our data were meta-analyzed with those of all similar studies published from January 1970 to June 2013. In our sample, REZ contact, nerve dislocation and nerve atrophy were independently associated with CTN (P=.027; P=.005; P=.035 respectively). Compared to a rather low sensitivity of each of these items (alone or in combination), their specificity was high. When REZ contact and nerve atrophy coexisted, both specificity and positive predictive value rose to 100%. Meta-analysis showed that REZ NVC was detected in 76% of symptomatic and 17% of asymptomatic nerves (PNVC, as detected by MRI, is highly likely to be symptomatic when it is associated with anatomical nerve changes.

  12. Sensitivity and specificity of MRA in the diagnosis of neurovascular compression in patients with trigeminal neuralgia. A correlation of MRA and surgical findings

    Energy Technology Data Exchange (ETDEWEB)

    Boecher-Schwarz, H.G.; Bruehl, K.; Kessel, G.; Guenthner, M.; Perneczky, A.; Stoeter, P. [Neurosurgical Department, Klinikum der Johannes Gutenberg-Universitaet, Mainz (Germany)

    1998-02-01

    The published rates of operatively confirmed neurovascular compression as the cause for trigeminal neuralgia range from 10 % to nearly 100 %. High-definition magnetic resonance angiography (MRA) was performed in 27 consecutive patients (in 6 cases with 3D reconstructions) to show neurovascular compression preoperatively. The MRA findings were compared with the relationship between the Vth nerve and the surrounding vessels at surgery. In 23 patients MRA showed present neurovascular compression in accordance with surgical findings (18/27 in complete accordance of type and side of vessel, site and direction of compression). One woman had no neurovascular compression either on MRA or intraoperatively. One MRA prediction of neurovascular compression was false, and two results were false negative. The sensitivity of MRA was therefore 88.5 % but the specificity only 50 %, if surgical findings are the reference. In one patient with right trigeminal neuralgia MRA revealed bilateral neurovascular compression of the Vth nerves. Therefore, the overall specificity of MRA might be below 50 %. In one patient with multiple sclerosis, the decision to operate was markedly influenced by the clear finding of neurovascular compression on MRA. The patient has been free from trigeminal pain for 149 weeks after microvascular decompression. In 6 patients, 3D reconstructions of the MRA data were performed. The images helped in 3D visualisation of the operation, but did not yield new information about the nature of the vessels revealed, or the site, direction or side of the neurovascular compression. (orig.) With 3 figs., 4 tabs., 25 refs.

  13. Novel design for a phase IIa placebo-controlled, double-blind randomized withdrawal study to evaluate the safety and efficacy of CNV1014802 in patients with trigeminal neuralgia

    Science.gov (United States)

    2013-01-01

    Background Trigeminal neuralgia (TN) is a rare severe unilateral facial pain condition. Current guidelines in trigeminal neuralgia management recommend sodium channel blockers – carbamazepine or oxcarbazepine – as the first-line treatment. However, the currently available drugs are often associated with poor tolerability resulting in sub-optimal pain control. CNV1014802 is a novel sodium channel blocker that is being assessed in the treatment of trigeminal neuralgia. Due to the severity of the condition, it is not ethical to conduct a traditional placebo-controlled randomized controlled trial. It is also difficult to use an active control such as carbamazepine, the current gold standard, because of its complex pharmacology and potential for drug interactions. Methods/Design The trial uses a randomized withdrawal design to assess efficacy in this rare condition. There is a 21-day open-label phase followed by a randomized 28-day placebo-controlled phase for responders. Thirty patients will be randomized. The primary outcome measure will be pain relief, but secondary measures of quality of life will be of significant importance given the effect of this condition on activities of daily living. Safety and adverse event endpoints are described. Discussion There have been very few well-controlled, randomized, placebo-controlled studies in trigeminal neuralgia, and the majority of drugs have had other primary uses. Due to the severity of the pain, minimizing the time a patient is administered placebo was a key factor in designing this study. This study will not only provide data on the efficacy of CNV1014802 in trigeminal neuralgia, but will also provide information on the effectiveness and acceptability of a novel trial design in trigeminal neuralgia. Trial registration Trial number NCT01540630 PMID:24267010

  14. Clinical analysis of linear accelerator radiosurgery for 42 cases with trigeminal neuralgia%X刀治疗三叉神经痛42例临床分析

    Institute of Scientific and Technical Information of China (English)

    陈苏; 王如密; 王守森

    2008-01-01

    Objective To study the treatment effect of linear accelerator radiosurgery (X knife) on trigeminal neuralgia and the complications. Methods Follow-up was conducted in 42 cases of trigeminal neuralgia treated with linear accelerator radiosurgery in our department, and their complications and degree of pain relief were recorded. Results Outcomes were excellent in 14 (33.3%), good in 22 (52.4%), effective in 4 (9.5%) and poor in 2 (4.8%). The mean time of pain relief was 2.1 months. Seven (16.7%) cases experienced increased facial paresthesia. Conclusion Linear accelerator radiosurgery is a precise and effective treatment for trigeminal neuralgia.%目的 探讨直线加速器放射外科(X 刀)治疗三叉神经痛的疗效及其并发症.方法 回顾性分析我科收治的42例三叉神经痛患者的临床资料,均采用X刀治疗并随访疼痛缓解情况和并发症.结果 本组治疗效果为治愈14例(33.3%).显效22例(52.4%),有效4例(9.5%),无效2例(4.8%).疼痛缓解出现时间平均在2.1月之后.7例(16.7%)术后出现面部麻木.结论 X刀是一种精确而有效的治疗三叉神经痛的方法.

  15. Preoperative detection of the neurovascular relationship in trigeminal neuralgia using three-dimensional fast imaging employing steady-state acquisition (FIESTA) and magnetic resonance angiography (MRA).

    Science.gov (United States)

    Zeng, QingShi; Zhou, Qin; Liu, ZhiLing; Li, ChuanFu; Ni, ShiLei; Xue, Feng

    2013-01-01

    Microvascular decompression is an accepted treatment for trigeminal neuralgia (TN). Preoperative identification of neurovascular compression, therefore, could aid determination of the appropriate treatment for TN. To preoperatively visualize the neurovascular relationship, three-dimensional fast imaging employing steady-state acquisition (3D FIESTA) and magnetic resonance angiography (MRA) were performed on 37 patients with TN in our study. 3D FIESTA in combination with MRA identified surgically verified neurovascular contact in 35 of 36 symptomatic nerves. The offending vessel (artery or vein) was correctly identified in 94.4% of patients, and agreement between preoperative MRI visualization and surgical findings was excellent (k=0.92; 95% confidence interval, 0.67-1.00). Thus, 3D FIESTA in combination with MRA is useful in the detection of vascular contact with the trigeminal nerve in patients with TN. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. THIRTY-TWO CASES OF TRIGEMINAL NEURALGIA TREATED BY MEDICATION PLUS MOXIBUSTION%药物结合艾灸治疗三叉神经痛32例

    Institute of Scientific and Technical Information of China (English)

    蒋利群

    2007-01-01

    @@ 1 CLINICAL DATA In this series, all the 32 cases were outpatients except one. Of them, 10 cases were male and 22 cases female, ranging from 26 to 78 yeas in age and from 1 month to 12 years in the course of disease. Of the total, 18 cases had the pain involving the 2nd branch of the trigeminal nerves, 5 cases involving the 3rd branch, and 9 cases involving both the 2nd and 3rd branches. 25 cases had obvious trigger points, 6 cases were accompanied by twitching and flushed complexion. No cases were found to be positive indicated by the examination of the nervous system. They were all diagnosed as having primary trigeminal neuralgia.

  17. WE-G-BRD-08: End-To-End Targeting Accuracy of the Gamma Knife for Trigeminal Neuralgia

    Energy Technology Data Exchange (ETDEWEB)

    Brezovich, I; Wu, X; Duan, J; Benhabib, S; Huang, M; Shen, S; Cardan, R; Popple, R [University Alabama Birmingham, Birmingham, AL (United States)

    2014-06-15

    Purpose: Current QA procedures verify accuracy of individual equipment parameters, but may not include CT and MRI localizers. This study uses an end-to-end approach to measure the overall targeting errors in individual patients previously treated for trigeminal neuralgia. Methods: The trigeminal nerve is simulated by a 3 mm long, 3.175 mm (1/8 inch) diameter MRI contrast-filled cavity embedded within a PMMA plastic capsule. The capsule is positioned within the head frame such that the cavity position matches the Gamma Knife coordinates of 10 previously treated patients. Gafchromic EBT2 film is placed at the center of the cavity in coronal and sagittal orientations. The films are marked with a pin prick to identify the cavity center. Treatments are planned for delivery with 4 mm collimators using MRI and CT scans acquired with the clinical localizer boxes and acquisition protocols. Coordinates of shots are chosen so that the cavity is centered within the 50% isodose volume. Following irradiation, the films are scanned and analyzed. Targeting errors are defined as the distance between the pin prick and the centroid of the 50% isodose line. Results: Averaged over 10 patient simulations, targeting errors along the x, y and z coordinates (patient left-to-right, posterior-anterior, head-to-foot) were, respectively, −0.060 +/− 0.363, −0.350 +/− 0.253, and 0.364 +/− 0.191 mm when MRI was used for treatment planning. Planning according to CT exhibited generally smaller errors, namely 0.109 +/− 0.167, −0.191 +/− 0.144, and 0.211 +/− 0.94 mm. The largest errors in MRI and CT planned treatments were, respectively, y = −0.761 and x = 0.428 mm. Conclusion: Unless patient motion or stronger MRI image distortion in actual treatments caused additional errors, all patients received the prescribed dose, i.e., the targeted section of the trig±eminal nerve was contained within the 50% isodose surface in all cases.

  18. Trigeminal Neuralgia Treated With Stereotactic Radiosurgery: The Effect of Dose Escalation on Pain Control and Treatment Outcomes.

    Science.gov (United States)

    Kotecha, Rupesh; Kotecha, Ritesh; Modugula, Sujith; Murphy, Erin S; Jones, Mark; Kotecha, Rajesh; Reddy, Chandana A; Suh, John H; Barnett, Gene H; Neyman, Gennady; Machado, Andre; Nagel, Sean; Chao, Samuel T

    2016-09-01

    To analyze the effect of dose escalation on treatment outcome in patients undergoing stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN). A retrospective review was performed of 870 patients who underwent SRS for a diagnosis of TN from 2 institutions. Patients were typically treated using a single 4-mm isocenter placed at the trigeminal nerve dorsal root entry zone. Patients were divided into groups based on treatment doses: ≤82 Gy (352 patients), 83 to 86 Gy (85 patients), and ≥90 Gy (433 patients). Pain response was classified using a categorical scoring system, with fair or poor pain control representing treatment failure. Treatment-related facial numbness was classified using the Barrow Neurological Institute scale. Log-rank tests were performed to test differences in time to pain failure or development of facial numbness for patients treated with different doses. Median age at first pain onset was 63 years, median age at time of SRS was 71 years, and median follow-up was 36.5 months from the time of SRS. A majority of patients (827, 95%) were clinically diagnosed with typical TN. The 4-year rate of excellent to good pain relief was 87% (95% confidence interval 84%-90%). The 4-year rate of pain response was 79%, 82%, and 92% in patients treated to ≤82 Gy, 83 to 86 Gy, and ≥90 Gy, respectively. Patients treated to doses ≤82 Gy had an increased risk of pain failure after SRS, compared with patients treated to ≥90 Gy (hazard ratio 2.0, P=.0007). Rates of treatment-related facial numbness were similar among patients treated to doses ≥83 Gy. Nine patients (1%) were diagnosed with anesthesia dolorosa. Dose escalation for TN to doses >82 Gy is associated with an improvement in response to treatment and duration of pain relief. Patients treated at these doses, however, should be counseled about the increased risk of treatment-related facial numbness. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Predictive Nomogram for the Durability of Pain Relief From Gamma Knife Radiation Surgery in the Treatment of Trigeminal Neuralgia

    Energy Technology Data Exchange (ETDEWEB)

    Lucas, John T., E-mail: johnthomas75@gmail.com [Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina (United States); Nida, Adrian M. [Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina (United States); Isom, Scott [Department of Biostatistical Sciences, Section of Biostatistics, Wake Forest School of Medicine, Winston-Salem, North Carolina (United States); Marshall, Kopriva [Wake Forest School of Medicine, Winston-Salem, North Carolina (United States); Bourland, John D. [Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina (United States); Laxton, Adrian W.; Tatter, Stephen B. [Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina (United States); Chan, Michael D. [Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina (United States)

    2014-05-01

    Purpose: To determine factors associated with the durability of stereotactic radiation surgery (SRS) for treatment of trigeminal neuralgia (TN). Methods and Materials: Between 1999 and 2008, 446 of 777 patients with TN underwent SRS and had evaluable follow-up in our electronic medical records and phone interview records. The median follow-up was 21.2 months. The Barrow Neurologic Institute (BNI) pain scale was used to determine pre- and post-SRS pain. Dose-volume anatomical measurements, Burchiel pain subtype, pain quality, prior procedures, and medication usage were included in this retrospective cohort to identify factors impacting the time to BNI 4-5 pain relapse by using Cox proportional hazard regression. An internet-based nomogram was constructed based on predictive factors of durable relief pre- and posttreatment at 6-month intervals. Results: Rates of freedom from BNI 4-5 failure at 1, 3, and 5 years were 84.5%, 70.4%, and 46.9%, respectively. Pain relief was BNI 1-3 at 1, 3, and 5 years in 86.1%, 74.3%, and 51.3% of type 1 patients; 79.3%, 46.2%, and 29.3% of type 2 patients; and 62.7%, 50.2%, and 25% of atypical facial pain patients. BNI type 1 pain score was achieved at 1, 3, and 5 years in 62.9%, 43.5%, and 22.0% of patients with type 1 pain and in 47.5%, 25.2%, and 9.2% of type 2 patients, respectively. Only 13% of patients with atypical facial pain achieved BNI 1 response; 42% of patients developed post-Gamma Knife radiation surgery (GKRS) trigeminal dysfunction. Multivariate analysis revealed that post-SRS numbness (hazard ratio [HR], 0.47; P<.0001), type 1 (vs type 2) TN (HR, 0.6; P=.02), and improved post-SRS BNI score at 6 months (HR, 0.009; P<.0001) were predictive of a durable pain response. Conclusions: The durability of SRS for TN depends on the presenting Burchiel pain type, the post-SRS BNI score, and the presence of post-SRS facial numbness. The durability of pain relief can be estimated pre- and posttreatment by using our

  20. Long-term effectiveness of an ad hoc tailored titanium implant as a spacer for microvascular decompression in the treatment of trigeminal neuralgia caused by megadolichoectatic basilar artery anomaly: 9-year follow-up.

    Science.gov (United States)

    Banczerowski, Péter; Czigléczki, Gábor; Nyáry, István

    2014-12-01

    An enlarged, elongated, ectatic, and sclerotic aberration of the vertebrobasilar system is known as a megadolichoectatic basilar artery (BA) anomaly. The anomaly is often involved in the pathological process of trigeminal neuralgia by compressing and distorting the trigeminal nerve. First-line medical treatment includes drug therapy, but a second-line surgical procedure could be effective in medication-resistant cases. The authors report the case of a 65-year-old man with a 12-year history of progressing trigeminal neuralgia who underwent microvascular decompression after the first-line drug treatment had failed. This case is unique because an in situ tailored titanium microplate was used as a spacer to alleviate compression by the BA on the trigeminal nerve. The titanium implant provided durable and sufficient retraction for the sclerotic arterial complex when the trigeminal nerve was placed in the tunnel of the implant. The 9-year follow-up examination proves the safety and long-term efficacy of titanium implants in the treatment of trigeminal neuralgia caused by a megadolichoectatic BA anomaly. The method applied in this case was not intended to be and certainly is not an alternative to routine microvascular decompression-this surgical solution may be reserved for some extreme cases.

  1. Trigeminal neuralgia: how often are trigeminal nerve-vessel contacts found by MRI in normal volunteers; Trigeminusneuralgie: Wie haeufig gibt es einen Gefaess-Nerven-Kontakt bei schmerzfreien Probanden?

    Energy Technology Data Exchange (ETDEWEB)

    Kress, B.; Schindler, M.; Haehnel, S.; Sartor, K. [Abt. Neuroradiologie, Neurologische Klinik, Universitaetsklinik Heidelberg (Germany); Rasche, D.; Tronnier, V. [Neurochirurgische Klinik, Universitaetsklinik Schleswig-Holstein, Luebeck (Germany)

    2006-03-15

    Purpose: To assess prospectively how often contacts are found between the trigeminal nerve and arteries or veins in the perimesencephalic cistern via MRI in normal volunteers. Materials and methods: 48 volunteers without a history of trigeminal neuralgia were examined prospectively (MRI at 1.5T; T2-CISS sequence, coronal orientation, 0.9 mm slice thickness). Two radiologists decided by consensus whether there was a nerve-vessel contact in the perimesencephalic cistern. Results: In 27% of the volunteers, no contact was found between the trigeminal nerve and regional vessels, while in 73%, such a contact was present. In 61% of the cases, the offending vessel was an artery, in 39%, it was a vein. In 2 volunteers, a deformation of the nerve was noted. Conclusion: Contrary to what has been suggested by retrospective studies, the majority of normal volunteers, if studied prospectively, do show a contact between the trigeminal nerve and local vessels. A close proximity between the nerve and regional vessels is thus normal and is not necessarily proof of a pathological nerve-vessel conflict. (orig.)

  2. Presurgical visualization of the neurovascular relationship in trigeminal neuralgia with 3D modeling using free Slicer software.

    Science.gov (United States)

    Han, Kai-Wei; Zhang, Dan-Feng; Chen, Ji-Gang; Hou, Li-Jun

    2016-11-01

    To explore whether segmentation and 3D modeling are more accurate in the preoperative detection of the neurovascular relationship (NVR) in patients with trigeminal neuralgia (TN) compared to MRI fast imaging employing steady-state acquisition (FIESTA). Segmentation and 3D modeling using 3D Slicer were conducted for 40 patients undergoing MRI FIESTA and microsurgical vascular decompression (MVD). The NVR, as well as the offending vessel determined by MRI FIESTA and 3D Slicer, was reviewed and compared with intraoperative manifestations using SPSS. The k agreement between the MRI FIESTA and operation in determining the NVR was 0.232 and that between the 3D modeling and operation was 0.6333. There was no significant difference between these two procedures (χ(2) = 8.09, P = 0.088). The k agreement between the MRI FIESTA and operation in determining the offending vessel was 0.373, and that between the 3D modeling and operation was 0.922. There were significant differences between two of them (χ(2) = 82.01, P = 0.000). The sensitivity and specificity for MRI FIESTA in determining the NVR were 87.2 % and 100 %, respectively, and for 3D modeling were both 100 %. The segmentation and 3D modeling were more accurate than MRI FIESTA in preoperative verification of the NVR and offending vessel. This was consistent with surgical manifestations and was more helpful for the preoperative decision and surgical plan.

  3. The Continuous Assessment of Cranial Motion in Thermoplastic Masks During CyberKnife Radiosurgery for Trigeminal Neuralgia

    Science.gov (United States)

    Mayville, Alan

    2016-01-01

    Stereotactic radiosurgery (SRS) treatment is characterized by high doses per fraction and extremely steep dose gradients. This requires a great degree of accurate localization to the appropriate treatment position, and continuous immobilization during the treatment session. In the case of Trigeminal Neuralgia (TGN) treatment this is especially true as the very small target volume makes positional accuracy critical. In this study we carried out a quantitative analysis of patient motion during the full treatment fraction within a radiosurgery immobilization mask system. Patient cranial movement was assessed by using the image guidance stereo x-ray cameras on a CyberKnife (CK) M6 robotic radiosurgery system (Accuray, Sunnyvale, CA). A total of five patients received treatments for either right or left TGN. The duration of treatment varied from 24-64 minutes. Orthogonal images were taken every 15 seconds during the treatment to assess patient movement. Approximately 60 stereo images were taken per patient and a total of 560 images were analyzed in this study. The mean absolute movement in each of longitudinal, lateral or vertical directions was approximately 0.3 mm for the duration of the treatment; however, on occasion much greater movement was observed during a fraction. The maximum displacement was in the longitudinal direction and reached 2.4 mm compared to the initial setup. Images taken at the end of the treatment session showed that the patients typically return to a position closer to the original setup position than the maximum excursion that occurred. This data suggests that although this mask system appears stable during much of the treatment session; for some patients there may be momentary patient movements that take place. Frequent imaging and correction can help mitigate the effect of this movement. It is important to understand the limitations of non-invasive mask systems when used for very high precision treatment. PMID:27330875

  4. Endoscopic versus microscopic microvascular decompression for trigeminal neuralgia: equivalent pain outcomes with possibly decreased postoperative headache after endoscopic surgery.

    Science.gov (United States)

    Lee, John Y K; Pierce, John T; Sandhu, Sukhmeet K; Petrov, Dmitriy; Yang, Andrew I

    2017-05-01

    OBJECTIVE Endoscopic surgery has revolutionized surgery of the ventral skull base but has not yet been widely adopted for use in the cerebellopontine angle. Given the relatively normal anatomy of the cerebellopontine angle in patients with trigeminal neuralgia (TN), the authors hypothesized that a fully endoscopic microvascular decompression (E-MVD) might provide pain outcomes equivalent to those of microscopic MVD (M-MVD) but with fewer complications. METHODS The authors conducted a single-institution, single-surgeon retrospective study with patients treated in the period of 2006-2013. Before surgery, all patients completed a questionnaire that included a validated multidimensional pain-outcome tool, the Penn Facial Pain Scale (PFPS, formerly known as Brief Pain Inventory-Facial), an 11-point scale that measures pain intensity, interference with general activities of daily living (ADLs), and facial-specific ADLs. Using a standardized script, independent research assistants conducted follow-up telephone interviews. RESULTS In total, 167 patients were available for follow-ups (66.5% female; 93 patients underwent M-MVD and 74 underwent E-MVD). Preoperative characteristics (i.e., TN classification, PFPS components, and medication use) were similar for the 2 surgical groups except for 2 variables. Patients in the M-MVD group had slightly higher incidence of V3 pain, and the 2 groups differed in the date of surgery and hence in the length of follow-up (2.4 years for the M-MVD group and 1.3 years for the E-MVD group, p facial-specific ADLs. Actuarial freedom from pain recurrence was equivalent in the 2 groups, with 80% pain control at 3 years. CONCLUSIONS Both the fully endoscopic MVD and the conventional M-MVD appear to provide patients with equivalent pain outcomes. Complication rates were also similar between the groups, with the exception of the rate of headaches, which was significantly lower in the E-MVD group 1 month postoperatively.

  5. Trigeminal somatosensory-evoked potential: A neurophysiological tool to monitor the extent of lesion of ganglion radiofrequency thermocoagulation in idiopathic trigeminal neuralgia

    Science.gov (United States)

    Zhao, Yan-Xing; Miao, Su-Hua; Tang, Yuan-Zhang; He, Liang-Liang; Yang, Li-Qiang; Ma, Yu; Ni, Jia-Xiang

    2017-01-01

    Abstract To reflect the extent of thermolesion of ganglion by testing the change of trigeminal somatosensory-evoked potential (TSEP) before and after ganglion radiofrequency thermocoagulation surgery (GRT), and evaluate long-term clinic effect by follow-up visiting of 1 year. Patients with idiopathic trigeminal neuralgia (TN) in the second division were enrolled between October 2014 and October 2015. They were treated with computed tomography-guided GRT and a follow-up visiting of 1 year. Bilateral TSEP measurements were performed 1 day before and 2 days after the GRT surgery. The latency and peak-to-peak amplitude of W2 and W3 were recorded. Immediate postprocedure pain relief (grades I–III) was 100% and 92.5% 1 year later. Facial numbness rate of grades III and IV was 70%, 40%, and 12.5%, respectively, at immediate, 2 days, and 1 year after GRT. No sever complications happened. The latency of W2 and W3 of patients who had no pain no numbness after 1 year of GRT was 1.74 ± 0.24 and 3.84 ± 0.66 ms, respectively, of TN side, and 1.71 ± 0.39 and 3.63 ± 0.85 ms of the healthy side before GRT. The amplitude of W2 and W3 was 1.13 ± 0.50 and 1.99 ± 1.09 uv, respectively, of TN side and 1.24 ± 0.40 and 1.89 ± 0.81 uv of the healthy side before GRT. There was no statistical difference of the latency and amplitude between 2 sides of W2 and W3 before surgery (P > 0.05). The latency of W2 and W3 delayed and the amplitude reduced especially in TN side after surgery comparing before (P < 0.001). And, comparisons of the latency and amplitude of W2 and W3 between TN side and the healthy side after surgery showed the latency of W2 and W3 delayed (W2: P = 0.02; W3: P = 0.01) and the amplitude of W2 reduced (P = 0.003), but the amplitude of W3 had no statistical difference (P = 0.22). The mean delayed latency and 95% confident interval of W2 and W3 were 0.22 ± 0.35 (0.1–0.34) ms and 0.35 ± 0.64 (0.14–0

  6. Long-term safety and efficacy of Gamma Knife surgery in classical trigeminal neuralgia: a 497-patient historical cohort study.

    Science.gov (United States)

    Régis, Jean; Tuleasca, Constantin; Resseguier, Noémie; Carron, Romain; Donnet, Anne; Gaudart, Jean; Levivier, Marc

    2016-04-01

    Gamma Knife surgery (GKS) is one of the surgical alternatives for the treatment of drug-resistant trigeminal neuralgia (TN). This study aims to evaluate the safety and efficacy of GKS in a large population of patients with TN with very long-term clinical follow-up. Between July 1992 and November 2010, 737 patients presenting with TN were treated using GKS. Data were collected prospectively and were further retrospectively evaluated at Timone University Hospital. The frequency and severity of pain, as well as trigeminal nerve function, were evaluated before GKS and regularly thereafter. Radiosurgery using the Gamma Knife (model B, C, 4C, or Perfexion) was performed with the help of both MR and CT targeting. A single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 7.6 mm (range 4-14 mm) anterior to the emergence of the nerve (retrogasserian target). A median maximum dose of 85 Gy (range 70-90 Gy) was prescribed. The safety and efficacy are reported for 497 patients with medically refractory classical TN who were never previously treated by GKS and had a follow-up of at least 1 year. The median age in this series was 68.3 years (range 28.1-93.2 years). The median follow-up period was 43.8 months (range 12-174.4 months). Overall, 456 patients (91.75%) were initially pain free in a median time of 10 days (range 1-180 days). Their actuarial probabilities of remaining pain free without medication at 3, 5, 7, and 10 years were 71.8%, 64.9%, 59.7%, and 45.3%, respectively. One hundred fifty-seven patients (34.4%) who were initially pain free experienced at least 1 recurrence, with a median delay of onset of 24 months (range 0.6-150.1 months). However, the actuarial rate of maintaining pain relief without further surgery was 67.8% at 10 years. The hypesthesia actuarial rate at 5 years was 20.4% and at 7 years reached 21.1%, but remained stable until 14 years with a median delay of onset of 12 months (range 1-65 months

  7. Comparison of evoked vs. spontaneous tics in a patient with trigeminal neuralgia (tic doloureux

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    Aiello-Lammens Matthew

    2007-11-01

    Full Text Available Abstract A 53-year old woman with tic doloureaux, affecting her right maxillary division of the trigeminal nerve (V2, could elicit shooting pains by slightly tapping her teeth when off medication. The pains, which she normally rated as > 6/10 on a visual analog scale (VAS, were electric shock-like in nature. She had no other spontaneous or ongoing background pain affecting the region. Based on her ability to elicit these tics, functional magnetic resonance imaging (fMRI was performed while she produced brief shocks every 2 minutes on cue (evoked pain over a 20 min period. In addition, she had 1–2 spontaneous shocks manifested between these evoked pains over the course of functional image acquisition. Increased fMRI activation for both evoked and spontaneous tics was observed throughout cortical and subcortical structures commonly observed in experimental pain studies with healthy subjects; including the primary somatosensory cortex, insula, anterior cingulate, and thalamus. Spontaneous tics produced more decrease in signals in a number of regions including the posterior cingulate cortex and amygdala, suggesting that regions known to be involved in expectation/anticipation may have been activated for the evoked, but not spontaneous, tics. In this patient there were large increases in activation observed in the frontal regions, including the anterior cingulate cortex and the basal ganglia. Spontaneous tics showed increased activation in classic aversion circuitry that may contribute to increased levels of anxiety. We believe that this is the first report of functional imaging of brain changes in tic-doloureaux.

  8. Comparison of evoked vs. spontaneous tics in a patient with trigeminal neuralgia (tic doloureux).

    Science.gov (United States)

    Borsook, David; Moulton, Eric A; Pendse, Gautam; Morris, Susie; Cole, Sadie H; Aiello-Lammens, Matthew; Scrivani, Steven; Becerra, Lino R

    2007-11-06

    A 53-year old woman with tic doloureaux, affecting her right maxillary division of the trigeminal nerve (V2), could elicit shooting pains by slightly tapping her teeth when off medication. The pains, which she normally rated as > 6/10 on a visual analog scale (VAS), were electric shock-like in nature. She had no other spontaneous or ongoing background pain affecting the region. Based on her ability to elicit these tics, functional magnetic resonance imaging (fMRI) was performed while she produced brief shocks every 2 minutes on cue (evoked pain) over a 20 min period. In addition, she had 1-2 spontaneous shocks manifested between these evoked pains over the course of functional image acquisition. Increased fMRI activation for both evoked and spontaneous tics was observed throughout cortical and subcortical structures commonly observed in experimental pain studies with healthy subjects; including the primary somatosensory cortex, insula, anterior cingulate, and thalamus. Spontaneous tics produced more decrease in signals in a number of regions including the posterior cingulate cortex and amygdala, suggesting that regions known to be involved in expectation/anticipation may have been activated for the evoked, but not spontaneous, tics. In this patient there were large increases in activation observed in the frontal regions, including the anterior cingulate cortex and the basal ganglia. Spontaneous tics showed increased activation in classic aversion circuitry that may contribute to increased levels of anxiety. We believe that this is the first report of functional imaging of brain changes in tic-doloureaux.

  9. Trigeminal neuralgia: Assessment of neurovascular decompression by 3D fast imaging employing steady-state acquisition and 3D time of flight multiple overlapping thin slab acquisition magnetic resonance imaging

    Science.gov (United States)

    Prieto, Ruth; Pascual, José M.; Yus, Miguel; Jorquera, Manuela

    2012-01-01

    Background: Trigeminal neuralgia is most commonly caused by vascular compression at the trigeminal nerve (TN) root entry zone. Microvascular decompression (MVD) has been established as a useful treatment. Outcome depends on the correct identification of the compression site and its adequate decompression at surgery. Preoperative identification of neurovascular compression might predict which patients will benefit from MVD. Management of persistent or recurrent trigeminal neuralgia after an MVD is a baffling problem for neurosurgeons. An accurate neuroradiological evaluation of the TN padding following a failed MVD might help identify the underlying cause and plan further treatment. Case description: A 68-year-old female presented with a right-sided trigeminal neuralgia (V3) refractory to medical therapy. A high-resolution three-dimensional magnetic resonance imaging (3D MRI) study included fast imaging employing steady-state acquisition (FIESTA) and time of flight multiple overlapping thin slab acquisition (TOF MOTSA) sequences to evaluate the neurovascular anatomy in the cerebellopontine angle. An unambiguous compression of the right TN at the rostral-medial site by the superior cerebellar artery (SCA) was identified. The SCA loop compressing the TN was identical in location and configuration to that predicted in the preoperative study. After the MVD, the patient was relieved from her pain and a postoperative high-resolution 3D MRI study confirmed the appropriate placement of the Teflon implant between the TN and SCA. Conclusion: To our knowledge, this is the first report that characterizes the proper TN padding by high-resolution 3D MRI after trigeminal MVD. The present case also emphasizes the importance of performing a 3D MRI in patients with trigeminal neuralgia to anticipate the surgeon's view and predict the outcome after MVD. PMID:22629487

  10. Preoperative evaluation of neurovascular relationship by using contrast-enhanced and unenhanced 3D time-of-flight MR angiography in patients with trigeminal neuralgia

    Energy Technology Data Exchange (ETDEWEB)

    Qin, Zhou; Zhiling, Liu; Chuanfu, Li; Qingshi Zeng (Dept. of Radiology, Qilu Hospital of Shandong Univ., Jinan (China)), email: zengqingshi@yahoo.cn; Chuncheng, Qu (Dept. of Neurosurgery, the Second Hospital of Shandong Univ., Jinan (China)); Shilei, Ni (Dept. of Neurosurgery, Qilu Hospital of Shandong Univ., Jinan (China))

    2011-10-15

    Background Microvascular decompression is an etiological strategy for the therapy of trigeminal neuralgia (TN). Preoperative identification of neurovascular compression, therefore, could have an impact on the determination of appropriate treatment for TN. Purpose To evaluate the value of contrast-enhanced and unenhanced three-dimensional (3D) time-of-flight (TOF) MR angiography in the visualization of neurovascular relationship in patients with TN. Material and Methods Thirty-seven patients with unilateral TN underwent unenhanced and contrast-enhanced 3D TOF MR angiography with a 3.0-T MR system. Images were reviewed by a radiologist blinded to clinical details. Vascular contact with the trigeminal nerve was identified, and the nature of the involved vessels (artery or vein) was determined. All patients underwent microvascular decompression. Results In 37 patients with TN, contrast-enhanced 3D TOF MR angiography identified surgically verified neurovascular contact in 35 of 36 symptomatic nerves, and there was no false-positive. Based on surgical findings, the sensitivity of MR imaging was 97.2% and specificity 100%. The nature of the offending vessel was correctly identified in 94.4% of the patients by using the combination of contrast-enhanced and unenhanced MR angiography. Conclusion Contrast-enhanced 3D TOF MR angiography is useful in the detection of vascular contact with the trigeminal nerve in patients with TN, and this MR imaging in combination with unenhanced MR angiography could help in the identification of the nature of the responsible vessels

  11. Preoperative assessment of trigeminal neuralgia and hemifacial spasm using constructive interference in steady state-three-dimensional fourier transformation magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Yamakami, Iwao; Kobayashi, Eiichi; Hirai, Shinji; Yamaura, Akira [Chiba Univ. (Japan). School of Medicine

    2000-11-01

    Results of microvascular decompression (MVD) for trigeminal neuralgia (TN) and hemifacial spasm (HFS) may be improved by accurate preoperative assessment of neurovascular relationships at the root entry/exit zone (REZ). Constructive interference in steady state (CISS)-three-dimensional Fourier transformation (3DFT) magnetic resonance (MR) imaging was evaluated for visualizing the neurovascular relationships at the REZ. Fourteen patients with TN and eight patients with HFS underwent MR imaging using CISS-3DFT and 3D fast inflow with steady-state precession (FISP) sequences. Axial images of the cerebellopontine angle (CPA) obtained by the two sequences were reviewed to assess the neurovascular relationships at the REZ of the trigeminal and facial nerves. Eleven patients subsequently underwent MVD. Preoperative MR imaging findings were related to surgical observations and results. CISS MR imaging provided excellent contrast between the cranial nerves, small vessels, and cerebrospinal fluid (CSF) in the CPA. CISS was significantly better than FISP for delineating anatomic detail in the CPA (trigeminal and facial nerves, petrosal vein) and abnormal neurovascular relationships responsible for TN and HFS (vascular contact and deformity at the REZ). Preoperative CISS MR imaging demonstrated precisely the neurovascular relationships at the REZ and identified the offending artery in all seven patients with TN undergoing MVD. CISS MR imaging has high resolution and excellent contrast between cranial nerves, small vessels, and CSF, so can precisely and accurately delineate normal and abnormal neurovascular relationships at the REZ in the CPA, and is a valuable preoperative examination for MVD. (author)

  12. Preoperative evaluation of neurovascular relationship by using contrast-enhanced and unenhanced 3D time-of-flight MR angiography in patients with trigeminal neuralgia.

    Science.gov (United States)

    Zhou, Qin; Liu, Zhiling; Li, Chuanfu; Qu, Chuncheng; Ni, Shilei; Zeng, Qingshi

    2011-10-01

    Microvascular decompression is an etiological strategy for the therapy of trigeminal neuralgia (TN). Preoperative identification of neurovascular compression, therefore, could have an impact on the determination of appropriate treatment for TN. To evaluate the value of contrast-enhanced and unenhanced three-dimensional (3D) time-of-flight (TOF) MR angiography in the visualization of neurovascular relationship in patients with TN. Thirty-seven patients with unilateral TN underwent unenhanced and contrast-enhanced 3D TOF MR angiography with a 3.0-T MR system. Images were reviewed by a radiologist blinded to clinical details. Vascular contact with the trigeminal nerve was identified, and the nature of the involved vessels (artery or vein) was determined. All patients underwent microvascular decompression. In 37 patients with TN, contrast-enhanced 3D TOF MR angiography identified surgically verified neurovascular contact in 35 of 36 symptomatic nerves, and there was no false-positive. Based on surgical findings, the sensitivity of MR imaging was 97.2% and specificity 100%. The nature of the offending vessel was correctly identified in 94.4% of the patients by using the combination of contrast-enhanced and unenhanced MR angiography. Contrast-enhanced 3D TOF MR angiography is useful in the detection of vascular contact with the trigeminal nerve in patients with TN, and this MR imaging in combination with unenhanced MR angiography could help in the identification of the nature of the responsible vessels.

  13. SU-E-T-122: Dosimetric Comparison Between Cone, HDMLC and MicroMLC for the Treatment of Trigeminal Neuralgia

    Energy Technology Data Exchange (ETDEWEB)

    Vacca, N; Caussa, L; Filipuzzi, M; Garrigo, E; Venencia, C [Instituto Privado de Radioterapia - Fundacion Marie Curie, Cordoba (Argentina)

    2014-06-01

    Purpose: The purpose of this work was to evaluate the dosimetric characteristics of three collimation systems, 5mm circular cone (Brainlab) and square fields of 5mm with HDMLC (Varian) and microMLC Moduleaf, Siemens) for trigeminal neuralgia treatment. Methods: A TPS Iplan v4.5 BrainLAB was used to do treatment plans for each collimations system in a square solid water phantom with isocenter at 5cm depth. Single field and treatment plan including 11 arcs with fix field and 100° gantry range was made for each collimation systems. EBT3 films were positioned at isocenter in a coronal plane to measured dose distribution for all geometries. Films were digitized with a Vidar DosimetryPro Red scanner with a resolution of 89dpi and RIT113v6.1 software was used for analysis. Penumbra region (80%–20%), FWHM and dose percentage at 5mm and 10mm from CAX were determined. All profiles were normalized at CAX. Results: For single beam the penumbra (FWHM) was 1.5mm (5.3mm) for the cone, 1.9mm (5.5mm) for HDMLC and 1.8mm (5.4mm) for the microMLC. Dose percentage at 5mm was 6.9% for cone, 12.5% for HDMLC and 8.7% for the microMLC. For treatment plan the penumbra (FWHM) was 2.58mm (5.47mm) for the cone, 2.8mm (5.84mm) for HDMLC and 2.58mm (6.09mm) for the microMLC. Dose perecentage at 5mm was 13.1% for cone, 16.1% for HDMLC, 15.2% for the microMLC. Conclusion: The cone has a dose falloff larger than the microMLC and HDMLC, by its reduced penumbra, this translates into better protection of surrounding healthy tissue, however, the microMLC and HDMLC have similar accuracy to cone.

  14. Cognitive effects of electro-acupuncture and pregabalin in a trigeminal neuralgia rat model induced by cobra venom

    Directory of Open Access Journals (Sweden)

    Chen RW

    2017-08-01

    Full Text Available Ruo-Wen Chen,1,2 Hui Liu,2 Jian-Xiong An,1,2 Xiao-Yan Qian,2 Yi-De Jiang,2 Doris K Cope,3 John P Williams,3 Rui Zhang,1 Li-Na Sun1 1Department of Anesthesiology, Weifang Medical University, Weifang City, Shandong, 2Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, China; 3Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Objective: The objective of this study was to investigate the effects of electro-acupuncture (EA and pregabalin on cognition impairment induced by chronic trigeminal neuralgia (TN in rats. Design: Controlled animal study. Setting: Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University. Subjects: Forty adult male Sprague Dawley rats. Methods: Rats were randomly divided into four groups. The TN model was induced by administration of cobra venom to the left infraorbital nerve. On postoperative day 14, either EA or pregabalin was administered, free behavioral activities were observed. Spatial learning and memory abilities were determined in the Morris water maze. The ultrastructural alterations of the Gasserian ganglion, medulla oblongata and hippocampus were examined by electron microscopy. The changes on long-term potentiation were investigated. Results: After treatment, the exploratory behavior increased and the grooming behavior decreased (P<0.05 for the EA group and pregabalin group compared with the cobra venom group; moreover, demyelination of neurons in Gasserian ganglion and medulla oblongata was reversed. The number of platform site crossings, the average percentages of time in the target quadrant and the field excitatory postsynaptic potential slopes increased (P<0.05 in the EA group compared to the cobra venom group. However, the pregabalin group

  15. Treatment of refractory trigeminal neuralgia by micro-balloon compression trigeminal ganglion%半月神经节球囊压迫术微创治疗三叉神经痛

    Institute of Scientific and Technical Information of China (English)

    俞文华; 沈永锋; 杜垣锋; 朱强; 董晓巧; 张祖勇; 车志豪; 刘群杰; 王昊; 杜权; 杨定博

    2014-01-01

    Objective To evaluate the clinical effects of percutaneous micro-balloon compression (PBC) trigeminal ganglion for the treatment refractory trigeminal neuralgia. Methods Surgical results of 452 patients with trigeminal neuralgia treated by PBC from October 2009 to May 2013 were analyzed retrospectively. 125 cases aged over 80 years old and 70 cases′ pain belongs to the first branch neuralgia. Such procedures as Meckle′s cave cannulated with No.4 Forgarty catheter and the balloon inflated and compressed the gasserian ganglion monitored by X-ray were observed by PBC. Follow-up interview and curative effects were recorded. Results The average hospitalization was 6.1 days. Among them, 432(95.6%) cases had immediate relief from pain. The overall pain relief rate was 97.8% in our group without serious surgical complications. Postoperative complications include hemifacial numbness in 385 patients (85.2%), mild masseter muscle weakness in 248 patients (54.9%), diplopia in 2 patients. All symptoms relived or disappeared within 1 ~ 6 months. The average follow-up intervier period is 23.5 months. The recurrence rate is 10.2% (46 cases). Conclusion PBC is a safe and effective method with high pain relief rate in the treatment of refractory trigeminal neuralgia , especially for the treatment of the high risk patients , patients with recurrent symptoms or the patients suffered from the first branch neuralgia.%目的:总结经皮穿刺球囊压迫半月神经节手术(PBC)治疗顽固性三叉神经痛的临床效果。方法:对我科自2009年10月至2013年5月采用 PBC 方法治疗的452例顽固性三叉神经痛患者的临床资料进行回顾性总结,其中80岁以上高龄患者125例,疼痛累及第Ⅰ支70例;PBC在X线监视下应用Hartel前入法、通过鞘管导入4号Fogarty 球囊进入Meckel腔压迫半月节,术后对患者进行随访及疗效观察。结果:本组患者术后住院3~9 d,平均6.1 d,无

  16. Microvascular decompression for primary trigeminal neuralgia%微血管减压术治疗原发性三叉神经痛临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    陈波; 龚年春; 余小祥

    2011-01-01

    Objective To explore the clinical efficacy of microvascular decompressionon in the treatment of primary trigeminal neuralgia. Methods The clinical data of 58 patients with primary trigeminal neuralgia who underwent microvascular decompression between January 2008 and July 2010 in our hospital were retrospectively analyzed. Results After the operation, neuralgia disappeared in all of the 58 cases. Follow - up lasted 6 to 24 months. Four patients had recurrence after operation and 2 patients experienced mild pain which disappeared after taking carbamazepine. Conclusion Microvascular decompression is an effective method for primary trigeminal neuralgia.%目的 探讨微血管减压术治疗原发性三叉神经痛的方法及临床效果.方法 分析2008年1月至2010年7月我院治疗的58例原发性三叉神经痛患者的临床资料.结果 所有患者术后面部疼痛完全消失.随访6~24个月,4例复发,2例有轻微疼痛,口服卡马西平后疼痛可控制.结论 微血管减压术治疗原发性三叉神经痛疗效明显,可以作为首选外科治疗方法.

  17. Herpes Zoster with Post Herpetic Neuralgia Involving the Right Maxillary Branch of Trigeminal Nerve: A Case Report and Review of Literature

    Science.gov (United States)

    Subramanian, Kailasam; Sankari, S Leena; Potluri, Venkata Lakshmi Aparna; Prabakaran, Akila

    2017-01-01

    Herpes Zoster (HZ) is an acute, self-limiting, neuro cutaneous viral infection caused by the reactivation of the Varicella Zoster Virus (VZV) that remains latent in the dorsal root ganglion. About 50% of occurrence is seen in older age groups and immunocompromised patients. Less than 5% occur in children. HZ is characterized by the unilateral pain, burning and tingling sensation followed by the vesicular eruptions limited to the single dermatome that are innervated by the single cranial ganglion, sometimes it leads to Post Herpetic Neuralgia (PHN). We report a case of a HZ in a 22-year-old young female patient involving the right maxillary branch of the trigeminal nerve along with PHN. PMID:28274075

  18. Neuralgia do trigêmeo bilateral por cisticerco racemoso unilateral no ângulo-ponto cerebelar: relato de caso Unusual cause for bilateral trigeminal neuralgia: unilateral racemous cysticercus of cerebellopontine angle. Case report

    Directory of Open Access Journals (Sweden)

    PAULO HENRIQUE AGUIAR

    2000-12-01

    Full Text Available Descrevemos o caso de uma paciente de 42 anos portadora de cisticerco racemoso na região do ângulo ponto-cerebelar (APC direito com trigeminalgia bilateral mais intensa no lado ipsilateral à localização do parasita. O cisticerco foi totalmente removido por meio de craniotomia suboccipital. No primeiro dia pós-operatório houve desaparecimento bilateral da dor. Duas hipóteses fisiopatológicas foram aventadas para explicar a sintomatologia: lesões que ultrapassam os limites da cisterna do APC poderão através da cisterna pré-pontina alcançar a cisterna do APC atingindo o trigêmeo contralateral; lesões com grande efeito de massa poderão provocar rotação do tronco cerebral e deslocamento e tração de estruturas ipsi e contralaterais, provocando compressão arteriovenosa sobre o trigêmeo contralateral na porção superior da cisterna do APC. Salientamos a necessidade de exames de imagem ante qualquer algia craniofacial e observamos que, em lesões na região do APC, a cisticercose não pode ser esquecida.We report the case of a 42-year-old woman with a racemous cystecercus in the right cerebellopontine angle (CPA, who presented with bilateral trigeminal neuralgia. The parasite was completly removed via a right suboccipital craniotomy. On the first postoperative day, the patient indicated that the pain disappeared. The neuralgia was caused by two probable mechanisms: a distortion of the brain stem and compression of the nerve against an arterial loop at the entry zone or arachnoiditis caused by the parasite in the both CPA cisternae. This case demonstrates the advisability of obtaining imaging studies in all patients with trigeminal neuralgia before starting any management. We must always remind that the cysticercus may be a differential diagnosis of CPA lesions.

  19. Higher dose rate Gamma Knife radiosurgery may provide earlier and longer-lasting pain relief for patients with trigeminal neuralgia.

    Science.gov (United States)

    Lee, John Y K; Sandhu, Sukhmeet; Miller, Denise; Solberg, Timothy; Dorsey, Jay F; Alonso-Basanta, Michelle

    2015-10-01

    Gamma Knife radiosurgery (GKRS) utilizes cobalt-60 as its radiation source, and thus dose rate varies as the fixed source decays over its half-life of approximately 5.26 years. This natural decay results in increasing treatment times when delivering the same cumulative dose. It is also possible, however, that the biological effective dose may change based on this dose rate even if the total dose is kept constant. Because patients are generally treated in a uniform manner, radiosurgery for trigeminal neuralgia (TN) represents a clinical model whereby biological efficacy can be tested. The authors hypothesized that higher dose rates would result in earlier and more complete pain relief but only if measured with a sensitive pain assessment tool. One hundred thirty-three patients were treated with the Gamma Knife Model 4C unit at a single center by a single neurosurgeon during a single cobalt life cycle from January 2006 to May 2012. All patients were treated with 80 Gy with a single 4-mm isocenter without blocking. Using an output factor of 0.87, dose rates ranged from 1.28 to 2.95 Gy/min. The Brief Pain Inventory (BPI)-Facial was administered before the procedure and at the first follow-up office visit 1 month from the procedure (mean 1.3 months). Phone calls were made to evaluate patients after their procedures as part of a retrospective study. Univariate and multivariate linear regression was performed on several independent variables, including sex, age in deciles, diagnosis, follow-up duration, prior surgery, and dose rate. In the short-term analysis (mean 1.3 months), patients' self-reported pain intensity at its worst was significantly correlated with dose rate on multivariate analysis (p = 0.028). Similarly, patients' self-reported interference with activities of daily living was closely correlated with dose rate on multivariate analysis (p = 0.067). A 1 Gy/min decrease in dose rate resulted in a 17% decrease in pain intensity at its worst and a 22% decrease

  20. 三叉神经痛手术的护理配合%Nursing cooperation in the operation of trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    陈晓梅

    2012-01-01

    回顾性总结56例三叉神经痛手术治疗的护理配合.将术前准备、手术配合及配合体会和注意项等进行详细的介绍.探讨结合三叉神经痛患者的病理、心理和手术特点,强调充分做好术前准备、正确安排手术体位、默契做好手术配合的重要性.%By reviewing and summarizing the nursing coordination of 56 Trigeminal Neuralgia (TN) operative treatments, I introduced pre-operative provision, operative coordination, the feelings of coordinaton and the points of attention to you. According to discussing the features of pathology and psychology of the Trigeminal Neuralgic patients and its operative treatments,emphasizes the important role of making preparation adequatly,placing operative position appropriatly and making operation in good teamwork..

  1. Fact Sheet: Trigeminal Neuralgia

    Science.gov (United States)

    ... Other options include acupuncture, upper cervical chiropractic, biofeedback, vitamin therapy, and nutritional therapy. Some people report modest ... Complications of AIDS Information Page Neurological Complications of Lyme Disease ... Page Neuromyelitis Optica Information Page Neuronal Migration ...

  2. Efficacy of stereotactic gamma knife surgery and microvascular decompression in the treatment of primary trigeminal neuralgia: a retrospective study of 220 cases from a single center

    Directory of Open Access Journals (Sweden)

    Dai ZF

    2016-07-01

    Full Text Available Zi-Feng Dai, Qi-Lin Huang, Hai-Peng Liu, Wei Zhang Department of Neurosurgery, Xinqiao Hospital, The Third Military Medical University, Chongqing, People’s Republic of China Objectives: A retrospective study was undertaken to compare the efficacy of stereotactic gamma knife surgery (GKS and microvascular decompression (MVD in the treatment of primary trigeminal neuralgia (TN at a single center. The study included the evaluation of clinical outcomes of pain relief and pain recurrence and complications associated with GKS and MVD.Methods: The study included 202 patients with primary TN and was conducted between January 2013 and December 2014; about 115 patients were treated with GKS and 87 patients were treated with MVD. TN pain was evaluated using the Barrow Neurological Institute and the visual analog scale scoring systems. Preoperative magnetic resonance tomographic angiography was performed for all patients. Microscope-assisted MVD used the suboccipital retrosigmoid sinus approach. GKS targeted the trigeminal nerve root entry zone with a margin radiation dose of 59.5 Gy, and brainstem dose <12 Gy. Posttreatment follow-up was for 2 years.Results: Postoperative Barrow Neurological Institute scores for patients treated with GKS and MVD were significantly improved compared with preoperative scores (P<0.01. Reduction in postoperative pain following MVD (95.4% patients was significantly greater than that following GKS (88.7% patients (P<0.01. Postoperative visual analog scale scores of the MVD group were significantly reduced compared with those of patients treated with GKS at the same postoperative time points (P<0.01. Patients treated with GKS had a significantly increased rate of loss of corneal reflex compared with patients treated with MVD (P=0.002.Conclusion: Both GKS and MVD are safe and effective first-line and adjunctive treatment options for patients with TN. The clinical outcomes of pain relief and reduction of pain recurrence were

  3. Trigeminal Nerve Root Demyelination Not Seen in Six Horses Diagnosed with Trigeminal-Mediated Headshaking

    Directory of Open Access Journals (Sweden)

    Veronica L. Roberts

    2017-05-01

    Full Text Available Trigeminal-mediated headshaking is an idiopathic neuropathic facial pain syndrome in horses. There are clinical similarities to trigeminal neuralgia, a neuropathic facial pain syndrome in man, which is usually caused by demyelination of trigeminal sensory fibers within either the nerve root or, less commonly, the brainstem. Our hypothesis was that the neuropathological substrate of headshaking in horses is similar to that of trigeminal neuralgia in man. Trigeminal nerves, nerve roots, ganglia, infraorbital, and caudal nasal nerves from horse abattoir specimens and from horses euthanized due to trigeminal-mediated headshaking were removed, fixed, and processed for histological assessment by a veterinary pathologist and a neuropathologist with particular experience of trigeminal neuralgia histology. No histological differences were detected between samples from horses with headshaking and those from normal horses. These results suggest that trigeminal-mediated headshaking may have a different pathological substrate from trigeminal neuralgia in man.

  4. CT-guided semilunar ganglion radiofrequency thermocoagulation in treatment of trigeminal neuralgia%CT引导下半月神经节射频热凝治疗三叉神经痛

    Institute of Scientific and Technical Information of China (English)

    杨云春; 王昭斌; 武百山

    2011-01-01

    Objective To observe and analyze therapeutic effect by CT-guided semilunar ganglion radiofrequency thermocougulation in treatment trigeminal neuralgia. Methods 40 patients with trigeminal neuralgia received CT-guided semilunar ganglion apuncture, and then radiofrequency thermocougulation were performed under the thermal controlled from 65 to 80 ℃ and continued 3 minutes for 3 to 4 times. Results Pain was completed eliminated in 32 of the 40 patients, which was regarded as degree Ⅰ. 5 cases was of degree Ⅱ . 2 case was of degree Ⅲ. 1 case had no effect. The rate of satisfactory effectiveness was 92. 5% and the total rate of efficacy was 97.5%. Conclusion CT-guided semilunar ganglion radiofrequency thermocoagulation in treatment of trigeminal neuralgia is safe and effective to treat trigeminal neuralgia.%目的 观察CT引导下半月神经节射频热凝术治疗原发性三又神经痛的临床疗效.方法 40例三叉神经痛患者在CT引导下,经前入路法穿刺三又神经半月节后行射频热凝毁损治疗,温度控制在65~80℃持续时间3min,共3~4次.结果 40例患者中,32例疗效I级,5例疗效Ⅱ,2例疗效Ⅲ级;一次性治疗显效率92.5%,总有效率97.5%.1例为Ⅳ级无效.结论 CT引导行三又神经半月神经节射频热凝术是一种安全、可靠、有效的微创治疗技术,具有临床推广应用价值.

  5. Electric acupuncture combined with moxa-wool moxibustion on treating 9 cases of trigeminal neuralgia%电针结合艾灸治疗三叉神经痛9例

    Institute of Scientific and Technical Information of China (English)

    赵盛惠

    2013-01-01

    Objective: A significant effect on treating 9 cases of trigeminal neuralgia with electric acupuncture and moxa-wool moxibustion. Methods:To treat trigeminal neuralgia with electric acupuncture and moxibustion once a day, a course of 10 days. Results:The efficiency was 100%, cure rate was 77.8%. Conclusion: The effect is significant on treating trigeminal neuralgia with electric acupuncture and moxa-wool moxibustion.%  目的:利用电针结合艾灸治疗三叉神经痛9例疗效显著。方法:电针结合艾灸治疗三叉神经痛1次/d,10d为1个疗程。结果:有效率100%,治愈率77.8%。结论:电针结合艾灸治疗三叉神经痛疗效满意。

  6. A single-blinded pilot study assessing neurovascular contact by using high-resolution MR imaging in patients with trigeminal neuralgia

    Energy Technology Data Exchange (ETDEWEB)

    Qu Chuncheng [Neurosurgery Department of Second Hospital of Shandong University, Jinan 250033 (China)], E-mail: Jefferson-2004@163.com; Zeng Qingshi [Radiology Department of Qilu Hospital of Shandong University, Jinan 250012 (China)], E-mail: zengqingshi@sina.com; Zhang Jiqing [Neurosurgery Department of Second Hospital of Shandong University, Jinan 250033 (China)], E-mail: zhangjiqing001@126.com; Wang Zhigang [Neurosurgery Department of Second Hospital of Shandong University, Jinan 250033 (China)], E-mail: wzg1110@126.com

    2009-03-15

    Objective: To assess the feasibility and utility of high-resolution three-dimensional magnetic resonance angiography (3D MRA) and contrast-enhanced 3D spoiled gradient-recalled imaging (3D SPGRI) for the purpose of visualization of neurovascular contact in trigeminal neuralgia (TN) patients. Methods: Forty-five patients (25 males, 20 females; age range, 23-82 years; and mean age, 55.67 {+-} 18.23 years) with unilateral typical TN and 36 control subjects (21 males, 15 females; age range, 25-85 years; mean age, 57.53 {+-} 19.25 years) underwent high-resolution 3D MRA and contrast-enhanced 3D SPGRI assessment. The images were reviewed by two experienced neuroradiologists who were blinded to the clinical details. The imaging results were compared with the operative findings in all the patients; additionally, the degree of neurovascular contact was compared between the two groups based on MR imaging. Results: In 45 patients with unilateral typical TN, the use of 3D MRA in conjunction with the contrast-enhanced 3D SPGRI identified neurovascular contact in 40 of the 42 symptomatic nerves; the contact was verified surgically. Based on the surgical findings, the sensitivity and specificity of MR imaging were 95.20% and 100%, respectively. Based on MRI, the compressing vessel (artery, vein) was correctly identified in 32 of the 39 cases verified by microvascular decompression. There was good agreement (K = 0.77; 95% confidence interval, 0.54-0.99) between the position (medial, lateral, superior, and inferior) of the compressing vessel relative to the trigeminal nerve as defined by MR imaging and the surgical findings. The rates of vascular contact with the trigeminal nerve as observed on MRI were 31.94%, 48.89%, and 88.9% in the control subjects, asymptomatic, and symptomatic side of patients, respectively. Conclusion: The combined use of high-resolution 3D MRA and contrast-enhanced 3D SPGRI is an extremely sensitive and specific technique for demonstrating vascular contact

  7. CT引导射频热凝术治疗三叉神经痛临床分析%Clinical analysis of CT guided percutaneous radiofrequency thermocoagulation for treatment of trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    王晓志

    2013-01-01

    Objective To analyze and evaluate the clinical effect of CT guided percutaneous semilunar ganglion radiofrequency thermocoagulation for treatment of trigeminal neuralgia.Methods 52 patients with trigeminal neuralgia treated in our hospital were selected.They underwent the CT three-dimensional guidance on trigeminal neuralgia Ⅱ,Ⅲ,Ⅱ + Ⅲ neuralgia neuralgia patients with anterior foramen ovale puncture semilunar ganglion,verify the operative target,and a standard radiofrequency target temperature damage under general anesthesia.Results Of the 52 patients,the treatment effect was excellent in 49 cases,good in 1 patient,the effect of other 2 cases was poor,the excellent and good rate was 96.15%.Conclusion CT guided percutaneous puncture semilunar ganglion radiofrequency thermocoagulation in the treatment of patients with trigeminal neuralgia is simple,safe,and easy to be accepted by patients,the cure rate is high,it is worth learning and promotion.%目的 对CT引导经皮穿刺半月神经节射频热凝术治疗三叉神经痛的临床效果进行分析和评价.方法 选取三叉神经痛患者52例,在CT三维引导下对三叉神经第Ⅱ支痛、第Ⅲ支痛、Ⅱ+Ⅲ支痛患者应用前入路卵圆孔穿刺半月神经节,术中验证靶点,并在全身麻醉下进行标准射频靶点温控毁损.结果 52例患者中,经治疗效果优49例,良1例,差2例,优良率为96.15%.结论 对三叉神经痛患者采用CT引导经皮穿刺半月神经节射频热凝术治疗,简单、安全,且患者易于接受,治愈率较高,值得借鉴和推广.

  8. The neuralgias: diagnosis and management.

    Science.gov (United States)

    Gadient, Paul M; Smith, Jonathan H

    2014-07-01

    The neuralgias are characterized by pain in the distribution of a cranial or cervical nerve. While most often brief, severe, and paroxysmal, continuous neuropathic pain may occur. The most commonly encountered entities include trigeminal, postherpetic, glossopharyngeal, and occipital neuralgia. More unusual cranial neuralgias may occur in periorbital (eg, supraorbital neuralgia) and auricular (eg, nervus intermedius neuralgia) distributions. These disorders may be mimicked by structural and inflammatory/infectious neurologic disease, along with other primary headache disorders (eg, primary stabbing headache). The approach to diagnosis and treatment of this group of headache disorders is reviewed.

  9. A comparison of the oblique sagittal view obtained by magnetic resonance imaging and the intraoperative findings of vascular compression in cases of trigeminal neuralgia and hemifacial spasm

    Energy Technology Data Exchange (ETDEWEB)

    Nagaseki, Yoshishige; Horikoshi, Tohru; Omata, Tomohiro; Ueno, Takehiko; Uchida, Mikito; Nukui, Hideaki (Yamanashi Medical Coll., Tamaho (Japan)); Sasaki, Hideo; Tsuji, Reizou

    1992-06-01

    We show how neurosurgical planning can benefit from the better visualization of the precise vascular compression of the nerves provided by the oblique sagittal and gradient-echo method (OS-GR image) using magnetic resonance images (MRI) and by comparing these results with the findings of microvascular decompression. The scans of 5 patients with trigeminal neuralgia (TN) and 18 with hemifacial spasm (HFS) were analysed for the presence and appearance of the vascular compression of the nerves; all these 23 patients were operated on. Imaging sequences consisted of an OS-GR image (TR/TE: 200/20, 3-mm-thick slice) cut along each nerve shown by the axial view, which was scanned at the angle of 105 degrees taken between the dorsal line of the brain stem and the line corresponding to the pontmedullary junction. The rate of correspondence between the OS-GR images and the intraoperative findings was 80% in the TN's and 89% in the HFS's. In all these OS-GR images, the vascular compressions of the REZ of the trigeminal or facial nerve were well visualized as curvilinear high-intensity lines and/or spots. Furthermore, the relationship between the vascular compressions and nerves could be foreseen preoperatively in 40% of the TN's and in 55.6% of the HFS's. It is concluded that OS-GR images obtained by means of MRI may serve as useful planning aids prior to microvascular decompression for cases of TN and HFS because of the corresponding operative view along the approach. (author).

  10. 内窥镜配合显微镜微血管减压治疗三叉神经痛%Endoscopic-assisted Microvascular Decompression for Trigeminal Neuralgia

    Institute of Scientific and Technical Information of China (English)

    陆川; 孙军; 陈献东

    2013-01-01

    Objective To summarize our experience in endoscopic-assisted microvascular decompression for trigeminal neuralgia. Methods Since March 2008 to March 2011, we performed endoscopic-assisted microvascular decompression on totally 41 patients with trigeminal neuralgia. By endoscopy, we explored the cisternal segment of the trigeminal nerve, and then the root entry zone and Meckel' s cave to identify the vessels compressing or touching the root of the trigeminal nerve. The vessels were cut by electrocoagulation (veins) or separated with Teflon felt ( arteries). Results Among the patients, the trigeminal nerves were compressed by arteries alone in 29 cases, by veins alone in 6, and by both arteries and veins in the other 6. The involved arteries included the superior cerebellar artery (25 cases) , anterior inferior cerebellar artery (5 cases) , posterior inferior cerebellar artery (3 cases) , basilar artery (2 cases) , and twisted vertebral artery (2 cases) ; in two of these patients, two arteries were involved in two cases. The involved vein was the branch of the petrous vein (12 cases). After the operation, immediate pain extinction was achieved in 34 patients, delayed complete pain alleviation was reported by 5 cases in two weeks (4 patients) or one month (1 patient) , in the other two patients, the pain was not relieved. The effective rate of the procedure was 95. 1% (39/41). Postoperative complications included mild facial paralysis and tinnitus (1 case) , and facial numbness (1 case) , both the symptoms disappeared in three weeks. The 39 effective cases were followed up for a mean of 21.4 months (6 months to 3 years, > 12 months in 31 patients) , during which no patient had recurrence. Conclusions Microvascular decompression is effective for trigeminal neuralgia. We recommend endoscopic-assisted technique to decrease the rate of surgical complications and trauma, and avoid missing any involved arteries.%目的 总结采用内窥镜配合显微镜微血管减压术

  11. Simultaneous display of MRA and MPR in detecting vascular compression for trigeminal neuralgia or hemifacial spasm: comparison with oblique sagittal views of MRI

    Energy Technology Data Exchange (ETDEWEB)

    Arbab, A.S.; Aoki, S.; Yoshikawa, T.; Kumagai, H.; Araki, T. [Department of Radiology, Yamanashi Medical University, Yamanashi 409-3898 (Japan); Nishiyama, Y.; Nagaseki, Y.; Nukui, H. [Department of Neurosurgery, Yamanashi Medical University, Yamanashi 409-3898 (Japan)

    2000-07-01

    A new technique, simultaneous display of magnetic resonance angiography (MRA) and multiplanar reconstruction (MPR), was performed by a workstation to identify the involved vessels in patients with trigeminal neuralgia (TN) or hemifacial spasm (HFS), and the results were compared with those of oblique sagittal MRI technique. Twelve patients with either HFS or TN were prospectively assessed by simultaneous display of MRA and MPR, and oblique sagittal techniques, to point out the neurovascular compression and to identify the involved vessels. Three-dimensional (3D) time-of-flight (TOF) spoiled gradient-echo (SPGR) images were acquired to create MRA and MPR. Oblique sagittal views were also created and displayed on films. A total of 15 vessels in 12 patients were identified as compressing vessels during surgery. Simultaneous display of MRA and MPR technique pointed out the presence of vessels at and/or around root entry/exit zone (REZ) in all 12 patients, but proper identification by the name of the individual vessel was correct in 13 of 15 cases. However, oblique sagittal technique indicated the presence of vessels at and/or around REZ in 11 patients, but only 8 of 14 vessels were correctly identified. Our new method, simultaneous display of MRA-MPR, facilitated correct identification of the involved vessels compared with the oblique sagittal view method. (orig.)

  12. Facial palsy,hemifacal spasm,trigeminal neuralgia and vertebral- basilaris artery blood supply disturbance%面神经麻痹、面肌痉挛、三叉神经痛与椎-基底动脉供血障碍

    Institute of Scientific and Technical Information of China (English)

    张俊新; 谷玉娟; 谢辉; 于亚茹; 马颖; 王月洁; 刘英

    2003-01-01

    BACKGROUND:Facial palsy,hemifacal spasm,trigeminal neuralgia was diagnosed easily,According to clinical manifestation.But because of unclear etiology,the treatment effects are far from good.Idiopathic facial palsy about 15% recovers uncompletely.Hemifacial spasm,trigeminal neuralgia reattack rates are high. CT scanning,Transcnanial Doppler (TCD), Ultra- red Heat Scanning and so on coming into use in the clinical;for finding the etiology of the "idopathic" disease provide possible, and for finding the accordance of treatment using drugs provide possible.

  13. Radiofrecuencia pulsada en la neuralgia esencial del trigémino: ¿Es una alternativa válida a la radiofrecuencia convencional? Pulsed radiofrequency in the management of trigeminal essential neuralgia: Is a valid alternative to the conventional radiofrequency?

    Directory of Open Access Journals (Sweden)

    M. Castro

    2008-04-01

    Full Text Available Objetivos. Demostrar la eficacia y seguridad de la radiofrecuencia pulsada en el tratamiento de la neuralgia esencial del trigémino y compararla con la técnica convencional. Material y métodos. Estudio observacional prospectivo en 32 pacientes diagnosticados de neuralgia esencial del trigémino a los que se les realizó un total de 44 radiofrecuencias del ganglio de Gasser. Las radiofrecuencias fueron realizadas en quirófano, bajo control radioscópico con un generador Neurotherm, agujas SMK 22G, estimulación sensitiva a 50 Hz hasta notar parestesia con 0,3-0,5 V y motora a 2 Hz sin que haya contracción del músculo masetero excepto si se está estimulando la 3ª rama. Se realizaron 28 radiofrecuencias pulsadas (RFP y 16 convencionales (RFC. La RFP se realizaba a una tª de 40º C durante 120 sg mientras que la RFC se realizaba a una tª de 80º C durante 60 sg. La eficacia del tratamiento se basó en control del dolor según la EVA a los 30, 90, y 180 días y mediante el test de Lattinen antes y al final del estudio. Todos los pacientes fueron preguntados acerca de posibles efectos secundarios. Resultados. Se realizaron un total de 44 procedimientos. El 60% de los pacientes fueron varones y el 40% mujeres. La edad media fue de 68.32 años. Ambos grupos fueron comparables en cuanto a patología previa y antecedentes personales. Entre las ramas afectas el 4.5% de los pacientes tenía afectada la primera rama, el 31.8% la segunda rama, el 36.4% la tercera rama, el 13.6% la primera y segunda rama, y el 13.6% la segunda y tercera rama. Los pacientes recibieron RFP en el 63,6% de los casos y RFC en el 36.4%. En el grupo de RFP la evolución del VAS fue: VAS 0: 8; VAS 1: 3 .4; VAS 3: 2.5 y VAS 6: 2. y del índice de Lattinen, L0: 16.9 y L6: 6. En el grupo de RFC, VAS 0: 7.9; VAS 1: 3.25; VAS 3: 2 y VAS 6: 2. El índice de Lattinen, L0: 16.125 y L6: 5. No hubo diferencias estadísticamente significativas en la reducción del VAS y del Lattinen

  14. 应用MRI特殊序列诊断在三叉神经痛和面肌痉挛价值%The value of application of MRI special sequence in diagnosis of trigeminal neuralgia and facial spasm

    Institute of Scientific and Technical Information of China (English)

    公茂青; 佟志勇; 李喆; 王运杰

    2003-01-01

    AIM:To evaluate the diagnosis value of MRI for neurovascular compression (NVC) in trigeminal neuralgia(TN) and facial spasm(FS).METHODS:15 patients with TN and 2 patient with FS underwent SE T1WI and T2WI first, then 3D- TOF- SPGR sequences.RESULTS:NVC was found in all the patients, MRI findings were consistent with the surgical operative findings completely.CONCLUSION:It is considered to be of important to use MRI to find out the causes of TN and FS,especially to utilize the 3D- TOF- SPGR sequences, which may possess high sensitivity in determining NVC.

  15. Observation of Plasma Levels of β-Endorphin in Patients with Trigeminal Neuralgia%三叉神经痛患者血浆β-内啡肽含量的观察

    Institute of Scientific and Technical Information of China (English)

    赵云富; 姜晓钟; 胡世辉; 刘渊; 苗林; 宋朝佑

    2001-01-01

    目的 确定血浆β-内啡肽与三叉神经痛发病的关系。方法 用放射免疫法检测12例患者疼痛发作时患侧颈外静脉血、健侧颈外静脉血、肘静脉血及术后患侧颈外静脉血中β-内啡肽含量,12例正常自愿者颈外静脉血中β内啡肽含量作为正常对照。结果 患者血浆β-内啡肽含量显著低于正常人(P<0.05);疼痛发作时患侧颈外静脉血中β-内啡肽含量与健侧颈外静脉血、肘静脉血中β-内啡肽含量无显著差异,与术后患侧颈外静脉血中β-内啡肽含量也无显著差异(P>0.05)。结论 三叉神经痛患者血浆β-内啡肽含量降低,中枢内源性痛觉调制系统对疼痛的抑制作用可能减弱,外周神经源性炎症可能得不到有效的控制。%Objective To observe the relationship between plasma levels ofβ-endorphin and trigeminal neuralgia. Methods During the attacks of trigeminal neuralgia, β-endorphin levels of plasma from external jugular, cubital fossa vein blood ipsilateral to the pain and contralateral external jugular vein blood were assessed by sensitive radioimmunoassay in 12 cases, after operations the venous blood from the ipsilateral external jugular vein was sampled again, the external jugular vein blood of 12 normal volunteers was collected as control. Results The plasma levels of β-endorphin in patients with trigeminal neuralgia were significantly lower than that in normal volunteers(P<0.05). Conclusion The lowered plasma β-endorphin levels may be an important factor for the development of pain in patients with trigeminal neuralgia, which may result in pain and neurogenic inflammation that can not be controlled in central nervous system and peripheral nerve terminals.

  16. Postherpetic Zoster Neuralgia

    Directory of Open Access Journals (Sweden)

    F. S. Кharlamova

    2016-01-01

    Full Text Available The article is devoted postzoster neuralgia, which presents a literature review and clinical case own observations — unfavorable outcome of varicella in a child of 7 years in the form of formed postzoster ganglionitis facial and trigeminal nerve - Hunt syndrome, neuropathy greater occipital nerve. Debated tactics of complex treatment and prevention methods for this pathology

  17. Therapeutic efficacy and safety of Botulinum Toxin A Therapy in Trigeminal Neuralgia: a systematic review and meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Morra, Mostafa Ebraheem; Elgebaly, Ahmed; Elmaraezy, Ahmed; Khalil, Adham M; Altibi, Ahmed M A; Vu, Tran Le-Huy; Mostafa, Mostafa Reda; Huy, Nguyen Tien; Hirayama, Kenji

    2016-12-01

    Several different interventions have been examined to alleviate pain and reduce frequency of trigeminal neuralgia (TN) paroxysms. However, some patients continue to have persistent or recurrent painful attacks. Using a systematic review and meta-analysis approach, we aimed to synthesize evidence from published randomized controlled trials (RCTs) regarding safety and efficacy of botulinum toxin type A (BTX-A) as a possible emerging choice of treatment for TN. We conducted an electronic search in 10 databases/electronic search engines to access relevant publications. All articles in all languages reporting RCTs on the efficacy and safety of BTX-A in the treatment of TN were included for systematic review and meta-analysis. A total of four RCTs (n = 178) were identified for final meta-analysis. The overall effect favored BTX-A versus placebo in terms of proportion of responders (risk ratio RR = 2.87, 95 % confidence interval CI [1.76, 4.69], p <0.0001) with no significant detected heterogeneity (p = 0.31; I(2) = 4 %). Paroxysms frequency per day was significantly lower for BTX-A group (mean difference MD = -29.79, 95 % CI [-38.50,-21.08], p <0.00001) with no significant heterogeneity (p = 0.21; I(2) = 36 %). Despite limited data, our results suggest that BTX-A may be an effective and safe treatment option for patients with TN. Further larger and well-designed RCTs are encouraged to translate these findings into better clinical outcome and better quality of life for TN patients.

  18. Clinical analysis of carbamazepine combined with baclofen treating trigeminal neuralgia%卡马西平联合巴氯芬治疗三叉神经痛的临床分析

    Institute of Scientific and Technical Information of China (English)

    程福璋

    2015-01-01

    Objective To explore the clinical effect of carbamazepine combined with baclofen treating trigeminal neu-ralgia. Methods 82 patients with trigeminal neuralgia meeting clinical diagnostic criteria and received in our hospital from February 2013 to February 2015 were selected as study object.Patients were divided into control group and treat-ment group by random number table method,and each group was 41 cases.Patients in control group were treated simply with carbamazepine,while patients in treatment group were given carbamazepine combined with baclofen.Disappear time of trigeminal neuralgia symptom,the total time of medicine treatment plan implement,treatment effect and incidence rate of adverse reaction and so on in patients between two groups was compared respectively. Results The disappear time of trigeminal neuralgia symptom and the total time of medicine treatment plan implement in treatment group [(7.32±1.08) d and (10.75±1.68) d] was obviously shorter than that of control group [(10.68±2.15) d and (14.79±2.53) d] respectively (P<0.05).The total effective rate in treatment group (90.3%) was obviously higher than that of control group (68.3%) (P<0.05).The incidence rate of adverse reaction in treatment group (2.4%) obviously lower than that of control group (17.1%) (P<0.05). Conclusion The clinical effect is very obvious by using carbamazepine combined with baclofen treat-ing trigeminal neuralgia.%目的:探讨卡马西平联合巴氯芬治疗三叉神经痛的临床效果。方法选择2013年2月~2015年2月我院收治的符合临床诊断标准的三叉神经痛患者82例作为研究对象,采取随机数字表法将其分成对照组和治疗组,每组41例。对照组患者给予单纯卡马西平治疗;治疗组患者给予卡马西平联合巴氯芬治疗。比较两组患者的三叉神经痛症状消失时间和用药治疗计划实施总时间、治疗效果、不良反应发生率等。结果治疗组患者的三

  19. Advances of The Pathogenesis of Trigeminal Neuralgia and The Efifciency of Stereotactic Radiosurgery%三叉神经痛的发病机制及立体定向放射外科治疗进展

    Institute of Scientific and Technical Information of China (English)

    潘绵顺; 李勇; 邱书珺

    2015-01-01

    Trigeminal neuralgia (TN) is a debilitating pain syndrome within the trigeminal nerve distribution, that is characterized by agonizing, paroxysmal and lancinating pain. The pathophysiology of trigeminal neuralgia is not clear and no satisfactory animal model so far. But with the rapid development of pathophysiology and neuroimaging, there are some evidences showed that the central nervous and peripheral nerve factors may cause trigeminal neuralgia attacks. The recommended ifrst-line treatment for TN is medical therapy, but this often fails to provide pain relief. Thus, secondline treatment modalities are given to patients whose symptoms are intractable or who cannot tolerate medication. These treatment modalities include invasive procedures such as microvascular decompression (MVD), and ablative procedures such as radiosurgery, percutaneous balloon microcompression, radiofrequency rhizotomy and glycerol rhizolysis. Among them, gamma knife and CyberKnife radiosurgery have becoming an important method in the treatment of TN because of its’ minimally invasive and signiifcant efifciency.%三叉神经痛是指在三叉神经分布区内反复发作的阵发性剧烈疼痛。其发病机制是一个非常复杂的病理过程,至今没有满意的动物模型,制约了其病因学的研究,随着病理生理及神经影像学的发展,有越来越多的证据表明:中枢神经因素及外周神经因素均可导致三叉神经痛的发作。三叉神经痛的一线治疗方案是药物治疗,如卡马西平或奥卡西平等;但对于不耐受药物副作用或是药物难治性TN可选择二线治疗,如微血管减压术,立体定向放射外科,经皮穿刺微球囊压迫术,射频或甘油注射三叉神经阻断术。其中,以伽玛刀和射波刀为代表的立体定向放射外科因创伤性极小,且疗效显著成为TN患者治疗的重要方法。

  20. Cranial neuralgias: from physiopathology to pharmacological treatment.

    Science.gov (United States)

    De Simone, Roberto; Ranieri, Angelo; Bilo, Leonilda; Fiorillo, Chiara; Bonavita, Vincenzo

    2008-05-01

    Cranial neuralgias are paroxysmal painful disorders of the head characterised by some shared features such as unilaterality of symptoms, transience and recurrence of attacks, superficial and "shock-like" quality of pain and the presence of triggering factors. Although rare, these disorders must be promptly recognised as they harbour a relatively high risk for underlying compressive or inflammatory disease. Nevertheless, misdiagnosis is frequent. Trigeminal and glossopharyngeal neuralgias are sustained in most cases by a neurovascular conflict in the posterior fossa resulting in a hyperexcitability state of the trigeminal circuitry. If the aetiology of trigeminal neuralgia (TN) and other typical neuralgias must be brought back to the peripheral injury, their pathogenesis could involve central allodynic mechanisms, which, in patients with inter-critical pain, also engage the nociceptive neurons at the thalamic-cortical level. Currently available medical treatments for TN and other cranial neuralgias are reviewed.

  1. Surgical treatment of cranial neuralgias.

    Science.gov (United States)

    Franzini, Angelo; Ferroli, Paolo; Messina, Giuseppe; Broggi, Giovanni

    2010-01-01

    The most common types of cranial neuralgias amenable to surgical therapeutic options are trigeminal neuralgia and glossopharyngeal neuralgia, the former having an approximate incidence of 5/100000 cases per year and the latter of 0.05/100000 cases per year. Surgical therapy of these pathological conditions encompasses several strategies, going from ablative procedures to neurovascular decompression, to radiosurgery. The choice of the most appropriate surgical option (which must be taken into account when all conservative treatments have proven to be unsuccessful) has to take into account many factors, the most important ones being neuroradiological evidence of a neurovascular conflict, severity of symptoms, the age and clinical history of the patient, and the patient's overall medical condition. In this chapter we report our experience with the treatment of trigeminal and glossopharyngeal neuralgia, describing the surgical procedures performed and reviewing the most recent aspects on this subject in the past literature.

  2. 原发性三叉神经痛显微血管减压术后复发相关因素的研究%Related factors of recurrence of primary trigeminal neuralgia after microvascular decompression

    Institute of Scientific and Technical Information of China (English)

    唐四强; 漆松涛; 刘忆; 陈铭; 张喜安; 潘军; 曹永福

    2014-01-01

    Objective To evaluate the related factors of the recurrence of primary trigeminal neuralgia after microvascular decompression(MVD).Methods 147 patients with initial primary trigeminal neuralgia treated with MVD in our departerment were retrospectively analyzed.The preoperative treatment,clinical presentation,operative findings and postoperative outcomes were recorded.The related factors of recurrence were statically analyzed.Results The mean follow-up time was 39.5 months and the recurrence rate was 11.6% (17/147).The univariate analysis showed that the duration of disease(x2 =8.226,P =0.016),clinical presentation (x2 =4.940,P =0.026),offending artery (x2 =45.759,P =0.000),compression degree(x2 =13.811,P =0.003),decompression degree (x2 =39.910,P =0.000),outer arachnoid(x2 =33.117,P =0.000),arachnoidcompression (x2 =27.245,P =0.000) and arachnoid adhesion(x2 =20.710,P =0.000)were statically related to the recurrence of neuralgia.After the Logistic regression analysis,the outer arachnoid (P =0.033),arachnoid trabecula compression (P =0.008),offending artery (P =0.002) and decompression degree (P =0.004) were the predictors of the recurrence.Conclusions MVD was effective in the treatment of primary trigeminal neuralgia.The arachnoid factors might play an important role in the pathogenesis of trigeminal neuralgia and MVD.%目的 探讨原发性三叉神经痛显微血管减压术后复发的相关因素.方法 回顾性分析我院147例首次经微血管减压术治疗的原发性三叉神经痛患者的临床资料,包括术前治疗方式、临床特征、术中所见、术后第1周时的疗效,并分析随访期内复发的相关因素.结果 147例患者平均随访39.5个月,17例(11.6%)复发;复发的单因素分析显示病程(x2=8.226,P=0.016),临床特征(x2=4.940,P=0.026),责任血管(x2 =45.759,P=0.000),压迫程度(x2=13.811,P=0.003),减压程度(x2=39.910,P=0.000),外层蛛网膜(x2=33.117,P=0.000),蛛网膜卡压(x2=27.245,P=0.000),

  3. Analysis of factors influencing effect of gamma knife radiosurgery for idiopathic trigeminal neuralgia%影响原发性三叉神经痛伽玛刀治疗效果的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    何占彪; 许建新; 谢富堂

    2009-01-01

    目的 探讨伽玛刀治疗原发性三叉神经痛的疗效及影响预后的因素.方法 回顾性分析75例原发性三叉神经痛的患者行伽玛刀治疗的效果,均经OUR-XGD旋转式伽玛刀治疗,采用4~8 mm准直器,半月节照射采用多靶点,三叉神经根照射采用单靶点或双靶点,中心剂量70~90 Gy,脑干表面受量<15 Gy.通过随访患者疼痛发作的频率和程度的减轻评价疗效.结果 随访时间为3~72个月,平均37.6个月,总有效率90.7%.4例患者2~3年后复发,6例在伽玛刀治疗后半年出现患侧面部麻木感,无其他并发症.经统计学分析,某些因素与疗效相关.结论 伽玛刀治疗原发性三叉神经痛一种安全有效的方法,靶点选择、剂量选择、照射部位是影响预后的因素,而病史长短及疼痛分布与预后无相关性.%Objective To investigate the effect and prognostic factors of gamma knife treatment for idi-opathic trigeminal neuralgia. Methods Retrospective analysis of 75 cases of patients with idiopathic trigeminal neuralgia were treated by gamma knife,32 cases of male,female 43 cases,have been considered by the OUR-XGD rotating gamma knife treatment,using 4 mm ~8 mm collimator,And a half section exposure multi-target, trigeminal nerve root exposure to a single target or two targets, the center dose of 70 ~ 90 Gy, the brain stem sur-face dose < 15 Gy. Through follow-up of patients with pain onset of the frequency and extent of reduction were e-valuated. Results Follow-up for 3 ~ 72 months, an average of 37.6 months, the total efficiency of 90. 7 %. 4 pa- tients relapse after 2 ~ 3 years, 6 cases had ipsilateral facial numbness after gamma knife treatment in six months, no other complications, the effect of gamma knife radiosurgery for primary trigeminal neuralgia has statis-tical significance with some factor. Conclusions Gamma knife radiosurgery for idiopathie trigeminal neuralgia is a safe and effective method,target selection

  4. Surgery by a retro-sigmoid keyhole approach in treatment of trigeminal neuralgia, hemi-facial spasm and glossopharyngeal neuralgia%乙状窦后锁孔手术治疗三叉神经痛、半面痉挛和舌咽神经痛

    Institute of Scientific and Technical Information of China (English)

    马兆鑫; 李明; 曹奕; 陈旭辉

    2011-01-01

    Objective The aim of the study was to describe and evaluate the efficacy of keyhole microsurgery to manage patients with trigeminal neuralgia (TN), hemi-facial spasm (HFS) and glossopharyngeal neuralgia (GPN). Methods Two hundred and seven patients underwent micro-vascular decompression (MVD) and neurotomy via the retrosigmoid keyhole approach in our department clinic; MVD for trigeminal neuralgia 169 cases, hemifacial spasm 31 cases , glossopharyngeal neuralgia 4 cases and neurotomy for glossopharyngeal neuralgia 3 cases. There was no serious complication such as deaths or infarction in the cerebellum or the brainstem. Results Complete and partial symptoms relief was obtained in 160 (94.7% ) cases and failure in 9 (5.3% ) cases with MVD for trigeminal neuralgia, postoperatively. Also, complications occurred in one case with only cerebellar hematoma. The postoperative results of MVD for hemi-facial spasm with symptoms relief was noted in 29 (93.5% ) cases and failure in 2 (6.5% ) cases. Postoperative complications occurred in one case with moderate hearing loss, and another three cases complained of transient facial paralysis. Symptoms relief was achieved in all 7 (100% ) cases that had undergone MVD or neurotomy for glosspharyngeal neuralgia. Postoperative complications occurred in one case with moderate vocal paralysis. Conclusion We think that microsurgery via the retro-sigmoid keyhole approach is safe and effective for CPA hyperactive cranial nerve dysfunction syndromes.%目的 评价锁孔术治疗三叉神经痛(TN)、半面痉挛(HFS)和舌咽神经痛(GPN)的疗效.方法 对207例患者实施乙状窦后锁孔入路微血管减压术(MVD)和神经切断术,其中三叉神经痛169例,半面痉挛31例,舌咽神经痛7例.结果 三叉神经痛治愈和好转160例(94.7%),无效9(5.3%);半面痉挛患者治愈29例(93.5%),无效2例(6.5%);舌咽神经痛患者治愈7例(100%).术后未发生严重并发症,如死亡或小脑、脑干梗死等.

  5. Comparative study on gabapentin and carbamazepine medication in treatment of Trigeminal Neuralgia%加巴喷丁与卡马西平治疗三叉神经痛的对比分析

    Institute of Scientific and Technical Information of China (English)

    陈忠红

    2015-01-01

    目的:对比分析加巴喷丁与卡马西平对三叉神经痛的治疗效果。方法搜集本院2014年1月~2015年1月三叉神经痛40例,依据治疗用药不同将其分两组。对照组20例,用药选择卡马西平;实验组20例,用药选择加巴喷丁。观察两组疗效,比较分析。结果两组比较,实验组VAS改善明显(P <0.05),治疗有效率明显较高(P <0.05),不良反应较少(P <0.05),差异显著。结论加巴喷丁对三叉神经痛疗效确切,优于卡马西平,可推广。%Objective Clinical effects of gabapentin and carbamazepine in treatment of trigeminal neuralgia are to be comparatively studied.MethodsChoose 40 patients of trigeminal neuralgia who are treated in hospital from January 2014 to January 2015 and separate them into two groups according to different medication treatments; 20 patients in control group are given carbamazepine medication treatment and 20 patients in study group are given gabapentin medication treatment; and then make a comparative study on treatment effects between two groups.Results Patients’ VAS are improved better in study group (P < 0.05), and treatment efficacy in study group is much higher than that in control group (P < 0.05); besides, side-effect incidence in study group is less (P < 0.05) there is a treatment differential between two groups.Conclusion Gabapentin medication is much more effective in treatment of trigeminal neuralgia than carbamazepine medication; thus, such a treatment is quite worthwhile to be promoted and applied widespread.

  6. Recurrence of trigeminal neuralgia after microvascular decompression and its microsurgical management%显微血管减压术治疗三叉神经痛术后复发与再手术

    Institute of Scientific and Technical Information of China (English)

    杨德宝; 王之敏; 蒋栋毅; 陈寒春; 周强; 万意; 沈李奎

    2013-01-01

    目的 探讨显微血管减压术治疗三叉神经痛术后复发的因素和再手术治疗方法.方法 对苏州九龙医院神经外科自2006年1月至2011年12月收治的21例显微血管减压术后复发患者行手术治疗,术中辅助性应用神经内镜,17例行显微血管减压术,2例行单纯蛛网膜松解术,1例行三叉神经感觉根部分切断术,1例行显微血管减压术加三叉神经感觉根部分切断术. 结果 21例患者平均随访28.5月,随访再手术有效率为95.2%,术后面部麻木2例,轻度面瘫1例. 结论 显微血管减压术后复发原因是多样的,血管压迫仍是主要病因;再手术仍应首选显微血管减压术,神经内镜辅助可提高手术疗效及安全性.%Objective To study the influencing factors of recurrence of trigeminal neuralgia after microvascular decompression and its microsurgical management.Methods Twenty one patients with recurrent trigeminal neuralgia after microvascular decompression (MVD),admitted to our hospital from 2006 to 2011,were treated by microsurgical operations assisted by neuroendoscope.MVD was performed again in 17 patients,arachnoid membranes reflaxation in 2,partial rhizotomy (PR) in 1,and both MVD and PR in 1.Results All patients were followed up for about 28.5 months (mean duration).The total effective rate during the follow-up period was 95.2%.Facial numbness was found in 2 patients and light facial paralysis in 1.Conclusion Many factors were responsible for the recurrence of trigeminal neuralgia after MVD; and vascular compression is still the main cause; MVD should be the first choice; curative effect and safety would be improved by the assistance ofneuroendoscope.

  7. Imaging the trigeminal nerve

    Energy Technology Data Exchange (ETDEWEB)

    Borges, Alexandra [Radiology Department, Instituto Portugues de Oncologia Francisco Gentil, Centro de Lisboa, Rua Prof. Lima Basto, 1093, Lisboa (Portugal)], E-mail: borgalexandra@gmail.com; Casselman, Jan [Department of Radiology, A. Z. St Jan Brugge and A. Z. St Augustinus Antwerpen Hospitals (Belgium)

    2010-05-15

    Of all cranial nerves, the trigeminal nerve is the largest and the most widely distributed in the supra-hyoid neck. It provides sensory input from the face and motor innervation to the muscles of mastication. In order to adequately image the full course of the trigeminal nerve and its main branches a detailed knowledge of neuroanatomy and imaging technique is required. Although the main trunk of the trigeminal nerve is consistently seen on conventional brain studies, high-resolution tailored imaging is mandatory to depict smaller nerve branches and subtle pathologic processes. Increasing developments in imaging technique made possible isotropic sub-milimetric images and curved reconstructions of cranial nerves and their branches and led to an increasing recognition of symptomatic trigeminal neuropathies. Whereas MRI has a higher diagnostic yield in patients with trigeminal neuropathy, CT is still required to demonstrate the bony anatomy of the skull base and is the modality of choice in the context of traumatic injury to the nerve. Imaging of the trigeminal nerve is particularly cumbersome as its long course from the brainstem nuclei to the peripheral branches and its rich anastomotic network impede, in most cases, a topographic approach. Therefore, except in cases of classic trigeminal neuralgia, in which imaging studies can be tailored to the root entry zone, the full course of the trigeminal nerve has to be imaged. This article provides an update in the most recent advances on MR imaging technique and a segmental imaging approach to the most common pathologic processes affecting the trigeminal nerve.

  8. Comparison of clinical symptoms and magnetic resonance angiographic (MRA) results in patients with trigeminal neuralgia and persistent idiopathic facial pain. Medium-term outcome after microvascular decompression of cases with positive MRA findings.

    Science.gov (United States)

    Kuncz, A; Vörös, E; Barzó, P; Tajti, J; Milassin, P; Mucsi, Z; Elek, P; Benedek, K; Tarjányi, J; Bodosi, M

    2006-03-01

    Neurovascular compression (NC) seems to have been confirmed as the major cause of classical trigeminal neuralgia (TN). In spite of the large number of surgically positive cases, however, there are still cases where no vascular compression of the trigeminal nerve can be found. To evaluate whether NC could be demonstrated preoperatively, high-resolution magnetic resonance angiography (MRA) was performed in 287 consecutive patients with TN and persistent idiopathic facial pain (PIFP) on a 0.5-T and a 1-T MR unit. Depending on the clinical symptoms, the TN cases were divided into typical TN and trigeminal neuralgia with non-neuralgic interparoxysmal pain (TNWIP) groups. Microvascular decompression (MVD) was performed in 103 of the MRA-positive cases. The patients were followed up postoperatively for from 1 to 10 years. The clinical symptoms were compared with the imaging results. The value of MRA was assessed on the basis of the clinical symptoms and surgical findings. The outcome of MVD was graded as excellent, good or poor. The clinical symptoms were compared with the type of vascular compression and the outcome of MVD. The MRA image was positive in 161 (56%) of the 287 cases. There were significant differences between the clinical groups: 66.5% of the typical TN group, 47.5% of the TNWIP group and 3.4% of the PIFP group were positive. The quality of the MR unit significantly determined the ratio of positive/negative MRA results. The surgical findings corresponded with the MRA images. Six patients from the MRA-negative group were operated on for selective rhizotomy and no NC was found. Venous compression of the trigeminal nerve was observed in a significantly higher proportion in the background of TNWIP than in that of typical TN on MRA imaging (24.1% and 0.8%, respectively) and also during MVD (31.2% and 1.2%, respectively). Four years following the MVD, 69% of the patients gave an excellent, 23% a good and 8% a poor result. The rate of some kind of recurrence of

  9. 老年三叉神经痛患者的显微外科治疗%Microsurgery for trigeminal neuralgia in elderly patients

    Institute of Scientific and Technical Information of China (English)

    谢红雯; 姜宏志; 袁庆国; 沙成; 杨玉明; 王大明

    2012-01-01

    Objective To investigate the efficacy and safety of microsurgery for trigeminal neuralgia (TN) in elderly patients.Methods Totally 143 patients with intractable primary TN who received microsurgery were retrospectively analyzed.There were 92 cases in the elderly group with age of 65-82 years,and the other 51 cases in control group with age of 40-62 years.All the patients in both groups were classified as American Society of Anesthesiologists (ASA) Scale Grade 1 to 3.After suboccipital retrosigmoid craniotomy,microvascular decompression (MVD) was performed in 136patients and partial sensory trigeminal rhizotomy in 7 patients.The complications and efficacy were compared between the two groups.Results 87 cases in the elderly group and 49 cases in control group underwent MVD procedure,complete and part pain relief were achieved in 78 cases and 9 cases in the elderly group,45 cases and 4 cases in control group,respectively.After an average follow-up period of 2.6 and 2.1 years,4 cases (5.1%) among 79 follow-up cases and 3 cases (6.5%) among 46follow-up cases experienced TN recurrences in the elderly and control groups,respectively.No statistically significant differences existed in the efficacy and recurrence rate between the two groups (P>0.05).There were 3 cases with aseptic meningitis,1 cases with hearing decrease,1 case with cerebrospinal fluid leakage,1 case with pulmonary infection and 1 cases with deliration in the elderlygroup,meanwhile,1 cases with aseptic meningitis,1 case with tinnitus and 1 case with cerebrospinal fluid leakage after surgery in control group (P>0.05).No facial hypoesthesia appeared in the patients receiving MVD.5 cases in the elderly and 2 cases in control group underwent partial trigeminal rhizotomy with facial hypoesthesia,but the pain released,and no recurrence was found.There were no dead cases in both groups.Conclusions With cautious and proper treatment,microsurgical procedure can be performed safely and effectively in the

  10. SU-F-T-647: Linac-Based Stereotactic Radiosurgery (SRS) in the Treatment of Trigeminal Neuralgia: Detailed Description of SRS Procedural Technique and Reported Clinical Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Pokhrel, D; Sood, S; Badkul, R; Jiang, H; Stepp, T; Camarata, P; Wang, F [University of Kansas Hospital, Kansas City, KS (United States)

    2016-06-15

    Purpose: SRS is an effective non-invasive alternative treatment modality with minimal-toxicity used to treat patients with medically/surgically refractory trigeminal neuralgia root(TNR) or those who may not tolerate surgical intervention. We present our linac-based SRS procedure for TNR treatment and simultaneously report our clinical outcomes. Methods: Twenty-eight TNR-patients treated with frame-based SRS at our institution (2009–2015) with a single-fraction point-dose of 60-80Gy to TNR were included in this IRB-approved study. Experienced neurosurgeon and radiation oncologist delineated the TNR on 1.0mm thin 3D-FIESTA-MRI that was co-registered with 0.7mm thin planning-CT. Treatment plans were generated in iPlan (BrainLAB) with a 4-mm diameter cone using 79 arcs with differential-weighting for Novalis-TX 6MV-SRS(1000MU/min) beam and optimized to minimize brainstem dose. Winston-Lutz test was performed before each treatment delivery with sub-millimeter isocenter accuracy. Quality assurance of frame placement was maintained by helmet-bobble-measurement before simulation-CT and before patient setup at treatment couch. OBI-CBCT scan was performed for patient setup verification without applying shifts. On clinical follow up, treatment response was assessed using Barrow Neurological Institute Pain Intensity Score(BNI-score:I–V). Results: 26/28 TNR-patients (16-males/10-females) who were treated with following single-fraction point-dose to isocenter: 80Gy(n=22),75Gy(n=1),70Gy(n=2) and 60Gy(n=1, re-treatment) were followed up. Median follow-up interval was 8.5-months (ranged:1–48.5months). Median age was 70-yr (ranged:43–93-yr). Right/left TNR ratio was 15/11. Delivered total # of average MUs was 19034±1204. Average beam-on-time: 19.0±1.3min. Brainstem max-dose and dose to 0.5cc were 13.3±2.4Gy (ranged:8.1–16.5Gy) and 3.6±0.4Gy (ranged:3.0–4.9Gy). On average, max-dose to optic-apparatus was ≤1.2Gy. Mean value of max-dose to eyes/lens was 0.26Gy/0.11Gy

  11. [Neurosurgical treatment of vago-glossopharyngeal neuralgia].

    Science.gov (United States)

    Sindou, M; Keravel, Y

    2009-04-01

    Glossopharyngeal neuralgia, more accurately called vago-glossopharyngeal neuralgia (VGPN) because of the frequent association with pain irradiation in the sensory territory of the vagus nerve, is not always recognized because its incidence is much lower than the incidence of trigeminal neuralgia (100 times more frequent). As in trigeminal neuralgia, when pain becomes resistant to anticonvulsants - its specific medical treatment - VGPN can almost always be cured by surgery. The first option is microvascular decompression, since vascular compression is the main cause of the neuralgia. Percutaneous thermorhizotomy at the foramen jugularis (pars nervosa) is only indicated as a second option, because of unavoidable sensorimotor deficits in the ninth and tenth nerves. Tractonucleotomies at the medullary level should be reserved essentially for pain of malignant origin.

  12. Severity Analysis of Neurovascular Contact in Patients with Trigeminal Neuralgia: Assessment with the Inner View of the 3D MR Cisternogram and Angiogram Fusion Imaging

    National Research Council Canada - National Science Library

    Satoh, T; Omi, M; Nabeshima, M; Onoda, K; Date, I

    2009-01-01

    .... The frequency and severity of the NVC among the affected, contralateral, and normal trigeminal nerves were analyzed by 3D MR cisternogram and angiogram fusion imaging in relation to the cause of TN...

  13. Trigeminal Neuropathy in Sjogren′s Syndrome

    Directory of Open Access Journals (Sweden)

    Pinheiro L

    1999-01-01

    Full Text Available Trigeminal neuropathy is the most common CNS disorder in Sjogren′s syndrome. It is believed to be caused by vasculitis. Unless this is recognised, a diagnosis of trigeminal neuralgia is often made. The therapeutic response to steroids is unpredictable. There are two subgroups - those with associated collagen disorders and those only with the sicca syndrome.

  14. 脉冲射频用于三叉神经疱疹后神经痛治疗的对比观察%CLINICAL EFFECT OF PULSED RADIO-FREQUENCE ON TRIGEMINAL POST-HERPETIC NEURALGIA

    Institute of Scientific and Technical Information of China (English)

    魏星; 王家双; 包佳巾

    2011-01-01

    目的:三叉神经带状疱疹后神经痛是头面部疼痛疾病中最有代表性的疾病之一,本文报道脉冲射频为主治疗三叉神经区疱疹后遗神经痛的效果.方法:本组共计疼痛科住院的三叉神经带状疱疹后神经痛患者30例,门诊患者30例,观察药物及脉冲射频治疗前、后疼痛程度和性质、患区遗留症状和睡眠质量.结果:患者主诉头面部自发性闪电样疼痛、刀割样疼痛、烧灼样疼痛为主.激惹型42例,麻痹型18例,平均VAS评分为8.2分.药物组患者治疗后平均VAS评分为5.4分.经过加用2次脉冲射频治疗(2Hz,40℃,120s)平均VAS评分为3.3分.经过14-18个月的随访,脉冲射频组疗效稳定.结论:本组三叉神经疱疹后神经痛患者结果表明:加用脉冲射频治疗后大部分患者疼痛缓解明显,效果比较稳定,患者的生活质量明显改善.%Objective: Trigeminal post-herpetic neuralgia is one of typical painful diseases of human head or face. This paper report clinical effect of pulsed radio-frequence(PRF) on trigeminal pos-therpetic neuralgia. Methods: There are 60 cases, 30 is in-patient or out-patient, of trigeminal post-herpetic neuralgia are investigated and index of pain types, sleeping condition and remain symptoms in zoster area are used.Results: lightning pain, lancinating pain, burning pain are main complaint in clinical and average VAS score is 8.2. There are two sub-clinical types, irritable nociceptor group (42), deafferentation group (18) ,respectively. After PRF (2Hz,40℃, 120s), VAS score is 3.3, the control group is 5. 4. The effect is stable after 14 ~ 18 months follow up in PRF group. Conclusion: After treatment by PRF, the quality of life of patient markedly improve, the effect is better than the control group and stable during 14 ~18 months follow up.

  15. EFFECTS OF GABAPENTIN ON PLASMA SUBSTANCE P AND β-ENDORPHIN OF PATIENTS WITH TRIGEMINAL NEURALGIA%加巴喷丁对三叉神经痛患者血浆SP和β-EP的影响

    Institute of Scientific and Technical Information of China (English)

    吴信真; 宁巧明; 严兴福

    2011-01-01

    Objective: To assess the effects and security of Gabapentin for trigeminal neuralgia patients by clinical observation and changes of plasma SP and |}-EP. Methods: 36 patients with trigeminal neuralgia were randomly divided into 2 groups: group A (gabapentin n = 20) and group B (carbamazepine n = 16). The serum levels of SP and P-EP were measured before and after the treatmeant. The side effects were also observed form the begainning to the fourth weekend. Results: The total clinical effective rate of group A was significantly better than group B (P < 0.05), The serum levels of SP were significantly lower in group A compared with group B (P < 0.05). The serum levels of P-EP were significantly higher in group A than group B (P < 0.05). Conclusion: Gabapentin increased serum levels of p-EP and decreased SP compared with carbamazepine. The efficacy and safety of gabapentin for the treatment of trigeminal neuralgia are super to carbamazepine.%目的:通过加巴喷丁治疗原发性三叉神经痛的临床观察,以及血浆SP(P物质)和β-EP(β内啡肽)的含量变化,评估其治疗的安全性及有效性.方法:36例原发性三叉神经痛患者随机分为两组,A组为加巴喷丁组20例,B组为卡马西平组16例.首量从低剂量开始投药,观察疗效至第四周末,两组在治疗前和结束时使用酶联免疫法( ELISA)检测血浆SP和β-EP的含量;通过一般体检项目及全身症状观察治疗过程中的不良反应.结果:两组间临床总有效率经统计学分析具有显著性差异(P<0.05),治疗后两组SP含量均呈下降趋势,但A组下降更明显,与B组比较,有显著性差异(P< 0.05).治疗后两组β-EP含量均呈上升趋势,但A组上升更明显,与B组比较,有显著性差异(P< 0.05).结论:加巴喷丁不仅在血浆β-EP含量升高及SP含量下降方面较为明显,而且在临床有效及安全性方面也优于卡马西平.

  16. Rhizotomy targeting the intermediate nerve, the glossopharyngeal nerve and the upper 1st to 2nd rootlets of the vagus nerve for the treatment of laryngeal neuralgia combined with intermediate nerve neuralgia-a case report

    OpenAIRE

    Zong, Qiang; Zhang, Kai; Han, Guangliang; Yang, Shengye; Wang, Lijiang; Li, Hongxing

    2014-01-01

    Background In neurosurgery, the most common type of facial and pharyngeal pain is trigeminal neuralgia. In contrast, glossopharyngeal neuralgia is relatively rare, and laryngeal neuralgia is the most rarely observed. Case presentation A case of laryngeal neuralgia combined with intermediate nerve neuralgia that was admitted to our hospital in May 2012 was reported here. The patient was a 58-year-old middle-aged female, who experienced 2 years of paroxysmal burning and stabbing pain near the t...

  17. A Case Report About Cluster-Tic Syndrome Due to Venous Compression of the Trigeminal Nerve

    NARCIS (Netherlands)

    de Coo, Ilse; van Dijk, J. Marc C.; Metzemaekers, Jan D M; Haan, Joost

    2016-01-01

    BACKGROUND: The term "cluster-tic syndrome" is used for the rare ipsilateral co-occurrence of attacks of cluster headache and trigeminal neuralgia. Medical treatment should combine treatment for cluster headache and trigeminal neuralgia, but is very often unsatisfactory. CASE: Here, we describe a 41

  18. A Case Report About Cluster-Tic Syndrome Due to Venous Compression of the Trigeminal Nerve

    NARCIS (Netherlands)

    de Coo, Ilse; van Dijk, J. Marc C.; Metzemaekers, Jan D. M.; Haan, Joost

    2017-01-01

    Background.-The term "cluster-tic syndrome" is used for the rare ipsilateral co-occurrence of attacks of cluster headache and trigeminal neuralgia. Medical treatment should combine treatment for cluster headache and trigeminal neuralgia, but is very often unsatisfactory. Case.-Here, we describe a 41

  19. A Case Report About Cluster-Tic Syndrome Due to Venous Compression of the Trigeminal Nerve

    NARCIS (Netherlands)

    de Coo, Ilse; van Dijk, J. Marc C.; Metzemaekers, Jan D. M.; Haan, Joost

    Background.-The term "cluster-tic syndrome" is used for the rare ipsilateral co-occurrence of attacks of cluster headache and trigeminal neuralgia. Medical treatment should combine treatment for cluster headache and trigeminal neuralgia, but is very often unsatisfactory. Case.-Here, we describe a

  20. 卡马西平与加巴喷丁对复发性三叉神经痛的治疗价值比较%Therapeutic Value Comparison of Carbamazepine and Gabapentin in Recurrent Trigeminal Neuralgia

    Institute of Scientific and Technical Information of China (English)

    张雪

    2015-01-01

    目的:比较卡马西平与加巴喷丁治疗复发性三叉神经痛的临床应用价值。方法选取2014年1月~2015年1月我院收治的复发性三叉神经痛患者56例,将其随机分为对照组与观察组,对照组给予卡马西平治疗,观察组给予加巴喷丁治疗。结果两组患者总有效率比较无差异(P>0.05);治疗后两组VAS疼痛评分均低于治疗前,且观察组不良反应发生率低于对照组,有统计学意义(P0.05),after treatment VAS pain scores were lower than before treatment,and observed the adverse reaction rate group were less than the control group,with statistical significance(P<0.05). Conclusion Carbamazepine and gabapentin in treatment of recurrent trigeminal neuralgia with good results,but gabapentin and more secure.

  1. 静脉压迫性三叉神经痛的手术治疗(附33例临床分析)%Surgical treatment for idiopathic trigeminal neuralgia caused by venous compression: analysis of 33 cases

    Institute of Scientific and Technical Information of China (English)

    漆松涛; 朱蔚林; 张喜安

    2008-01-01

    Objective To explore the operative features and results of idiopathic trigeminal neuralgia (TN) caused by venous compression. Methods Surgical management technique and outcomes in 33 TN patients were retrospectively analyzed. Compressing venules were electrically coagulated and blocked, and the offending branches of superior petrosal vein complex (SPVC) were partially blocked with the vein trunk preserved. After the veins were divided away from the compressed nerve and the entire cisternal trigeminal nerve were exposed, Teflon graft was properly interpositioned to encircle the whole range of it. Results Location of the vein compression can be at all along the cistemal trigeminal nerve. In the 33 TN patients, 22 were attributed to vein compression associated with artery offence, and 11 to simple vein conflict venous compression, among them 3 to anonymous veins and 8 to SPVC near Meckel's cave. The drainage patterns of the SPVC were classified into 3 groups. The pain get completely relieved in all patients after microvascular decompression(MVD). No recurrence was found during the follow-ups of 2.5 years on average. Four patients developed trigeminal nerve impairment and 2 suffered from disordered cerebellum function after operation, but these complications were all improved through treatment. Conclusions SPVC is the most common offensive vein.Whether the venous compression is main compressing factor or not, it was essential to deal with them properly to get the trigeminal nerve completely decompressed from veins. MVD can accurately identify the venous compression and reduce the recurrence, however, it may result in higher postoperative complications.%目的 探讨静脉压迫性三叉神经痛的手术治疗特点和疗效. 方法 回顾性分析8年间33例原发性三叉神经痛患者术中静脉压迫的处理及结果.对静脉压迫的处理采取细小静脉予以电凝阻断,岩上静脉复合体分支可部分阻断.保留主干;全程解剖

  2. Nervus intermedius neuralgia: a case report.

    Science.gov (United States)

    Figueiredo, Rui; Vazquez-Delgado, Eduardo; Okeson, Jeffrey P; Gay-Escoda, Cosme

    2007-07-01

    Nervus intermedius neuralgia (NIN) is an uncommon disorder that affects a sensory branch of the facial nerve. This condition usually provokes a very intense and stabbing pain localized in the depth of the ear canal. Due to the close anatomical proximity, temporomandibular joint (TMJ) pathologies should be included in the differential diagnosis. The treatment of NIN has not been established, although it seems reasonable that the therapeutic approaches used in other more common craniofacial neuralgias, such as trigeminal neuralgia, should be effective. In this paper, the authors present a case report of a female patient diagnosed with NIN who was successfully managed with pharmacological treatment.

  3. [Herpes zoster-induced neuralgia (neuropathy)].

    Science.gov (United States)

    Maksimova, M Yu; Sineva, N A; Vodopyanov, N P

    2014-01-01

    Neuralgia (neuropathy) is the most common manifestation of herpes zoster (HZ). In spinal and cranial neuralgia, there are 3 types of pain: 1) spontaneous, persistent, burning pain; 2) intermittent sharp pain; 3) pain occurring with nonpainful stimulation. The skin exhibits areas of hypesthesia, anesthesia, and dysesthesia. Ophthalmic neuralgia (of the first branch of the trigeminal nerve) is encountered in 20% of HZ cases. HZ of the auricle and external auditory meatus concurrent with facial and vestibulocochlear neuropathy is diagnosed as Ramsay Hunt syndrome. Postherpetic neuralgia (neuropathy) is characterized by pain present for 3 months or more after the appearance of herpetic eruptions. Combined therapy involving the earlier use of antiviral agents, tricyclic antidepressants, analgesics, and neuromidine is the most effective option for HZ-induced neuralgia (neuropathy).

  4. Persistent trigeminal artery: angio-tomography and angio-magnetic resonance finding

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Licia Pacheco; Nepomuceno, Lara A.M.; Coimbra, Pablo Picasso; Oliveira Neto, Sabino Rodrigues de [Hospital Geral de Fortaleza (HGF), CE (Brazil). Radiology Dept.], e-mail: licia_p@hotmail.com; Natal, Marcelo Ricardo C. [Hospital de Base do Distrito Federal, Brasilia, DF (Brazil)

    2009-09-15

    The trigeminal artery (TA) is the most common embryonic carotid-vertebrobasilar anastomosis to persist into adulthood. It typically extends from the internal carotid artery to the basilar artery. Persistent primitive arteries are usually found incidentally, but are often associated with vascular malformation, cerebral aneurysm and, in case of TA, with trigeminal neuralgia. We present one patient with TA as a cause of trigeminal neuralgia and in other three as an incidental finding, on TC and MR angiograms. (author)

  5. 神经内镜辅助微血管减压术治疗三叉神经痛%Microvascular decompression surgery for trigeminal neuralgia assisted by endoscope

    Institute of Scientific and Technical Information of China (English)

    江力; 俞文华; 王清; 鲁晓杰; 苗增利

    2012-01-01

    Objective To explore the curative effect of endoscope-assisted microvascular decompression ( MVD ) on idiopathic trigeminal neuralgia ( ITN ) . Methods The clinical data of 72 patients with ITN in our department, in whom 38 underwent neuroendoscope-assisted MVD, the other used a conventional microscope with MVD surgery were analyzed retrospectively. The operative time, postoperative effects, postoperative complications and follow-up results were compared between the two groups. Results Neuroendoscope-assisted surgery needed 165.26 ±22.62 minutes, it was not longer than conventional MVD surgery (P > 0. 05 ). It showed that 36 patients (94. 7% ) were complete remission after the follow-up of one year and 2 with pain relief. It' s better than MVD surgery term ( P <0.05). The total incidence of postoperative complications were 7 patients (18. 4% ) . All of them were relieved in 2 weeks, no serious complications occurred and no patients died. It's also better than MVD surgery term(P < 0. 05 ). Conclusions The neuroendoscope-assisted MVD can widely and clearly show the anatomic structures of the cerebellopontine angle and the entire paragraph from trigeminal nerve REZ to Meckel cave. The vessels responsible for the neuralgia are easily and accurately indentified and the effect of Teflon can be checked through the endoscope.%目的 探讨神经内镜辅助技术,在三叉神经显微镜微血管减压术的临床效果.方法 回顾我科三叉神经痛手术患者共72人,其中采用神经内镜辅助MVD治疗的患者38人,其余采用常规显微镜下MVD手术.比较两组的手术时间,术后疗效,术后并发症和随访结果.结果 使用神经内镜辅助手术用时(165.26±22.62) min,与常规手术时间比较无统计学差异.1年后随访完全缓解36例(94.7%),疼痛减轻2例,优于常规组(P<0.05).术后并发症总发生率6例(15.79%),于2周内缓解,无严重并发症,无患者死亡.优于常规组(P<0.05).结论 使用神经内

  6. Postherpetic neuralgia - aftercare

    Science.gov (United States)

    Herpes zoster - postherpetic neuralgia; Varicella-zoster - postherpetic neuralgia ... Postherpetic neuralgia can: Limit your everyday activities and make it hard to work. Affect how involved you are with ...

  7. 逐瘀活络针刺法治疗原发性三叉神经痛临床研究%Clinical Study on Zhuyu Huoluo Acupuncture Treatment of Primary Trigeminal Neuralgia

    Institute of Scientific and Technical Information of China (English)

    肖峰; 徐淑珍

    2016-01-01

    Objective:To investigate the clinical efficacy and safety of Zhuyu Huoluo acupuncture in the treatment of primary trigeminal neuralgia (blood stasis blocking brain collaterals type).Methods:100 cases of primary trigeminal neuralgia (blood stasis blocking brain collaterals) were randomly divided into control group and observation group,each 50 cases.The control group was given Carbamazepine tablets,and the observation group was treated with Zhuyu Huoluo acupuncture method.Two groups were treated for 4 weeks and 3 months of follow-up.Compared the two groups before and after treatment,the main symptoms scores and visual analogue scale(VAS),pittsburgh sleep quality index (PSQI),Hamilton Anxiety Scale (HAMA),and Hamilton Anxiety Scale (HAMA) score and recorded adverse reactions.Results:In the observation group,the effective rate was 94%,which was higher than that of control group of 78% (x2 =5.315,P < 0.05);after treatment,main symptoms and VAS scores in the observation group were lower than the control group (P < 0.01);HAMA,HAMD and PSQL table score in the observation group was lower than that of control group(P <0.01);the total adverse reaction incidence rate in the control group was 24%,which was higher than the observation group of 2% (x2 =14.513,P < 0.01).Conclusion:Zhuyu Huoluo acupuncture therapy in the treatment of primary trigeminal neuralgia (blood stasis blocking brain collaterals type) is superior to carbamazepine in improving the clinical symptoms of the patients,reduce VAS score,improve sleep quality,improve the negative emotion of patients with and improve clinical efficiency,and the safety of clinical use.%目的:探讨逐瘀活络针刺法治疗原发性三叉神经痛(瘀阻脑络证)的临床疗效和安全性.方法:选择符合要求的100例原发性三叉神经痛(瘀阻脑络证)患者随机分为对照组和观察组各50例.对照组采用卡马西平片治疗,观察组采用逐瘀活络针刺法.两组疗程均为4

  8. Lacrimal neuralgia: so far, a missing cranial neuralgia.

    Science.gov (United States)

    Pareja, Juan A; Cuadrado, María-Luz

    2013-10-01

    The lacrimal nerve supplies the lacrimal gland, the lateral upper eyelid, and a small cutaneous area adjacent to the external CANTHUS . First division trigeminal neuralgia, supraorbital/supratrochlear neuralgia, and infraorbital neuralgia have been acknowledged as neuralgic causes of pain in the forehead and periorbit. However, the lacrimal nerve has never been identified as a source of facial pain. Here we report two cases of lacrimal neuralgia. A 66-year-old woman had continuous pain in the lateral aspect of her left superior eyelid and an adjacent area of the temple since age 64. A 33-year-old woman suffered from continuous pain in a small area next to the lateral CANTHUS of her left eye since age 25. In both patients the superoexternal edge of the orbit was tender. In addition, sensory dysfunction could be demonstrated within the painful area. Anaesthetic blockades of the lacrimal nerve with lidocaine 2% resulted in complete but short-lasting relief. Pregabalin provided a complete response in the first patient. The second patient was refractory to various oral and topical drugs and different radiofrequency procedures, but she eventually obtained partial relief with pregabalin. Lacrimal neuralgia should be considered among the neuralgic causes of orbital and periorbital pain.

  9. Value of B-FFE MR sequence before CT-guided radiofrequency thermocoagulation for the treatment of primary trigeminal neuralgia%射频热凝术前磁共振B-FFE序列三叉神经成像评估

    Institute of Scientific and Technical Information of China (English)

    胡芸; 金朝林; 王翔; 张树桐; 蔡毅

    2015-01-01

    目的:探讨 CT 定位射频温控热凝治疗原发性三叉神经痛术前,磁共振平衡式快速梯度回波(B-FFE)序列三叉神经成像检查的必要性和临床意义。方法采用B-FFE 序列扫描63例拟行射频温控热凝治疗的原发性三叉神经痛患者的患侧三叉神经,观察三叉神经脑池段、半月神经节及其三大分支的解剖形态、走行方式,半月神经节与卵圆孔之间的位置关系,指导术中CT定位穿刺。结果本研究63例患者中,23例(37%)病变侧三叉神经跨岩骨尖时呈聚拢束状,40例(63%)病变侧三叉神经跨岩骨尖时呈三支分散状。眼神经走行于前内侧,下颌神经走行于后外方,上颌神经则走行于两者之间。三叉神经跨岩骨尖角度(150.11±8.32)°。卵圆孔至半月神经节距离(12.37±3.21) cm。结论三叉神经痛射频热凝温控治疗术前行磁共振B-FFE 序列三叉神经成像检查,明确相应解剖结构关系,可以提高术中 CT 定位的准确性,缩短手术时间,减低手术风险,具有较高的临床实用价值。%Objective To analyze the value of B-FFE MR sequence before CT-guided radiofrequency thermocoagulation for the treatment of primary trigeminal neuralgia..Methods The B-FFE Sequence were performed on 63 patients with primary trigeminal neuralgia before CT-guided radiofrequency thermocoagulation..MR images were analyzed to identify the relationship between trigeminal nerves and surrounding vessels,.the anatomy of trigeminal ganglion in Meckel′s caves and their branches,.the relationship between the trigeminal semilunar ganglion and the oval foramen..Results The affected trigeminal nerve roots were bundled (23/63, 37%) or divided (40/63, 63%) at (150.11±8.32) angle at the petrous apex before entering the Meckel′s caves. The ophthalmic division travelled anteromedially,.maxillary division in the middle,.and mandibular division posterolaterally

  10. Establishment of a rat model of trigeminal neuralgia induced by photochemical nerve injury%一种光化学损伤诱导的三叉神经痛大鼠模型的建立

    Institute of Scientific and Technical Information of China (English)

    崔悦; 王丹巧; 高天乐; 徐晓军; 赵佳; 王晔; 孙丹丹; 张莹; 刘洋; 赵小亮; 牛晓红; 张美玉

    2014-01-01

    Aim To investigate the behavioral changes of the pain related neuromodulation and neurotransmission in peripheral and central nervous systems in rats with trigeminal neuralgia (TN)and provide a disease relevant animal model for mecha-nism study of TN.Methods The male SD rats were randomly divided into sham operation group and TN surgical group.The latter group was further divided into model group and gabapentin group (100 mg · kg-1 ). TN was induced by intravenous erythrosine B injection and laser irradiation.The pain behavior of rats was evaluated using mechanical pain threshold measured with Von Frey hairs.Fluorescence quantitative PCR technique was deployed to study the change of Tac1 mRNA expressions in trigeminal ganglia.Utilizing microdialysis technique followed by high performance liquid chromatography fluorescence detection (HPLC-FLD),the extracellular striatum fluid was collected and glutamate(Glu)concentration was determined.Results In the model group,the average mechanical pain threshold in facial ar-ea innervated by the trigeminal nerve remained below 4g after 7 days post surgery.The mechanical threshold of the model group (1.63 ±1.27)g was significantly lower (P<0.01)than the control group (24.17 ±4.49)g on day10 post surgery.In gen-eral,the mechanical withdraw threshold was decreased from the preoperative value of 26g to the postoperative value of (1.60 ± 1.74)g (P<0.01),and maintained stable at (0.71 ±1.24) g during the whole dynamic monitoring period from day7 to day60.The successful rate of this model was 63%.After sur-gery,Tac1 mRNA expression in trigeminal ganglia and extracel-lular Glu levels in striatum were significantly up-regulated (P<0.05 ) in the model group. Animals receiving Gabapentin showed significant improvement in pain symptoms,as well as re-ductions of Tac1 mRNA expression in trigeminal ganglia and ex-tracellular Glu concentration in striatum (P<0.05 ).Conclu-sions The above described photochemically induced TN rat model can

  11. [Postherpetic neuralgia].

    Science.gov (United States)

    Goßrau, G

    2014-05-01

    Postherpetic neuralgia is considered to be a neuropathic pain syndrome. Typically, patients experience pain in the dermatomes of skin lesions persisting for more than 3 months after skin restitution. About 10 % of patients with herpes zoster develop postherpetic neuralgia. Its prevalence increases with age. Common clinical symptoms include continuous burning pain, sharp pain attacks, and allodynia. Additionally, sensory hyperactivation or loss in the affected skin area is present. Pathophysiology includes mechanisms of peripheral and central sensitization, based on damaged nerve fibers as the main mechanisms for pain generation and its maintenance. Clinical studies did show pain relief in postherpetic neuralgia after administration of antidepressants, antiepileptic drugs, opioids, and topical capsaicin and lidocaine. Nevertheless, about one third of patients do not respond to conventional treatment. Given the fact that postherpetic neuralgia is considered to be a chronic pain disease, a multidisciplinary treatment approach is necessary.

  12. 慢性原发性三叉神经痛患者静息态镜像同伦功能连接研究%Decreased interhemispheric resting-state functional connectivity in chronic primary trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    马鸣岳; 刘雨峰; 高磊; 王渊; 邬小平; 银小辉; 高燕军; 杨军乐

    2015-01-01

    目的:观察慢性原发性三叉神经痛(CPTN)患者静息状态下大脑半球间功能连接的变化。方法对20例 CPTN 患者及20例年龄、性别、受教育程度匹配的正常对照进行静息态功能磁共振(rs-fMRI)扫描,采用 SPM 8和 DPARSFA 软件计算静息态镜像同伦功能连接(VMHC)和统计学分析,获得2组间存在差异的对称脑区。结果与正常对照相比,CPTN 患者两侧内、外侧眶额皮层及运动前区的镜像同伦功能连接显著减低(P <0.05,GRF 多重校正)。结论CPTN 患者伴有减低的半球间功能整合和交互,这些异常的功能整合和交互可能反映了感觉和情绪加工的改变,以及复杂运动功能整合的受限。%Objective To investigate the alterations of interhemispheric resting-state functional connectivity in patients with chro-nic primary trigeminal neuralgia (CPTN).Methods Twenty patients with CPTN and 20 age-,gender-,and education-matched healthy subjects underwent a resting-state functional magnetic resonance imaging (rs-fMRI)scanning.The voxel-mirrored homo-topic connectivity(VMHC)approach and statistic analysis were used to investigate the interhemispheric coordination of the whole brain.Results Compared with healthy controls,decreased VMHC was found in patients with CPTN,including medial and lateral or-bitofrontal cortex,and premotor (P <0.05,GRF corrected).Conclusion Our results suggest that decreased VMHC in brain regions indicate the aberrant perceptual and affective processing of CPTN,and limited complex movements function.

  13. Evaluation of the efficacy of botulinum toxin type A in the treatment of trigeminal neuralgia%A 型肉毒素治疗三叉神经痛的系统评价

    Institute of Scientific and Technical Information of China (English)

    梁志红; 黄稔欢; 史宗道

    2015-01-01

    目的:评价 A 型肉毒素(BTX-A)注射治疗三叉神经痛的疗效。方法:对 A 型肉毒素注射治疗三叉神经痛的随机对照试验(RCT)进行系统评价。结果:纳入4个 A 型肉毒素注射治疗三叉神经痛的随机对照试验,共纳入203人。各研究间异质性较大,对结果分别进行描述。3项试验报道试验组疗效优于对照组,1项试验报道试验组与对照组无显著差异。4项试验均报道副作用少见,且为轻到中度。结论:A 型肉毒素注射治疗三叉神经痛有一定疗效,无明显副作用,但尚需更多高质量的研究验证。%Objective:To review the clinical efficacy of botulinum toxin type A(BTX-A)in the treatment of trigeminal neuralgia (TN).Methods:The main bibliographic databases were searched from English and Chinese literatures on the topic and the refer-ences of the identified articles were also searched for additional studies.2 reviewers assessed the quality of the included studies and extracted data duplicate.Results:3 Chinese and 1 English reports with 203 participants were included.However,substantial hetero-geneity(I2 =77%)precluded meta-analysis and the results were individually described.3 trials reported that BTX-A was more effec-tive than the control and 1 showed no difference between groups.Adverse effects of BTX-A were reported in 4 reports and were mild to moderate.Conclusion:BTX-A is effective in treating TN with few adverse effects.However,the evidence is weak because of a few studies included and most of them with low methodological quality.Further studies with high quality are needed to testify the evidence.

  14. Occipital nerve block is effective in craniofacial neuralgias but not in idiopathic persistent facial pain

    OpenAIRE

    Jürgens, T. P.; Müller, P.; Seedorf, H; Regelsberger, J; May, A

    2012-01-01

    Occipital nerve block (ONB) has been used in several primary headache syndromes with good results. Information on its effects in facial pain is sparse. In this chart review, the efficacy of ONB using lidocaine and dexamethasone was evaluated in 20 patients with craniofacial pain syndromes comprising 8 patients with trigeminal neuralgia, 6 with trigeminal neuropathic pain, 5 with persistent idiopathic facial pain and 1 with occipital neuralgia. Response was defined as an at least 50% reduction...

  15. 桥小脑角区小型占位致继发性三叉神经痛的手术疗效分析%Surgical outcome after resection of small cerebellopontine angle lesions resulted in secondary trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    陶传元; 魏攀; 庄进学; 陈登奎; 程宏炜; 宋朝理; 李海龙; 薛峰; 张炜; 郑小强

    2011-01-01

    目的 评估桥小脑角区(CPA)小型占位致继发性三叉神经痛的手术疗效.方法 回顾分析我科自2005年1月~2010年12月期间该类患者的临床资料,包括年龄、症状及体征、影像学表现、手术方式、疗效及并发症.结果 6年期间手术治疗三叉神经痛372例,其中CPA区小型病变(最大直径<3cm)致继发性三叉神经痛23例,约占6.2%;病种包括胆脂瘤12例、神经鞘瘤6例、脑膜瘤3例、蛛网膜囊肿2例;所有患者行乙状窦后入路显微镜下切除病变,3例另行三叉神经感觉根部分切断术;术后疼痛消失20例,面部麻木3例;术后并发症包括无菌性脑膜炎、脑脊液漏、颅内感染、短暂耳鸣及面瘫,均恢复,无死亡.随访1~5年,无疼痛复发.结论 CPA区小型占位所致继发性三叉神经痛患者由于病变小、易于全切,加之镜下暴露充分,手术疗效满意;术中若发现病变与三叉神经无确切关系,则需行微血管减压或三叉神经部分感觉根切断术.%Objective To evaluate the surgical outcome after resection of small cerebel-lopontine angle lesions resulted in secondary trigeminal neuralgia (TN). Methods Clinical data including age, symptom and sign, image manifestation, surgical modality, surgical outcome and complications in patients diagnosed secondary TN resulted from small cerebellopontine angle lesions are analyzed retrospectively between 2005. 1 and 2010. 12. Results Of 6 years duration, 372 cases of TN underwent operations. There were 23 cases of such kind (the largest diameter less than 3cm) accounting for 6. 2% among them which involved 12 cholesteatomas, 6 schwanno-mas, 3 meningiomas and 2 arachnoid cysts. All lesions were resected under microscope through retrosigmoid approach and additional partial sensory rhizotomy was performed in 3 cases. After operation, 20 cases got complete pain relief and the rest had facial numbness. Postoperative complications included aseptic

  16. Probable relación entre la neuralgia del trigémino y patología de columna cervical: Reporte de Casos

    Directory of Open Access Journals (Sweden)

    Teresa Sada Ovalle

    2008-07-01

    Full Text Available Introducción. La neuralgia del trigémino (NT descrita por primera vez en 1773 por John Fothergill, se describe como dolor súbito, usualmente unilateral, intenso y breve, lancinante, en la distribución de una o más de las ramas del quinto par. Se han descrito muy diversas causas que oscilan entre condiciones que afectan los senos paranasales, la dentadura, abscesos orales, anormalidades de la articulación temporomandibular, enfermedades reumatológicas, tumores entre otras. Son pocas las descripciones encontradas de patología cervical como presentación de neuralgia del trigémino. Objetivo. Describir los hallazgos clínicos de cuatro pacientes inicialmente diagnosticados como neuralgia del trigémino a los cuales se inicio tratamiento médico e invasivo a nivel trigeminal que evolucionaron con datos de patología a nivel de columna cervical, los pacientes fueron estudiados demostrándose patología a éste nivel, variando de osteofitos cervicales hasta canal cervical estrecho. Material y Métodos. Se realizó la revisión de expedientes de una serie de cuatro casos de neuralgia del trigémino como presentación de patología de origen cervical en la clínica del dolor del Hospital General de México. Casos. 4 casos de 31 a 68 años que cumplían los criterios de la asociación internacional de cefaleas para neuralgia del trigémino, previamente tratados con anticonvulsivantes por distintos servicios, a los cuales también se les habían realizado bloqueos desinflamatorios de distintas ramas trigéminales sin éxito. Posteriormente presentaron sintomatología cervical y fueron estudiados con radiología, resonancia magnética entre otros demostrándose patología cervical, por este motivo se les realizaron bloqueos de raíces nerviosas cervicales y presentaron mejoría de un 80 a 90%, también se dio tratamiento requerido para la patología cervical específica. Conclusiones. Aunque la neuralgia del trigémino como presentación de patolog

  17. Auriculotemporal neuralgia secondary to TMJ synovial cyst: a rare presentation of a rare entity.

    Science.gov (United States)

    Ansari, Hossein; Robertson, Carrie E; Lane, John I; Viozzi, Christopher F; Garza, Ivan

    2013-01-01

    Synovial cysts of the temporomandibular joint are rare, and to our knowledge, only 14 cases have been reported. The most common presentation is local pain and swelling. We present a case of a synovial cyst presenting with neuralgia in the distribution of the auriculotemporal nerve, initially misdiagnosed as trigeminal neuralgia.

  18. 加巴喷丁与卡马西平治疗原发性三叉神经痛对照研究%Comparison and research on the clinical effects of Gabapentin and Carbamazepine in the treatment primary trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    周梨

    2014-01-01

    目的:观察加巴喷丁与卡马西平治疗原发性三叉神经痛的临床效果并进行对比。方法随机选取我院原发性三叉神经痛患者86例,随机分为2组。实验组接受加巴喷丁治疗,对照组接受卡马西平治疗,治疗前后采用视觉模拟评分法(VAS)评分。观察2组患者满意度、康复情况以及不良反应。结果实验组有效37例(86.05%)对照组有效34例(79.07%);2组VAS评分均下降,但差异无统计学意义(P>0.05);患者满意度和不良反应比较差异均有统计学意义(P<0.05)。结论加巴喷丁与卡马西平治疗原发性三叉神经痛均有较好疗效,但加巴喷丁不良发应少于卡马西平。%Objective To observe the clinical effects of Gabapentin and Carbamazepine in the treatment of primary trigem-inal neuralgia patients.Methods Eighty-six cases of primary trigeminal neuralgia patients in our hospital randomly were select-ed and divided into two groups averagely.Patients in experimental group received Gabapentin ,while patients in control group received Carbamazepine.The visual analogue scale (VAS) was used to evaluate the feelings and investigate the degree of satis-faction ,recovery situations and adverse reactions. Results There were 37 cases with effective efficacy in experimental group , it was 86.05%.There were 34 cases with effective efficacy in control group ,it was 79.07%.The value of VAS decreased in the two groups and the discrepancy was not clear.The degree of satisfaction and adverse reactions were different obviously in the two groups. Conclusion Both Gabapentin and Carbamazepine have good curative effect for primary trigeminal neuralgia pa-tients.However ,Gabapentin performs better in the degree of satisfaction and adverse reactions than Carbamazepine.

  19. Ensayo no aleatorizado del tratamiento con acupuntura de la neuralgia del trigémino resistente a tratamiento convencional

    OpenAIRE

    E. Collazo; F. Gómez Armenta

    2015-01-01

    Objetivos: valorar la efectividad global de la acupuntura como terapia complementaria en la reducción del dolor crónico en la neuralgia del trigémino resistente a terapias habituales en grupos apareados de pacientes en condiciones de práctica clínica real. Conocer en qué proporción disminuye el consumo de analgésicos en estos pacientes tras un ciclo de acupuntura. Determinar las reacciones adversas debidas a acupuntura. Material y métodos: estudio cuasi-experimental en 57 pacientes ambulatori...

  20. Clinical Observation on Combined Gabapentin and Nerve Block in the Treatment of Primary Trigeminal Neuralgia%加巴喷丁联合神经阻滞治疗原发性三叉神经痛的临床观察

    Institute of Scientific and Technical Information of China (English)

    黄云峰; 韦程瀚

    2013-01-01

    Objective To evaluate the efficacy and adverse reaction of combined gabapentin and nerve block in the treatment of primary trigeminal neuralgia. Methods 90 adult patients with trigeminal neuralgia were divided into gabapentin medical treatment group( A )and combined gabapentin and nerve block group ( B ),45 cases each group. Patients of group A were given gabapentin 1200 mg per day,treated for 4 weeks. The usage of gabapentin in group B was same as group A, and patients of group B were treated with nerve block once a week for 3 weeks. The numeric rating scales( NRS )changes, efficacy rate of relieving pain and the adverse reaction were observed after 4 weeks. Results The NRS scores of group A and group B were obviously decreased after treatment with pre-treatment( P 0.05 ). Conclusion The treatment of primary trigeminal neuralgia by combined gabapentin and nerve block has better efficacy and little adverse reactions,which is a good choice for the non-surgical treatment of trigeminal neuralgia.%目的 观察加巴喷丁联合神经阻滞治疗原发性三叉神经痛的临床疗效及不良反应.方法 将2010年3月至2011年12月南宁市红十字会医院收治的90例原发性三叉神经痛患者按随机数字表法分为单纯加巴喷丁药物治疗组(A组)和加巴喷丁联合神经阻滞治疗组(B组),各45例,A组每天口服加巴喷丁1200 mg,连服4周;B组加巴喷丁用法与A组相同,同时每周给予神经阻滞治疗1次,连续3周.4周后观察两组的疼痛强度(PI)、疼痛缓解度(PAR)、镇痛有效率及不良反应发生情况.结果 两组治疗后NRS评分明显低于治疗前(P<0.05),B组在治疗后3、7、14、21、28 d的NRS评分均明显低于A组(P<0.05);B组镇痛效率在治疗后3、7 d与A组无差别,在治疗后14、21、28 d高于A组(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05).结论 加巴喷丁联合神经阻滞治疗原发性三叉神经痛临床效果好,不良反应少,是非手术疗法的较好选择.

  1. 加巴喷丁、卡马西平治疗复发性三叉神经痛的疗效对比观察%A comparative study on the efficacy of gabap-entin and carbamazepine in the treatment of recurrent trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    杨艳丽

    2015-01-01

    AIM: To compare and observe the clinical efficacy of gabapentin and carbamazepine in the treatment of recurrent trigeminal neuralgia. METHODS: A total of 76 patients with recurrence of trigeminal neuralgia in our hospital were selected and randomly divided into carbamazepine group and gabapentin group. Patients in carbamazepine group were treated by carbamaz⁃epine, and those in gabapentin group were treated by gabapentin. Clinical curative effect was compared between the two groups. RESULTS: Dosage of carbamazepine was less than that of gabapentin, and the difference was statistically significant ( P<0.05) . VAS of 1, 2 and 4 weeks after treatment in the two groups were significantly higher than that before treatment, and the difference was statistically significant ( P<0. 05 ) . LSI⁃B of the gabapentin group after 4⁃week treatment was higher than that of the carbamazepine group, and LSI⁃B improved in both groups after treatment, with statistically significant difference ( P<0.05) . Besides, incidence of adverse reactions of gabapentin group was lower than that of the gabapentin group, and the difference was statistically significant (P<0.05). CONCLUSION: The clinical curative effect of carbamazepine and gabapentin in the treatment of recurrent trigeminal neuralgia are almost the same, but gabapentin cause lower incidence of adverse reactions, improves the quality of life of patients more obviously, and is a better choice for the treatment of trigeminal neuralgia.%目的:观察加巴喷丁与卡马西平治疗复发性三叉神经痛的临床疗效.方法:选取我院收诊的复发性三叉神经痛患者76例,采取数字随机法分成加巴喷丁组和卡马西平组,加巴喷丁组采取加巴喷丁治疗,卡马西平组采取卡马西平治疗,比较两组临床疗效.结果:卡马西平组药物用量低于加巴喷丁组,差异有统计学意义(P<0.05).两组治疗后1、2、4周VAS评分均高于治疗前,差异有

  2. Supraorbital neuralgia

    Directory of Open Access Journals (Sweden)

    Vasudha Jadhav

    2014-01-01

    Full Text Available Supraorbital neuralgia is one of the rare types of neuralgias where there is persistent pain in the supraorbital region and forehead with occasional sudden shocklike paresthesia in the distribution of the supraorbital nerve. The primary treatment is identification and removal of anything causing compression over the supraorbital nerve. A brief trial of simple analgesics alone or in combination with gabapentin should be considered for patients who do not respond to the above-mentioned treatments. Supraorbital nerve block using local anesthetics and steroids is the next step.

  3. Symptomatic cranial neuralgias in multiple sclerosis: clinical features and treatment.

    Science.gov (United States)

    De Santi, Lorenzo; Annunziata, Pasquale

    2012-02-01

    In multiple sclerosis, neuropathic pain is a frequent condition, negatively influencing the overall quality of life. Cranial neuralgias, including trigeminal, glossopharyngeal neuralgias, as well as occipital neuralgia, are typical expression of neuropathic pain. Neuralgias are characterised by paroxysmal painful attacks of electric shock-like sensation, occurring spontaneously or evoked by innocuous stimuli in specific trigger areas. In multiple sclerosis, demyelination in the centrally myelinated part of the cranial nerve roots plays an important role in the origin of neuralgic pain. These painful syndromes arising in multiple sclerosis are therefore considered "symptomatic", in contrast to classic cranial neuralgias, in which no cause other than a neurovascular contact is identified. At this time, the evidence on the management of symptomatic cranial neuralgias in multiple sclerosis is fragmentary and a comprehensive review addressing this topic is still lacking. For that reason, treatment is often based on personal clinical experience as well as on anecdotal reports. The aim of this review is to critically summarise the latest findings regarding the pathogenesis, the diagnosis, the instrumental evaluation and the medical as well as neurosurgical treatment of symptomatic trigeminal, glossopharyngeal and occipital neuralgia in multiple sclerosis, providing useful insights for neurologists and neurosurgeons and a broad range of specialists potentially involved in the treatment of these painful syndromes.

  4. 原发性三叉神经痛伽玛刀放射外科治疗的有效性评估%THE CLINICAL STUDY OF GAMMA KNIFE RADIOSURGERY IN THE TREATMENT OF TRIGEMINAL NEURALGIA

    Institute of Scientific and Technical Information of China (English)

    潘绵顺; 王鹏; 李勇; 邱书珺; 邵显军

    2012-01-01

    Objective: To evaluate the efficacy and safety of gamma knife radiosurgery in the treatment of trigeminal neuralgia (TN). Methods: From Aug 2004 to Sep 2009, 98 patients with TN refractory to medical or other managements were treated with gamma knife radiosurgery. The median prescription dose was 80 Gy (75 ~ 85 Gy). The therapeutic effects were evaluated by patient self-reports of pain control, life satisfaction index A (LSI-A). Results: 89 patients were followed up for 35 months (13 ~ 60 months). Excellent pain relief was in 51 cases (57.3%), good pain relief was in 19 cases (21.3%), moderate pain relief was in 11 cases (12.4%) and no pain relief was in 8 cases (9%). The total pain relief rate was 91%. LSI-A after treatment (36.25 ± 3.87) was higher than that before treatment (25.67 ± 3.5). In 67 cases never undergone operation, 62 cases were followed up and the total pain relief rate was 93.5% (58/62). Only 11 cases complained facial numbness without physical and neurological deficit. One case had slight dysmasis. Conclusion: Gamma knife radiosurgery is effective for TN with significant pain relief and improvement of quality of life.%目的:评价伽玛刀放射外科治疗原发性三叉神经痛的安全性、有效性和心理状态.方法:2004年8月~2010年9月,98例经药物和其他方法治疗无效的原发性三叉神经痛患者接受伽玛刀放射外科治疗.放射剂量中位值是80Gy (75~85Gy).采用患者自我报告疼痛的控制、生活满意度指数A (life satisfaction index A,LSI-A)的变化进行疗效评估.结果:治疗后89例(90.8%)患者获得随访,平均随访期35个月(13 ~ 60个月).本组病例中治愈51例(57.3%);显效19例(21.3%);有效11例(12.4%);无效8例(9%),总有效率为91%;伽玛刀治疗后LSI-A总分平均值(36.25±3.87)高于治疗前(25.67±3.5);其中67例以往未接受过手术治疗患者中62例获得随访,58例有效,总有效率为93.5%.11例患

  5. Characteristics of neurovascular compression in facial neuralgia patients by 3D high-resolution MRI and fusion technology

    National Research Council Canada - National Science Library

    Zi-Yi Guo Jing Chen Guang Yang Qian-Yu Tang Cai-Xiang Chen Shui-Xi Fu Dan Yu

    2012-01-01

    <正>Objective:To evaluate the anatomical characteristics and patterns of neurovascular compression in patients suffering trigeminal neuralgia,using 3D high-resolution magnetic resonance imaging methods and fusion...

  6. Trigeminal trophic syndrome: A rare entity

    Directory of Open Access Journals (Sweden)

    Sunil N Mishra

    2011-01-01

    Full Text Available Trigeminal trophic syndrome is a rare condition resulting from self-manipulation of the skin after a peripheral or central injury to the trigeminal system. The syndrome consists of a classic triad of anaesthesia, paraesthesia, and a secondary persistent or recurrent facial ulceration. We describe a 60 year-old woman who developed this syndrome as a sequel to the gasserian ganglion block for trigeminal neuralgia. She had also developed melasma within 1 year. A remarkable benefit was achieved by proper patient education and topical antibiotics which led to the healing of all ulcerations within 4 weeks. In the case reported here, the diagnosis of the trigeminal trophic syndrome was made primarily as a result of the physician′s experience with the syndrome previously.

  7. Management of trigeminal neuralgia by radiofrequency ...

    African Journals Online (AJOL)

    Wael Fouad

    2011-06-24

    Jun 24, 2011 ... Idiopathic TN (ITN) is paroxysmal shock like electrical pain restricted to ... use of electrophysiological stimulation to check the optimal site of the needle .... results: pain relief, analgesia, tactile sensitivity deficit at the tri- geminal ...

  8. Wallenberg's syndrome and symptomatic trigeminal neuralgia

    National Research Council Canada - National Science Library

    Ordás, Carlos M; Cuadrado, María L; Simal, Patricia; Barahona, Raúl; Casas, Javier; Matías-Guiu Antem, Jordi; Porta-Etessam, Jesús

    2011-01-01

    .... However, facial pain is not uncommon in Wallenberg's syndrome. Facial pain related to a Wallenberg's syndrome may be either persistent of intermittent, and occasionally occurs in brief attacks...

  9. Experience of using C-arm-X-ray guided radiofrequency thermocoagulation in the treatment of 2700 patients with trigeminal neuralgia%C形臂引导下射频温控热凝术治疗三叉神经痛2700例体会

    Institute of Scientific and Technical Information of China (English)

    彭胜; 董自立

    2012-01-01

    Objective To explore the methods and clinical effects of radiofrequency thermocoagulation in the treatment of primary trigeminal neuralgia guided with C-arm-X-ray. Methods Retrospective analysis of the C-arm-X-ray guided percutaneous foramenovale a half ganglion radiofrequency thermocoagulation technique (the temperature setting of 65-80℃ and time was set to 30-60 s) of the clinical data of 2 700 cases of patients with trigeminal neuralgia were near long-term efficacy evaluation, to observe the complications. Results The pain compleately disappeared in 2 697 cases, the total efficiency of 98.56%, ineffective in 9 cases (0.33%), recurrence in 30 cases (1.11%). Conclusion C-arm-X-ray guided selective the ganglionnervi trigernini radiofrequency thermocoagulation is a minimally invasive, safe, broad indications and has significant effect of treatment, especially the recurrence of the trigeminal nerve associated with cardiovascular disease and otler treatments pain in patients with this methods is safe and reliable.%目的 探讨C形臂定位下选择性射频热凝治疗原发性三叉神经痛的方法及临床效果.方法 回顾性分析用C形臂引导下经皮穿刺卵圆孔半月神经节,射频温控热凝术(温度设定65~80℃,时间设定为30~60 s)治疗三叉神经痛患者2 700例.对临床资料进行疗效评定.结果 疼痛完全消失2 661例,总有效率为98.56%,无效9例(0.33%),复发30例(1.11%).结论 C形臂引导下选择性卵圆孔半月神经节射频热凝术治疗三叉神经痛是一种微创、安全、适应证广、效果显著的治疗方法,对伴有心血管疾病及其他治疗方法复发的三叉神经痛患者,该方法是安全可靠的.

  10. [Chili for therapy of trigeminus neuralgia: a case report].

    Science.gov (United States)

    Loeser, J; Pilgram, B; Dagtekin, O

    2012-08-01

    We report the case of a 39-year-old female patient who suffered from trigeminal neuralgia of the left lingual nerve for 6 years. The previous therapy according to the guidelines including a Jannetta operation was unsuccessful. Only after beginning with daily mastication and consumption of very hot chilli peppers has the patient become reliably pain-free.

  11. Termorrizotomía percutánea por radiofrecuencia para el tratamiento de la neuralgia esencial del nervio trigémino. Caso clínico

    OpenAIRE

    Acevedo González, Juan Carlos; Pontificia Universidad Javeriana; Durán Mora, Daniel; Pontificia Universidad Javeriana; Berbeo Calderón, Miguel Enrique; Pontificia Universidad Javeriana, Bogotá; Díaz Orduz, Roberto Carlos; Pontificia Universidad Javeriana; Feo Lee, Óscar; Pontificia Universidad Javeriana; Zorro Guío, Óscar; Pontificia Universidad Javeriana

    2012-01-01

    La neuralgia del trigémino es el dolor neuropático unilateral, intenso, súbito, paroxístico y recurrente que aparece en el territorio del nervio. El dolor trigeminal puede ser “clásico” o “sintomático” y se diferencia por la presencia de déficit neurológico. Cuando el dolor se acompaña de déficit sensitivo o motor y existe una lesión estructural en relación con el nervio, es neuralgia sintomática. Cuando no existe lesión estructural o solo hay contacto anormal entre arteria/nervio, es clásica...

  12. Difficulties and Solutions in Compilation of Evidence-based Guidelines of Clinical Practice with Acupuncture and Moxibustion in the Treat-ment of Primary Trigeminal Neuralgia%《循证针灸临床实践指南(原发性三叉神经痛)》编制难点与对策

    Institute of Scientific and Technical Information of China (English)

    陈勤; 周传龙; 方剑乔

    2016-01-01

    [目的]总结《循证针灸临床实践指南(原发性三叉神经痛)》编制中的关键点、难点,介绍指南推荐意见产生的背景及依据,并为中医药循证临床实践指南的制定和解读提供参考。[方法]运用循证医学理念及方法,对针灸治疗原发性三叉神经痛的诊疗方案研究进行回顾性分析。充分探究2010~2015年编写原发性三叉神经痛针灸临床实践指南过程中遇到的难点,选择本指南制定过程中具有代表性的4个关键问题和难点,包括如何产生指南临床问题、指南目标人群的选择、文献检索策略的制定、文献评价及推荐标准的选择进行对策探讨。[结果]针灸治疗原发性三叉神经痛临床研究证据质量较低,现代研究证据难以回答指南中的全部问题、全面反映针灸治疗三叉神经痛的临床特色,中医药指南制定过程中有多个难点需要解决。中医药指南制定的过程不仅参考了现有循证医学指南制定方法,还选择了能够反映中医药特色的评价方法。在对文献进行循证评价的基础上,选择问卷调查、小组讨论、专家共识等方法为指南推荐意见的产生提供依据。[结论]中医药循证临床实践指南的制定需与中医药疗法自身具备的特点相符,目前循证针灸临床实践指南的制定方法还待进一步完善,针灸临床研究证据的论证强度还待进一步加强。%Objective] In order to promote the application of acupuncture in the treatment of primary trigeminal neuralgia, improving the proportion of doctors in standardized application of acupuncture and moxibustion therapy. The author summarized the difficulties and solutions in compilation of the guideline,"Evidence-based Guidelines of Clinical Practice in Acupuncture and Moxibustion" of trigeminal neuralgia; And introduce the background and basis for the recommendations of guideline. Further more,to provide new

  13. Trigeminal autonomic cephalalgias.

    Science.gov (United States)

    Eller, M; Goadsby, P J

    2016-01-01

    The trigeminal autonomic cephalalgias (TACs) are a group of primary headache disorders characterised by lateralized symptoms: prominent headache and ipsilateral cranial autonomic features, such as conjunctival injection, lacrimation and rhinorrhea. The TACs are: cluster headache (CH), paroxysmal hemicrania (PH), short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)/short-lasting neuralgiform headache attacks with cranial autonomic features (SUNA) and hemicrania continua (HC). Their diagnostic criteria are outlined in the International Classification of Headache Disorders, third edition-beta (ICHD-IIIb). These conditions are distinguished by their attack duration and frequency, as well as response to treatment. HC is continuous and by definition responsive to indomethacin. The main differential when considering this headache is chronic migraine. Other TACs are remarkable for their short duration and must be distinguished from other short-lasting painful conditions, such as trigeminal neuralgia and primary stabbing headache. Cluster headache is characterised by exquisitely painful attacks that occur in discrete episodes lasting 15-180 min a few times a day. In comparison, PH occurs more frequently and is of shorter duration, and like HC is responsive to indomethacin. SUNCT/SUNA is the shortest duration and highest frequency TAC; attacks can occur over a hundred times every day.

  14. [Intermedius neuralgia].

    Science.gov (United States)

    Penkert, G

    1986-09-01

    We report 2 cases of microvascular decompression of the nervus intermedius. The current views of aetiology of neuralgia and spasm of the cranial nerves are discussed based on intraoperative observations and electro-optical investigation reported in the literature. The complex anatomy within the sensory system of the facial nerve, and the intersection of its area of supply with that of the glossopharyngeal and vagus nerves are discussed. Surgical treatment is proposed with emphasis on the current preoperative difficulties of interpretation and the intraoperative constant variations in the course of the anterior inferior cerebellar artery.

  15. Infratrochlear neuralgia.

    Science.gov (United States)

    Pareja, Juan A; Casanova, Ignacio; Arbex, Andrea; Cuadrado, María L

    2015-11-01

    The infratrochlear nerve supplies the medial aspect of the upper eyelid, the superolateral aspect of the nose and the lacrimal caruncle. This nerve may contribute to the pain stemming from the trochlea, but infratrochlear neuralgia has not been identified as a specific cause of pain. Over a 10-year period we have been recruiting patients with pain in the internal angle of the orbit that did not show features of trochlear pain. Seven patients (six female, one male; mean age, 46.1 ± 18.9) presented with pain in the territory of the infratrochlear nerve. The pain appeared in the internal angle of the orbit and upper eyelid (n = 3), the superolateral aspect of the nose (n = 3), or the lacrimal caruncle (n = 1). All patients had a paroxysmal pain, with the attacks lasting five to 30 seconds. Pain attacks were mostly spontaneous, but two patients had triggers. Between attacks, all patients had local allodynia. Pain did not increase with vertical eye movements. Six patients were treated with gabapentin with complete response, and one patient experienced long-lasting relief with an anesthetic blockade of the infratrochlear nerve. Infratrochlear neuralgia should be considered as a possible cause of pain in the internal angle of the orbit. © International Headache Society 2015.

  16. Histopathological effects of radiosurgery on a human trigeminal nerve

    Science.gov (United States)

    Al-Otaibi, Faisal; Alhindi, Hindi; Alhebshi, Adnan; Albloushi, Monirah; Baeesa, Saleh; Hodaie, Mojgan

    2013-01-01

    Background: Radiosurgery is a well-established treatment modality for medically refractory trigeminal neuralgia. The exact mechanism of pain relief after radiosurgery is not clearly understood. Histopathology examination of the trigeminal nerve in humans after radiosurgery is rarely performed and has produced controversial results. Case Description: We report on a 45-year-old female who received radiosurgery treatment for trigeminal neuralgia by Cyberknife. A 6-mm portion of the cisternal segment of trigeminal nerve received a dose of 60 Gy. The clinical benefit started 10 days after therapy and continued for 8 months prior to a recurrence of her previous symptoms associated with mild background pain. She underwent microvascular decompression and partial sensory root sectioning. Atrophied trigeminal nerve rootlets were grossly noted intraoperatively under surgical microscope associated with changes in trigeminal nerve color to gray. A biopsy from the inferolateral surface of the nerve proximal to the midcisternal segment showed histological changes in the form of fibrosis and axonal degeneration. Conclusion: This case study supports the evidence of histological damage of the trigeminal nerve fibers after radiosurgery therapy. Whether or not the presence and degree of nerve damage correlate with the degree of clinical benefit and side effects are not revealed by this study and need to be explored in future studies. PMID:24605252

  17. Trigeminal nerve deficit in large and compressive acoustic neuromas and its correlation with MRI findings.

    Science.gov (United States)

    Karkas, Alexandre; Lamblin, Eléa; Meyer, Mikael; Gay, Emmanuel; Ternier, Jessica; Schmerber, Sébastien

    2014-10-01

    Evaluate the prevalence of preoperative trigeminal nerve deficit in large/compressive acoustic neuromas and try to find a correlation between pre/postoperative magnetic resonance imaging (MRI) findings and pre/postoperative trigeminal nerve deficit. Case series with chart review. University medical center. Retrospective study (1994-2009) including patients with stage 4 or 5 acoustic neuromas (Zini-Magnan classification). All patients underwent surgical resection. Pre- and postoperative trigeminal symptoms were sought. Imaging criteria were sought on pre- and 3-month postoperative MRI scans. Pearson χ(2) statistical test was used. Fifty-three patients (27 females, mean 51 years) were operated on. Preoperatively, 3 patients (5.7%) had trigeminal neuralgia, 1 (1.9%) trigeminal anesthesia, and 28 (52.8%) trigeminal hypoesthesia. Sixteen patients (30.2%) had no corneal reflex (ophthalmic branch); keratitis occurred in 1 patient (1.9%). Postoperatively, 2 patients (3.8%) had trigeminal neuralgia, 1 (1.9%) trigeminal anesthesia, and 24 (45.3%) trigeminal hypoesthesia. Twenty-six patients (49%) had no corneal reflex; keratitis occurred in 11 patients (20.7%). Preoperative trigeminal hypoesthesia was statistically correlated with impaction of the tumor on cerebellar peduncles on preoperative MRI. Postoperative trigeminal hypoesthesia was statistically correlated with nonvisibility of the trigeminal nerve on postoperative MRI. In large/compressive acoustic neuromas, trigeminal nerve deficit has to be sought to avoid corneal complications in particular. Trigeminal hypoesthesia occurs preoperatively in about half of the cases. It remains relatively stable after tumor removal, but there appears to be an increased rate of absent corneal reflex and keratitis postoperatively. We were able to correlate pre/postoperative trigeminal hypoesthesia with pre/postoperative MRI findings. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

  18. Percutaneous radiofrequency rhizotomy and neurovascular decompression of the trigeminal nerve for the treatment of facial pain Rizotomia percutânea por radiofreqüência e a descompressão neurovascular do nervo trigêmeo no tratamento das algias faciais

    OpenAIRE

    Teixeira, Manoel J.; Siqueira,Silvia R. D. T. de; Gilberto M. de Almeida

    2006-01-01

    OBJECTIVE: To determine the outcomes of 354 radiofrequency rhizotomies and 21 neurovascular decompressions performed as treatment for 367 facial pain patients (290 idiopathic trigeminal neuralgia, 52 symptomatic trigeminal neuralgia, 16 atypical facial pain, 9 post-herpetic neuralgia). METHOD: Clinical findings and surgery success rate were considered for evaluation. A scale of success rate was determined to classify patients, which considered pain relief and functional/sensorial deficits. RE...

  19. Anesthesia Dolorosa of Trigeminal Nerve, a Rare Complication of Acoustic Neuroma Surgery

    Directory of Open Access Journals (Sweden)

    Foad Elahi

    2014-01-01

    Full Text Available Anesthesia dolorosa is an uncommon deafferentation pain that can occur after traumatic or surgical injury to the trigeminal nerve. This creates spontaneous pain signals without nociceptive stimuli. Compression of the trigeminal nerve due to acoustic neuromas or other structures near the cerebellopontine angle (CPA can cause trigeminal neuralgia, but the occurrence of anesthesia dolorosa subsequent to acoustic tumor removal has not been described in the medical literature. We report two cases of acoustic neuroma surgery presented with anesthesia dolorosa along the trigeminal nerve distribution. The patients’ pain was managed with multidisciplinary approaches with moderate success.

  20. Descripción de las propiedades funcionales del sistema nociceptivo trigeminal en relación con el dolor pulpar

    Directory of Open Access Journals (Sweden)

    Andrés O Pérez Ruíz

    Full Text Available El sistema trigeminal nociceptivo es un componente del sistema sensorial somestésico que tiene la capacidad de discriminar cuatro variables básicas de los estímulos que provocan daño tisular, ellas son: cualidad, curso temporal, localización e intensidad. Las fibras A delta y C, vinculadas a la nocicepción están presentes en la pulpa dental. Se utilizan varias clasificaciones del dolor, atendiendo a diversos criterios: calidad de la sensación, velocidad de transmisión por las fibras, en relación con el lugar del cuerpo donde se exprese, y a la ubicación del nociceptor. La evolución de las condiciones pulpares se clasifican como: pulpitis reversible, pulpitis transicional, pulpitis irreversible y pulpa necrótica.Según su cualidad, el dolor pulpar puede ser punzante o continuo; atendiendo a su aparición, provocado o espontáneo; por su curso, intermitente o continuo; por su localización puede ser limitado a una región, irradiado y referido; y en relación con su intensidad se considera leve, moderado o severo. La capacidad del sistema sensorial nociceptivo en cuanto a discriminar la modalidad, curso temporal, localización e intensidad del estímulo, permite conocer las diferentes etapas de un proceso inflamatorio pulpar.

  1. Efficacy and Safety of CT Guided Percutaneous Radiofrequency Thermocoagulation in the Treatment of Recurrent Trigeminal Neuralgia After Other Surgical Treatment%CT 引导下经皮三叉神经半月节射频热凝术治疗其他术式术后复发三叉神经痛的疗效及安全性分析

    Institute of Scientific and Technical Information of China (English)

    杨惠婕; 唐元章; 倪家骧

    2016-01-01

    目的:探讨 CT 引导下经皮三叉神经半月节射频热凝术(PRT)治疗其他术式术后复发三叉神经痛的临床疗效及安全性。方法选取2002—2013年首都医科大学宣武医院疼痛科收治的采用 CT 引导下 PRT 治疗其他术式术后复发三叉神经痛的88例患者的临床资料。采用巴罗神经学研究所(BNI)分级评定标准评定患者临床疗效(疼痛缓解、疼痛未缓解)。记录患者术后并发症:面部麻木、咀嚼力下降、角膜炎、复视、脑脊液漏、死亡等。采用生存分析中的 Kaplan - Meier 法计算患者术后1、2、5、10年疼痛缓解率。结果本组88例患者均成功行 CT 引导下 PRT。83例(94.3%)患者术后疼痛缓解,5例(5.7%)患者术后疼痛未缓解。88例患者术后1年疼痛缓解率为83.0%,术后2年疼痛缓解率为75.0%,术后5年疼痛缓解率为59.0%,术后10年疼痛缓解率为49.0%。76例(93.8%)患者在随访期间存在持续麻木;咀嚼肌力下降8例(9.1%);角膜炎4例(4.5%),其中三叉神经第一支受累1例、三叉神经三支均受累3例,采用人工泪液滴眼后症状缓解;无复视、脑脊液漏等严重并发症发生;无因 CT 引导下 PRT 死亡患者。结论 CT 引导下 PRT 治疗其他术式术后复发三叉神经痛安全、有效,值得临床借鉴。%Objective To investigate the efficacy and safety of CT guided percutaneous radiofrequency thermocoagulation(PRT)in the treatment of recurrent trigeminal neuralgia after other surgical treatment. Methods From 2002 to 2013,we collected the clinical data of 88 patients with recurrent trigeminal neuralgia after other surgical treatment who were treated through CT guided PRT in Department of Pain Management,Xuanwu Hospital Capital Medical University. The clinical efficacy(pain remission and no pain remission)was evaluated using the grading scale of Barrow Neurological Institute(BNI). Postoperative

  2. Occipital nerve block is effective in craniofacial neuralgias but not in idiopathic persistent facial pain.

    Science.gov (United States)

    Jürgens, T P; Müller, P; Seedorf, H; Regelsberger, J; May, A

    2012-04-01

    Occipital nerve block (ONB) has been used in several primary headache syndromes with good results. Information on its effects in facial pain is sparse. In this chart review, the efficacy of ONB using lidocaine and dexamethasone was evaluated in 20 patients with craniofacial pain syndromes comprising 8 patients with trigeminal neuralgia, 6 with trigeminal neuropathic pain, 5 with persistent idiopathic facial pain and 1 with occipital neuralgia. Response was defined as an at least 50% reduction of original pain. Mean response rate was 55% with greatest efficacy in trigeminal (75%) and occipital neuralgia (100%) and less efficacy in trigeminal neuropathic pain (50%) and persistent idiopathic facial pain (20%). The effects lasted for an average of 27 days with sustained benefits for 69, 77 and 107 days in three patients. Side effects were reported in 50%, albeit transient and mild in nature. ONBs are effective in trigeminal pain involving the second and third branch and seem to be most effective in craniofacial neuralgias. They should be considered in facial pain before more invasive approaches, such as thermocoagulation or vascular decompression, are performed, given that side effects are mild and the procedure is minimally invasive.

  3. 新型苯二氮卓类药物L-838,417对三叉神经痛大鼠机械痛行为的影响%Effect of L-838,417 on pain behavior in a rat model of trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    龚政; 熊源长

    2011-01-01

    Objective To investigate the effect of L-838,417 on the results of behavioral test in rats with experimentally induced trigeminal neuralgia. Methods Male SD rats were randomized into model group (n=34), sham-operated group (n=30) and control group (n=6). Thirty rats with trigemina neuralgia induced by chronic constriction injury of the infraorbital nerve below the zygomatic bone were randomly divided into 5 equal groups for treatment with 1.0 mg/kg L-838,417 (L1 group), 10.0 mg/kg L-838,417 (L10 group), 5 mg/kg morphine (M group), 3 mg/kg diazepam (D group), or normal saline (NS group). The pain threshold of the tentacles pad to von-Frey filament stimulation was measured in the rats before and at 1, 2,3,4, 5 h after the treatments. The sedative effect of L-838,417 was evaluated by recording the position scores and righting reflex scores, and the drug tolerance was also evaluated. Results Nine days after the operation, the pain threshold of the rats in the model group was significantly decreased compared with that before operation and that of the sham group (P0.05).模型组术后第9天疼痛阈值较术前明显降低(P0.05)外,其余4组给药后1 h疼痛阈值明显增加(P0.05).NS组、L1组及L10组均没有出现异常姿势和翻正反射.连续给药后,M组第3天最高疼痛阈值明显下降,与第1天相比有统计学差异(P0.05).结论 L-838,417对三叉神经痛大鼠具有良好的抗痛觉过敏作用,且不会带来镇静及运动损害等副作用,长期给药不会产生药物耐受.

  4. Pain relief clinical effect of carbamazepine combined nursing intervention on patients with primary trigeminal neuralgia%卡马西平联合护理干预对缓解原发性三叉神经痛患者疼痛的临床效果

    Institute of Scientific and Technical Information of China (English)

    杜玉娟

    2015-01-01

    Objective:To observe the clinical effect pain relief with carbamazepine combined nursing intervention on patients with primary trigeminal neuralgia.Method:76 cases of patients with primary trigeminal neuralgia from February 2012 to October 2014 were randomly divided into the control group and the observation group,with 38 cases in each group.The control group were given carbamazepine treatment orally,the starting quantity was 0.1 g/time,3 times/d,gradually increasing doses to 0.4~0.6 g according to the situation of the pain,and gradually reduced after the pain controlled.The observation group were treated with targeted nursing intervention on the basis of the treatment above,including daily life care,medication nursing,psychological counseling,pain nursing,continuous treatment for 30 days.The patients' pain,changes of the SAS scores and SDS scores of the two groups were observed and the clinical treatment effective rate were compared.Results:The pain of the two groups were alleviated after treatment,VAS scores were reduced,that of the observation group were lower than that of the control group,the differences were statistically significant(P<0.05).The anxiety,depression and other negative emotions of the two groups after treatment were improved,the SAS scores and SDS scores were significantly decreased,that of the observation group were lower than that of the control group,the differences were statistically significant(P<0.05).The effective rate of the observation group 92.1% was obviously higher than that of the control effectiveness 73.6% ,the difference was statistically significant(P<0.05).Conclusion:Carbamazepine combined nursing intervention could reduce the pain symptoms of patients with primary trigeminal neuralgia effectively and improve the patient's negative emotions and improve the treatment enthusiasm and confidence in clinical,worthy of clinical promotion.%目的:观察用卡马西平联合护理干预对缓解原发性三叉神经痛患者疼

  5. Intraoperative visualisation of the trigeminal cistern. Intraoperative Darstellung der Trigeminuszisterne

    Energy Technology Data Exchange (ETDEWEB)

    Bockermann, V.; Dieckmann, G. (Goettingen Univ. (Germany). Abt. Funktionelle Neurochirurgie)

    1991-07-01

    Percutaneous retrogassarian glycerol rhizotomy has passed the test of time as an immediately effective and reliable method for the treatment of trigeminal neuralgia. X-ray-assisted puncture of the trigeminal cistern and contrast-enhanced intraoperative visualisation techniques are absolute requirements of this surgical measure and invariably precede any further steps taken by the surgeon. The use of state-of-the-art fluoroscopic methods ensures that ample information is even obtained from the images of the base-of-scull region. (orig.).

  6. Occipital neuralgia: anatomic considerations.

    Science.gov (United States)

    Cesmebasi, Alper; Muhleman, Mitchel A; Hulsberg, Paul; Gielecki, Jerzy; Matusz, Petru; Tubbs, R Shane; Loukas, Marios

    2015-01-01

    Occipital neuralgia is a debilitating disorder first described in 1821 as recurrent headaches localized in the occipital region. Other symptoms that have been associated with this condition include paroxysmal burning and aching pain in the distribution of the greater, lesser, or third occipital nerves. Several etiologies have been identified in the cause of occipital neuralgia and include, but are not limited to, trauma, fibrositis, myositis, fracture of the atlas, and compression of the C-2 nerve root, C1-2 arthrosis syndrome, atlantoaxial lateral mass osteoarthritis, hypertrophic cervical pachymeningitis, cervical cord tumor, Chiari malformation, and neurosyphilis. The management of occipital neuralgia can include conservative approaches and/or surgical interventions. Occipital neuralgia is a multifactorial problem where multiple anatomic areas/structures may be involved with this pathology. A review of these etiologies may provide guidance in better understanding occipital neuralgia.

  7. Hemiatrofia facial progressiva (doença de Parry-Romberg: relato de dois casos associados a trigeminalgia e câimbras Progressive facial hemiatrophy (Parry-Romberg disease: report of two cases associated with trigeminal neuralgia and cramps

    Directory of Open Access Journals (Sweden)

    José Correia de Farias Brito

    1997-09-01

    Full Text Available Os autores relatam dois casos de hemiatrofia facial progressiva (HFP, ambos do sexo feminino, associados à hiperexcitabilidade neuromuscular, representada por dores neurálgicas e espasmos musculares (câimbras numa hemiface. Uma das pacientes (Caso 1, com 41 anos de idade, começou a notar a presença de atrofia no lado esquerdo da face, ao término da primeira década de vida. Nos últimos 3 meses, achando-se a doença estacionaria, a paciente passou a sofrer crises álgicas típicas de neuralgia do trigêmeo, cujo alívio só foi possível através de tratamento neurocirúrgico. A outra paciente (Caso 2, com 33 anos de idade, tem uma história de doença de 8 anos de duração, quando notou o desenvolvimento de atrofia ao nível da bochecha direita. Há cerca de 2 meses observou redução do diâmetro da coxa direita, o que sugere achar-se a doença em plena atividade. Freqüentemente, é acometida de espasmos dolorosos (câimbras na região submandibular direita, provocados, algumas vezes, pela abertura da boca. Uma possível relação entre os fenômenos de irritação neuromuscular e a HFP é discutida.The authors report two cases of progressive facial hemiatrophy (PFH associated with cranial nerves hyperexcitability. One of them (Case 1, a 41-year-old-woman noticed a slight atrophy on the left side of her face at age of ten. For the last three months, she has been suffering from fits of neuralgic pains on the left side of her face which have not ceased by drug treatment. In view of this, a surgery procedure was planned for the patient. The other patient (Case 2, a 33-year-old-woman has a 8 year history which started with cutaneous abnormalities (white and dark spots. Two years later she observed that her right cheek and right thigh had got a mild atrophy. Frequently, she has been complaining of cramps in the mandibular region which are precipitated, sometimes, by opening the mouth. A probable relation between neural excitability and PHF

  8. Acupuncture for episodic cluster headache: a trigeminal approach.

    Science.gov (United States)

    Hayhoe, Simon

    2015-09-10

    Following evidence that acupuncture is clinically feasible and cost-effective in the treatment of headache, the UK National Institute for Health and Care Excellence recommends acupuncture as prophylactic treatment for migraine and tension headache. There has thus been expectation that other forms of headache should benefit also. Unfortunately, acupuncture has not generally been successful for cluster headache. This may be due to acupuncturists approaching the problem as one of severe migraine. In fact, cluster headache is classed as a trigeminal autonomic cephalgia. In this case report, episodic cluster headache is treated in the same way as has been shown effective for trigeminal neuralgia. Acupuncture is applied to the contralateral side at points appropriate for stimulating branches of the trigeminal nerve. Thus, ST2 is used for the infraorbital nerve, BL2 and Yuyao for the supratrochlear and supraorbital nerves, and Taiyang for the temporal branch of the zygomatic nerve.

  9. Painful Traumatic Trigeminal Neuropathy.

    Science.gov (United States)

    Rafael, Benoliel; Sorin, Teich; Eli, Eliav

    2016-08-01

    This article discusses neuropathic pain of traumatic origin affecting the trigeminal nerve. This syndrome has been termed painful traumatic trigeminal neuropathy by the International Headache Society and replaces atypical odontalgia, deafferentation pain, traumatic neuropathy, and phantom toothache. The discussion emphasizes the diagnosis and the early and late management of injuries to the trigeminal nerve and subsequent painful conditions.

  10. [Trigeminal autonomic cephalgias].

    Science.gov (United States)

    Maximova, M Yu; Piradov, M A; Suanova, E T; Sineva, N A

    2015-01-01

    Review of literature on the trigeminal autonomic cephalgias are presented. Trigeminal autonomic cephalgias are primary headaches with phenotype consisting of trigeminal pain with autonomic sign including lacrimation, rhinorrhea and miosis. Discussed are issues of classification, pathogenesis, clinical picture, diagnosis, differential diagnosis and treatment of this headache. Special attention is paid to cluster headache, paroxysmal hemicrania, SUNCT syndrome, hemicrania continua.

  11. Descompresión microvascular en neuralgia del trigémino: Reporte de 36 casos y revisión de la literatura

    Directory of Open Access Journals (Sweden)

    Alvaro Campero

    2014-01-01

    Full Text Available Background: The aim of this study is to describe the results of 36 patients with trigeminal neuralgia treated with microvascular decompression. Methods: Between June 2005 and May 2012, 36 patients with trigeminal neuralgia were operated by the first author (AC, underwent microvascular decompression. The age, sex, duration of symptoms before surgery, and surgical finds, were all evaluated. In addition, postoperative results were also analyzed. Results: Twenty-five patients were women and 11 were men. The average age of the patients was 48 years. The average time of postoperative follow-up after the surgery was 36 months. Relief from pain until now occurred in 32 patients (88%. Pain recurrence was observed in 4 patients; of those, 2 cases showed a vein compression. Conclusion: The microvascular decompression for trigeminal neuralgia is a safe an effective option. A vein compression could point out an unfavorable follow-up.

  12. Optimal duration of percutaneous microballoon compression for treatment of trigeminal nerve injury

    Institute of Scientific and Technical Information of China (English)

    Fuyong Li; Shuai Han; Yi Ma; Fuxin Yi; Xinmin Xu; Yunhui Liu

    2014-01-01

    Percutaneous microballoon compression of the trigeminal ganglion is a brand new operative technique for the treatment of trigeminal neuralgia. However, it is unclear how the procedure mediates pain relief, and there are no standardized criteria, such as compression pressure, com-pression time or balloon shape, for the procedure. In this study, percutaneous microballoon compression was performed on the rabbit trigeminal ganglion at a mean inlfation pressure of 1,005 ± 150 mmHg for 2 or 5 minutes. At 1, 7 and 14 days after percutaneous microballoon compression, the large-diameter myelinated nerves displayed axonal swelling, rupture and demy-elination under the electron microscope. Fragmentation of myelin and formation of digestion chambers were more evident after 5 minutes of compression. Image analyzer results showed that the diameter of trigeminal ganglion cells remained unaltered after compression. These experi-mental ifndings indicate that a 2-minute period of compression can suppress pain transduction. Immunohistochemical staining revealed that vascular endothelial growth factor expression in the ganglion cells and axons was signiifcantly increased 7 days after trigeminal ganglion compression, however, the changes were similar after 2-minute compression and 5-minute compression. The upregulated expression of vascular endothelial growth factor in the ganglion cells after percu-taneous microballoon compression can promote the repair of the injured nerve. These ifndings suggest that long-term compression is ideal for patients with recurrent trigeminal neuralgia.

  13. Effect of “No.1 Pain-relieving Formula” combined with Doxium Tablets and Mecobalamin for trigeminal neuralgia: a report of 50 cases%止痛一号方联合羟苯磺酸钙与甲钴胺治疗三叉神经痛50例

    Institute of Scientific and Technical Information of China (English)

    刘云; 潘卫东; 杨硕慧; 俞晓飞; 孙燕; 王骏

    2013-01-01

    目的 从改善微循环角度评价止痛一号方联合羟苯磺酸钙与甲钴胺治疗三叉神经痛的临床疗效.方法 将98例患者随机分为治疗组和对照组.治疗组50例予中药止痛一号方联合羟苯磺酸钙与甲钴胺;对照组48例予卡马西平加甲钴胺;两组疗程均为8周,观察临床疗效及VAS评分变化情况.结果 治疗组、对照组总有效率分别为86.0%、68.8%,治疗组临床疗效优于对照组(P<0.05).两组VAS评分在治疗后均明显下降(P<0.05),组间治疗后差异有统计学意义(P<0.05).治疗组不良反应发生率为12.0%,明显低于对照组的31.25% (P <0.05).结论 止痛一号方联合羟苯磺酸钙与甲钴胺治疗三叉神经痛安全、有效.%Objective To evaluate the clinical efficacy of “No.1 Pain-relieving Formula” combined with Doxium Tablets and Mecobalamin in treating trigeminal neuralgia (TN).Methods Ninety-eight cases were randomized into two groups:treatment group in which 50 cases were treated by “ No.1 Pain-relieving Formula” combined with Doxium Tablets and Mecobalamin,and control group in which 48 cases were treated by Carbamazepine and Mecobalamin,with the course of 8 weeks.The clinical efficacy and score of VAS were evaluated.Results The overall effective rate was86.0% in the treatment group and 68.8 % in the control group,with significant difference between the two groups (P < 0.05).After treatment,the scores of VAS in the two groups were markedly decreased (P < 0.05),with significant difference between the two groups (P < 0.05).The occurrence rate of adverse reaction was 12.0% in treatment group,which was markedly lower than the 31.25% of the control group (P < 0.05).Conclusion “No.1 Pain-relieving Formula” combined with Doxium Tablets and Mecobalamin is safe and effective in the treatment of TN.

  14. 普瑞巴林对原发性三叉神经痛患者血浆 P物质和降钙素基因相关肽的影响%Influence of Pregabalin on plasma substance P and calcitonin gene-related peptide in patients with trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    熊勋波; 杨涛; 邓刚; 成祥林; 向明清; 刘焰

    2014-01-01

    目的::观察普瑞巴林( PGB )和卡马西平( CBZ )对原发性三叉神经痛( PTN )患者血浆 P 物质( SP )和降钙素基因相关肽( CGRP)以及疼痛视觉模拟评分( VAS)的影响,评估PGB治疗PTN的疗效和安全性。方法:130例PTN患者随机分为观察组64例使用PGB治疗,对照组66例使用CBZ治疗。分别从低剂量开始给药,观察患者的疗效及不良反应至第4周末,两组患者在治疗前和结束时以放免法测定血浆SP和CGRP含量,并进行VAS评分。结果:观察组患者的总有效率89.1%,对照组72.1%,两组患者差异有统计学意义(P<0.05);治疗后两组患者的血浆SP和CGRP均下降,观察组患者较对照组尤为明显(P<0.05)。观察组不良反应发生率31.3%明显低于对照组59.1%。结论:PGB治疗PTN疗效和安全性均高于CBZ。%Objective:To observe influence of Pregabalin ( PGB) and Carbamazepine ( CBZ) on plasma substance P ( SP) , calcitonin gene-related peptide ( CGRP) , and pain visual analogue score ( VAS) for patients with trigeminal neuralgia ( PTN) , and e﹣valuate efficacy and safety of PGB in treatment of PTN. Methods:130 patients with PTN were randomly divided into observation group ( PGB, 64 cases) and control group ( CBZ, 66 cases) . Both groups were administered with low dose at first, and then the therapeutic effect and adverse effect until termination of the fourth week were observed. The plasma SP and CGRP were detected by radioimmuno﹣assay before and after the treatment, while the visual analogue scales ( VAS) were measured. Results:The clinical efficiency of PGB was 89. 1%, that of CBZ was 72. 1%, and there was a significant difference between the two groups (P<0. 05). The treatments re﹣duced plasma SP and CGRP levels in both groups, and the change of PGB group was more obvious than that of CBZ group (P<0. 05). The incidence rate of adverse effect by PGB (31. 3%) was less than that by CBZ (59. 1%) (P<0. 05). Conclusions

  15. Perception of trigeminal mixtures.

    Science.gov (United States)

    Filiou, Renée-Pier; Lepore, Franco; Bryant, Bruce; Lundström, Johan N; Frasnelli, Johannes

    2015-01-01

    The trigeminal system is a chemical sense allowing for the perception of chemosensory information in our environment. However, contrary to smell and taste, we lack a thorough understanding of the trigeminal processing of mixtures. We, therefore, investigated trigeminal perception using mixtures of 3 relatively receptor-specific agonists together with one control odor in different proportions to determine basic perceptual dimensions of trigeminal perception. We found that 4 main dimensions were linked to trigeminal perception: sensations of intensity, warmth, coldness, and pain. We subsequently investigated perception of binary mixtures of trigeminal stimuli by means of these 4 perceptual dimensions using different concentrations of a cooling stimulus (eucalyptol) mixed with a stimulus that evokes warmth perception (cinnamaldehyde). To determine if sensory interactions are mainly of central or peripheral origin, we presented stimuli in a physical "mixture" or as a "combination" presented separately to individual nostrils. Results showed that mixtures generally yielded higher ratings than combinations on the trigeminal dimensions "intensity," "warm," and "painful," whereas combinations yielded higher ratings than mixtures on the trigeminal dimension "cold." These results suggest dimension-specific interactions in the perception of trigeminal mixtures, which may be explained by particular interactions that may take place on peripheral or central levels.

  16. Genitofemoral neuralgia: a review.

    Science.gov (United States)

    Cesmebasi, Alper; Yadav, Abhishek; Gielecki, Jerzy; Tubbs, R Shane; Loukas, Marios

    2015-01-01

    Genitofemoral neuralgia is a cause of neuropathic pain that is often debilitating in nature. It is characterized by chronic neuropathic groin pain that is localized along the distribution of the genitofemoral nerve. The symptoms include groin pain, paresthesias, and burning sensation spreading from the lower abdomen to the medial aspect of the thigh. It may present with scrotal pain in male, while females experience symptoms radiating to the labia majora and mons pubis. Genitofemoral neuropathy has been attributed to iatrogenic nerve injury occurring during inguinal and femoral herniorrhaphy, with cases developing after both open and laparoscopic techniques. Diagnosis of genitofemoral neuralgia can be challenging, due to the overlap in sensory distribution the nerve shares with the ilioinguinal and iliohypogastric nerve. Differential nerve blocks are recommended in effort to differentiate the nerves when patients present with lower abdominal and groin pain. Once a diagnosis has been made, there exist several treatment options for genitofemoral neuralgia ranging from medical management, non-invasive injections, and surgery. Literature has also brought light to radiofrequency ablation and cryoablation performed under ultrasound guidance as emerging treatments. The aim of the current article is to review the anatomy, diagnostic techniques, and treatment options for patients with genitofemoral neuralgia.

  17. Psychological assessment of a case of trigeminal neuralgia | Osawe ...

    African Journals Online (AJOL)

    ... the following Psychological assessment questionnaires: Eysenck Personality ... irresistible thoughts, impulses and actions, discomfort in social situations, loss of ... Scores on the tests suggests that the patient had a high state and trait anxiety ...

  18. Differential drug effects on spontaneous and evoked pain behavior in a model of trigeminal neuropathic pain

    Science.gov (United States)

    Deseure, K; Hans, GH

    2017-01-01

    Purpose Baclofen and morphine have shown efficacy against mechanical allodynia after infraorbital nerve chronic constriction injury (IoN-CCI). No drug effects have yet been reported on spontaneous trigeminal neuropathic pain. It has been proposed that the directed face grooming behavior that also develops following IoN-CCI offers a measure of spontaneous trigeminal neuropathic pain. Subjects and methods We examined the effects of a continuous 1-week infusion of 30 mg/day carbamazepine (the first-line drug treatment for trigeminal neuralgia), 1.06 mg/day baclofen, 4.18 mg/day clomipramine, and 5 mg/day morphine on spontaneous and mechanically evoked pain behavior (ie, directed face grooming and von Frey testing) in IoN-CCI rats. Results Isolated face grooming was significantly reduced in rats receiving carbamazepine and baclofen but not in clomipramine- or morphine-treated rats. All drugs showed significant antiallodynic effects; carbamazepine showed the strongest effects, whereas clomipramine had only minor efficacy. Conclusion The tested drugs have differential effects in the IoN-CCI model, and different neuropathological mechanisms may underlie the different somatosensory symptoms in this model. A mechanism-based approach may be needed to treat (trigeminal) neuropathic pain. The present data support IoN-CCI as a model of trigeminal neuralgia in which isolated face grooming is used as a measure of spontaneous neuropathic pain. PMID:28184169

  19. A REVIEW ON FACIAL NEURALGIAS

    OpenAIRE

    Solanki, Gaurav

    2010-01-01

    Facial neuralgias are produced by a change in neurological structure or function. This type of neuropathic pain affects the mental health as well as quality of life of patients. There are different types of neuralgias affecting the oral and maxillofacial region. These unusual pains are linked to some possible mechanisms. Various diagnostic tests are done to diagnose the proper cause of facial neuralgia and according to it the medical and surgical treatment is done to provide relief to patient.

  20. Hemifacial Pain and Hemisensory Disturbance Referred from Occipital Neuralgia Caused by Pathological Vascular Contact of the Greater Occipital Nerve

    Science.gov (United States)

    Choi, Jin-gyu

    2017-01-01

    Here we report a unique case of chronic occipital neuralgia caused by pathological vascular contact of the left greater occipital nerve. After 12 months of left-sided, unremitting occipital neuralgia, a hypesthesia and facial pain developed in the left hemiface. The decompression of the left greater occipital nerve from pathological contacts with the occipital artery resulted in immediate relief for hemifacial sensory change and facial pain, as well as chronic occipital neuralgia. Although referral of pain from the stimulation of occipital and cervical structures innervated by upper cervical nerves to the frontal head of V1 trigeminal distribution has been reported, the development of hemifacial sensory change associated with referred trigeminal pain from chronic occipital neuralgia is extremely rare. Chronic continuous and strong afferent input of occipital neuralgia caused by pathological vascular contact with the greater occipital nerve seemed to be associated with sensitization and hypersensitivity of the second-order neurons in the trigeminocervical complex, a population of neurons in the C2 dorsal horn characterized by receiving convergent input from dural and cervical structures. PMID:28331643

  1. Hemifacial Pain and Hemisensory Disturbance Referred from Occipital Neuralgia Caused by Pathological Vascular Contact of the Greater Occipital Nerve

    Directory of Open Access Journals (Sweden)

    Byung-chul Son

    2017-01-01

    Full Text Available Here we report a unique case of chronic occipital neuralgia caused by pathological vascular contact of the left greater occipital nerve. After 12 months of left-sided, unremitting occipital neuralgia, a hypesthesia and facial pain developed in the left hemiface. The decompression of the left greater occipital nerve from pathological contacts with the occipital artery resulted in immediate relief for hemifacial sensory change and facial pain, as well as chronic occipital neuralgia. Although referral of pain from the stimulation of occipital and cervical structures innervated by upper cervical nerves to the frontal head of V1 trigeminal distribution has been reported, the development of hemifacial sensory change associated with referred trigeminal pain from chronic occipital neuralgia is extremely rare. Chronic continuous and strong afferent input of occipital neuralgia caused by pathological vascular contact with the greater occipital nerve seemed to be associated with sensitization and hypersensitivity of the second-order neurons in the trigeminocervical complex, a population of neurons in the C2 dorsal horn characterized by receiving convergent input from dural and cervical structures.

  2. Vago-glossopharyngeal neuralgia: a literature review of neurosurgical experience.

    Science.gov (United States)

    Chen, Jianqing; Sindou, Marc

    2015-02-01

    Glossopharyngeal neuralgia (GPN), or better named vago-glossopharyngeal neuralgia (VGPN), is a rare disorder amounting to 1 % of the incidence of trigeminal neuralgia (TN). Pain is paroxysmal, of the electrical shooting type, and mainly provoked by stimulation of the pharynx or deep throat, especially during swallowing. Due to its rarity, VGPN is often misdiagnosed. The front line of medical treatment is based on anticonvulsants. Surgery should be considered when the pain is refractory to medications. In most patients, the cause is neurovascular conflict on root entry zone (REZ) or midcistern portion, of the IXth and/or Xth cranial nerves. Compressive vessels can be evidenced by means of a high sensibility and a high specificity resolution MR imaging in most centers. Present consensus is that the first option of neurosurgical treatment be microvascular decompression. In patients with precarious general conditions, stereotactic radiosurgery may be considered. Also, thermo-rhizotomy at the pars nervosa of foramen jugularis or tractotomy-nucleotomy at brainstem may be alternatives, but these methods entail a significant risk of deficits. In this article, the authors reviewed the main literature series on neurosurgical treatments of this disease.

  3. Neuralgias of the Head: Occipital Neuralgia.

    Science.gov (United States)

    Choi, Il; Jeon, Sang Ryong

    2016-04-01

    Occipital neuralgia is defined by the International Headache Society as paroxysmal shooting or stabbing pain in the dermatomes of the greater or lesser occipital nerve. Various treatment methods exist, from medical treatment to open surgical procedures. Local injection with corticosteroid can improve symptoms, though generally only temporarily. More invasive procedures can be considered for cases that do not respond adequately to medical therapies or repeated injections. Radiofrequency lesioning of the greater occipital nerve can relieve symptoms, but there is a tendency for the pain to recur during follow-up. There also remains a substantial group of intractable patients that do not benefit from local injections and conventional procedures. Moreover, treatment of occipital neuralgia is sometimes challenging. More invasive procedures, such as C2 gangliotomy, C2 ganglionectomy, C2 to C3 rhizotomy, C2 to C3 root decompression, neurectomy, and neurolysis with or without sectioning of the inferior oblique muscle, are now rarely performed for medically refractory patients. Recently, a few reports have described positive results following peripheral nerve stimulation of the greater or lesser occipital nerve. Although this procedure is less invasive, the significance of the results is hampered by the small sample size and the lack of long-term data. Clinicians should always remember that destructive procedures carry grave risks: once an anatomic structure is destroyed, it cannot be easily recovered, if at all, and with any destructive procedure there is always the risk of the development of painful neuroma or causalgia, conditions that may be even harder to control than the original complaint.

  4. Percutaneous radiofrequency rhizotomy and neurovascular decompression of the trigeminal nerve for the treatment of facial pain Rizotomia percutânea por radiofreqüência e a descompressão neurovascular do nervo trigêmeo no tratamento das algias faciais

    Directory of Open Access Journals (Sweden)

    Manoel J. Teixeira

    2006-12-01

    Full Text Available OBJECTIVE: To determine the outcomes of 354 radiofrequency rhizotomies and 21 neurovascular decompressions performed as treatment for 367 facial pain patients (290 idiopathic trigeminal neuralgia, 52 symptomatic trigeminal neuralgia, 16 atypical facial pain, 9 post-herpetic neuralgia. METHOD: Clinical findings and surgery success rate were considered for evaluation. A scale of success rate was determined to classify patients, which considered pain relief and functional/sensorial deficits. RESULTS: Radiofrequency rhizotomy was performed in 273 patients with idiopathic trigeminal neuralgia and in all other patients, except for trigeminal neuropathy; neurovascular decompression was performed in 18 idiopathic trigeminal neuralgia patients; 100% idiopathic trigeminal neuralgia, 96.2% symptomatic trigeminal neuralgia, 37.5% atypical facial pain and 88.9% post-herpetic neuralgia had pain relief. CONCLUSION: Both techniques for idiopathic trigeminal neuralgia are usefull. Radiofrequency rhizotomy was also efficient to treat symptomatic facial pain, and post-herpetic facial pain, but is not a good technique for atypical facial pain.OBJETIVO: Determinar eficácia e achados pós-operatórios após 354 rizotomias por radiofreqüência e 21 descompressões neurovasculares como tratamento de 367 pacientes com dor facial (290 neuralgia idiopática do trigêmeo, 52 neuralgia sintomática do trigêmeo, 16 dor facial atípica, 9 neuralgia pós-herpética. MÉTODO: Achados clínicos e taxa de sucesso das cirurgias foram considerados para a avaliação. Uma escala avaliando alívio da dor e complicações sensoriais e funcionais foi utilizada para classificar os pacientes. RESULTADOS: A rizotomia por radiofreqüência foi realizada em 273 pacientes com neuralgia idiopática do trigêmeo e em todos os outros pacientes, exceto neuropatia trigeminal; descompressão neurovascular foi realizada em 18 pacientes com neuralgia idiopática do trigêmeo; 100% dos pacientes

  5. Neuralgia del trigémino

    OpenAIRE

    Uribe Arango, Juan Alfonso; Fundación Valle de Lili

    2001-01-01

    ¿Qué es neuralgia del trigémino?/ ¿Cómo se diagnostica la neuralgia del trigémino?/ ¿Causas de la neuralgia del trigémino?/ ¿A quienes afecta?/Tratamiento médico de la neuralgia del trigémino/Tratamiento quirúrgico.

  6. A RARE CASE OF PERSISTENT TRIGEMINAL ARTERY IN AN ADULT FEMALE WITH PARA POSTERIOR COMMUNICATING ARTERY ANEURYSM

    Directory of Open Access Journals (Sweden)

    Banavathu Daya Bharath Singh

    2015-05-01

    Full Text Available Anastomosis found in the adulthood between the carotid and vertebro - basilar systems, apart from the posterior communicating artery, are extremely infrequent and are due to the persistence of vessels that joined both systems during the fetal period. This carotid - vertebrobasilar anastomosis are the trigeminal, otic, and hypoglossal and proatlantal arteries. P ersistent trigeminal artery is the commonest of the above mentioned four arteries. The reported incidence is about 0.2%. Patients may be asymptomatic or present symptoms due to low flow of posterior circulation or carotid microembolization from posterior circulation. PTA can cause trigemina l neuralgia. We report in this paper a case of a persistant trigeminal artery found in an adult female with a para p com aneurysm who had persistent trigeminal artery which was seen in C T angiogram .

  7. Predicting pain relief: Use of pre-surgical trigeminal nerve diffusion metrics in trigeminal neuralgia

    Directory of Open Access Journals (Sweden)

    Peter S.-P. Hung

    2017-01-01

    Our study demonstrates that pre-surgical DTI metrics can serve as a highly predictive, individualized tool to prognosticate surgical response. We further highlight abnormal pontine segment diffusivities as key features of treatment non-response and confirm the axiom that central pain does not commonly benefit from peripheral treatments.

  8. Facial herpes zoster infection precipitated by surgical manipulation of the trigeminal nerve during exploration of the posterior fossa: a case report

    Directory of Open Access Journals (Sweden)

    Mansour Nassir

    2009-09-01

    Full Text Available Abstract Introduction We present a case of herpes zoster infection (shingles precipitated by surgical manipulation of the trigeminal nerve root during an attempted microvascular decompression procedure. The pathogenesis of this phenomenon, as well as the importance and role of prophylactic acyclovir in its management, are discussed. Case presentation A 54-year-old Caucasian man with a classical long-standing left-sided V2 and V3 division primary trigeminal neuralgia refractory to medical management, underwent posterior fossa exploration for microvascular decompression via a standard retromastoid craniectomy. The patient had immediate and complete relief from pain. Three days after the operation, he developed severely painful vesicles with V2 and V3 dermatomal distribution. Rather than the classical paroxysmal, lancinating type of trigeminal neuralgia, the pain experienced by the patient was of a constant burning nature. A clinical diagnosis of herpes zoster (shingles was made after smear confirmation from microbiological testing. The patient was commenced on antiviral treatment with acyclovir. His vesicular rash and pain gradually subsided over the next two weeks. He remains asymptomatic one year later. Conclusions Postoperative shingles precipitated by trigeminal nerve manipulation during surgery for trigeminal neuralgia can be a distressing and demoralizing experience for the patient. A careful preoperative history, early recognition, and prompt antiviral therapy is necessary.

  9. Trigeminal trophic syndrome

    Directory of Open Access Journals (Sweden)

    Parimalam Kumar

    2014-01-01

    Full Text Available Trigeminal trophic syndrome (TTS is a rare cause of facial ulceration, consequent to damage to the trigeminal nerve or its central sensory connections. We reporta case of TTS in a 48-year-old woman with Bell′s palsy following herpes zoster infection. The patient was treated and counseled. There hasnot been any recurrence for 1 year and the patient is being followed-up. The diagnosis of TTS should be suspected when there is unilateral facial ulceration, especially involving the ala nasi associated with sensory impairment.

  10. Laser-evoked potentials in primary headaches and cranial neuralgias.

    Science.gov (United States)

    de Tommaso, Marina

    2008-09-01

    Using neurophysiological methods to explore nociceptive pathways may improve knowledge of the functional changes subtending pain processing in the different forms of headache and facial pain. Laser-evoked potentials (LEPs) are a reliable neurophysiological assay for the clinical assessment of pain syndromes. Reduced amplitude of LEPs seems to characterize trigeminal neuralgia and painful temporomandibular disorders, suggesting the neuropathic origin of pain. In tension-type headache, as well as in fibromyalgia, enhanced pericranial LEP amplitude suggests the psychogenic origin of pain. In migraine, a normal amplitude of basal LEPs with reduced habituation and altered attentive modulation seems to express a general dysfunction of cortical pain processing, which may also contribute, other than to predispose, to the persistence of migraine. LEPs may be employed in the clinical evaluation of the neurophysiological and psychophysiological aspects of pain in the different forms of headaches and facial pain to improve the therapeutic approach and provide an objective measure of treatment efficacy.

  11. Percutaneous trigeminal ganglion balloon compression : experience in 40 patients.

    Directory of Open Access Journals (Sweden)

    Natarajan M

    2000-10-01

    Full Text Available Forty patients of trigeminal neuralgia were treated with percutaneous trigeminal ganglion balloon compression. Symptoms had been present since six months to twenty years. The age ranged between 23 years and 73 years. All the patients had immediate relief from pain. Two had already undergone trigeminal cistern rhizolysis. One patient had foramen ovale stenosis. After the procedure, all the patients had mild to moderate degree of ipsilateral facial sensory loss which included buccal mucosa and anterior 2/3rd of the tongue. Facial dysaesthesia (anaesthesia dolorosa was seen in only one case, who had mild involvement lasting one week. Thirty patients had altered taste sensation, probably due to general somatic sensory loss. Five patients had herpes perioralis. In this study group, two patients had already undergone microvascular decompression. All the patients were followed for a period ranging from one to eighteen months. Balloon compression technique seems to be better than injection of alcohol, glycerol or radio frequency lesion. Recurrence of pain was noted in 3 patients after one year.

  12. Geniculate neuralgia: a systematic review.

    Science.gov (United States)

    Tang, I P; Freeman, S R; Kontorinis, G; Tang, M Y; Rutherford, S A; King, A T; Lloyd, S K W

    2014-05-01

    To systematically summarise the peer-reviewed literature relating to the aetiology, clinical presentation, investigation and treatment of geniculate neuralgia. Articles published in English between 1932 and 2012, identified using Medline, Embase and Cochrane databases. The search terms 'geniculate neuralgia', 'nervus intermedius neuralgia', 'facial pain', 'otalgia' and 'neuralgia' were used to identify relevant papers. Fewer than 150 reported cases were published in English between 1932 and 2012. The aetiology of the condition remains unknown, and clinical presentation varies. Non-neuralgic causes of otalgia should always be excluded by a thorough clinical examination, audiological assessment and radiological investigations before making a diagnosis of geniculate neuralgia. Conservative medical treatment is always the first-line therapy. Surgical treatment should be offered if medical treatment fails. The two commonest surgical options are transection of the nervus intermedius, and microvascular decompression of the nerve at the nerve root entry zone of the brainstem. However, extracranial intratemporal division of the cutaneous branches of the facial nerve may offer a safer and similarly effective treatment. The response to medical treatment for this condition varies between individuals. The long-term outcomes of surgery remain unknown because of limited data.

  13. Trigeminal neuropathic pain in a patient with progressive facial hemiatrophy (parry-romberg syndrome).

    Science.gov (United States)

    Viana, Michele; Glastonbury, Christine M; Sprenger, Till; Goadsby, Peter J

    2011-07-01

    We reviewed the literature on published cases of progressive facial hemiatrophy (Parry-Romberg syndrome) to identify possible pathophysiological mechanisms of the syndrome. To describe the somatosensory phenotype of a previously unreported patient with progressive facial hemiatrophy and facial pain. Case report and 4-month follow-up period. University-based tertiary referral headache center. A 37-year-old woman with progressive facial hemiatrophy and strictly left-sided facial pain over 12 years. Greater occipital nerve blockade with lidocaine, 2% (2 mL), and methylprednisolone sodium phosphate (80 mg). Trigeminal sensory phenotype on quantitative sensory testing using thermal threshold and Von Frey hairs. The case report includes patient photographs, neuroimaging, and neurophysiological findings. On the left side, there was continuous pain in V(1) and V(2) and intermittent sharp shooting pains in V(3). The sensory examination showed areas on the left side with pinprick hyperalgesia, cold and heat hyperalgesia, and dynamic mechanical allodynia. The pain in V(1) and V(3) and the allodynia dramatically improved after greater occipital nerve blockade. In the cases reported in the literature, a constant component of the pain was always part of the phenotype, and positive or negative trigeminal sensory signs were frequently described. The phenotype of our patient suggests neuropathic pain involving all 3 branches of the trigeminal nerve, and the patient fulfills newly defined stricter criteria for neuropathic pain. Similar to our case, phenotypes of the other published cases seem to agree with trigeminal neuropathic pain rather than trigeminal neuralgia specifically.

  14. [Partial vertical nucleotomy. A neurosurgical intervention in some forms of therapy-resistant facial neuralgia].

    Science.gov (United States)

    Fischer, J

    1985-01-01

    The partial vertical nucleotomy is presented as a new neurosurgical method for the treatment of therapy-resistant pain in the spreading area of the N. trigeminus. Strict indications are laid down which are mainly restricted to therapy-resistant pain in the above mentioned spreading area in the presence of diffusely growing malignant tumours, after traumas and infections and predominantly in forms of idiopathic trigeminal neuralgia that has been treated without any results over a period of many years. In the experimental part of the article; material and method as well as results of anterograde transport on the efferent trigeminal pathways in rabbits by means of horseradish peroxi- dase (HRP) and its representation by means of tratramethylbenzidine (TMB) are discussed. Furthermore fibre preparations of the tractus and nucles spinalis nervi trigemini and the radiating fibres of the Nervus vagus are shown.

  15. Occipital Neuralgia. A Case Report

    Directory of Open Access Journals (Sweden)

    Urbano Solis Cartas

    2016-02-01

    Full Text Available Occipital neuralgia or Arnold's neuralgia is a rare condition that primarily affects women. There are multiple causes that can trigger this disorder, which is clinically characterized by the presence of pain of varying intensity, characteristic radiation of pain and presence of trigger points. Occipital nerve block can be an important element in the diagnosis of the condition. The intensity, frequency and characteristics of pain can considerably limit the perception of quality of life of patients who suffer from it. The case of a 57-year-old patient with a diagnosis of rheumatoid arthritis and symptoms compatible with occipital neuralgia is presented. This case is of interest given the frequent emergency department visits by patients with neck pain and the scarcity of studies on this condition

  16. MR imaging of trigeminal neuropathy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Si Yeon; Yoon, Pyeong Ho; Chung, Jin Il; Lee, Seung Ik; Kim, Dong Ik [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    2001-03-01

    The trigeminal nerve is the largest of the cranial nerves and has both sensory and motor functions. It can be divided into proximal (brainstem, preganglionic, gasserian ganglion, and cavernous sinus) and distal (extracranial opthalmic, maxillary, and mandibular) segments. Patients with trigeminal neuropathy present with a wide variety of symptoms, and lesions producing those symptoms may occur anywhere along the protracted course of the trigeminal nerve, from its distal facial branches to its nuclear columns in the brainstem. The purpose of this article is to illustrate the normal anatomy of the trigeminal nerve and associated various pathologic conditions. These are arranged anatomically according to their site of interaction with it.

  17. Neuronal plasticity of trigeminal ganglia in mice following nerve injury

    Science.gov (United States)

    Lynds, Randi; Lyu, Chuang; Lyu, Gong-Wei; Shi, Xie-Qi; Rosén, Annika; Mustafa, Kamal; Shi, Tie-Jun Sten

    2017-01-01

    orofacial neuropathic pain following this type of injury. Further investigations on the relevance of these changes may help to target suitable treatment possibilities for trigeminal neuralgia. PMID:28223844

  18. Trigeminal pathways deliver a low molecular weight drug from the nose to the brain and orofacial structures.

    Science.gov (United States)

    Johnson, Neil J; Hanson, Leah R; Frey, William H

    2010-06-07

    Intranasal delivery has been shown to noninvasively deliver drugs from the nose to the brain in minutes along the olfactory and trigeminal nerve pathways, bypassing the blood-brain barrier. However, no one has investigated whether nasally applied drugs target orofacial structures, despite high concentrations observed in the trigeminal nerve innervating these tissues. Following intranasal administration of lidocaine to rats, trigeminally innervated structures (teeth, temporomandibular joint (TMJ), and masseter muscle) were found to have up to 20-fold higher tissue concentrations of lidocaine than the brain and blood as measured by ELISA. This concentration difference could allow intranasally administered therapeutics to treat disorders of orofacial structures (i.e., teeth, TMJ, and masseter muscle) without causing unwanted side effects in the brain and the rest of the body. In this study, an intranasally administered infrared dye reached the brain within 10 minutes. Distribution of dye is consistent with dye entering the trigeminal nerve after intranasal administration through three regions with high drug concentrations in the nasal cavity: the middle concha, the maxillary sinus, and the choana. In humans the trigeminal nerve passes through the maxillary sinus to innervate the maxillary teeth. Delivering lidocaine intranasally may provide an effective anesthetic technique for a noninvasive maxillary nerve block. Intranasal delivery could be used to target vaccinations and treat disorders with fewer side effects such as tooth pain, TMJ disorder, trigeminal neuralgia, headache, and brain diseases.

  19. Metastatic involvement of the Meckel's cave and trigeminal nerve. A case report.

    Science.gov (United States)

    Mastronardi, L; Lunardi, P; Osman Farah, J; Puzzilli, F

    1997-03-01

    The case of a patient with a right atypical trigeminal neuralgia caused by a metastatic tumor involving the Meckel's cave is reported. His medical history was significant for colon-rectal adenocarcinoma. The preoperative diagnosis of Meckel's cave neoplasm was made by MR. The patient underwent surgery, consisting of total removal of tumor and peeling of the ganglion and of the branches of the nerve, obtaining a histological diagnosis and a resolution of pain. The clinical, radiological findings and the treatment of this rare entity are discussed.

  20. [Maxillary trigeminal schwannoma. Presentation of a case and review of literature].

    Science.gov (United States)

    Madrid-Sánchez, Alejandro Jacob; Castillo-Rangel, Carlos; Contreras-Ayala, Myriam Leticia; Ruiz-García, Edgardo; Castillo-Castro, Ana Karen; Ramírez-Aguilar, Ricardo

    2016-12-30

    Schwannomas are benign tumours that are relatively common in the head, however the involvement of the sinunasal region is rare and there are only 5 cases reported in the maxilla in current literature, representing less than 1% of bone tumours. We report the case of a woman with a right maxillary schwannoma who underwent a complete resection of the lesion. Emphasis is placed on the rarity of the lesion in terms of its location and includes a review of clinical behaviour, diagnosis and current treatment options. Maxillary trigeminal schwannoma must be suspected if vague sinunasal symptoms, paranasal mass or, as in this case, trigeminal neuralgia present. Surgical treatment is indicated, and approaches vary according to location and tumour size. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  1. 38 CFR 4.124 - Neuralgia, cranial or peripheral.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Neuralgia, cranial or....124 Neuralgia, cranial or peripheral. Neuralgia, cranial or peripheral, characterized usually by a... code number and rating. Tic douloureux, or trifacial neuralgia, may be rated up to complete...

  2. Herpes Zoster Involving the Second Division of the Trigeminal Nerve: Case Report and Literature Review.

    Science.gov (United States)

    Paquin, Rebecca; Susin, Lisiane F; Welch, Garrett; Barnes, Jonathan B; Stevens, Mark R; Tay, Franklin R

    2017-09-01

    Herpes zoster along the maxillary division of the trigeminal nerve is a rare condition that is caused by reactivation of the varicella zoster virus that resides within the trigeminal ganglion after the primary infection of chickenpox. The disease may be manifested as a toothache during its prodromal stage. The active stage of the disease is characterized by the appearance of a vesicular rash. Postherpetic neuralgia is a common complication of herpes zoster after resolution of the facial and intraoral symptoms. There is increasing evidence for herpes zoster patients to develop stroke later in life. The present case reports the development of herpes zoster maxillaris in a 71-year-old man whose maxillary right canine was diagnosed as pulpal necrosis and symptomatic apical periodontitis and was subsequently treated endodontically by cleaning and shaping and filling the canal space with gutta-percha and an epoxy resin-based sealer. The patient presented 3 days later with midfacial ulceration, desquamation, and crusting as well as intraoral ulceration along the course of the V2 dermatome. After successful treatment with antiviral medication, postherpetic neuralgia developed within the next 2 months. Complete resolution of the neuralgia occurred at the 4-month recall with negligible facial scarring. Herpes zoster may mimic odontogenic pain during the prodromal stage of the disease. Reactivation of the virus has also been implicated in the pathogenesis of pulpal pathoses. These paradoxical facets are of interest to the endodontist and should be considered in the differential diagnosis of the disease. Published by Elsevier Inc.

  3. Experience in Acupuncture Treatment of Occipital Neuralgia

    Institute of Scientific and Technical Information of China (English)

    王宏宾; 陈红; 姜宏睿

    2002-01-01

    @@ Clinically, occipital neuralgia is commonly encountered. It is manifested by pain in the unilateral suboccipital and postmastoid region, which may radiate to the upper occipital part, the ear and copular part, and even to the orbit. The pain is severe, and often cause spasm of the cervical muscles. The authors applied acupuncture for treating occipital neuralgia with good therapeutic results reported as follows.

  4. Capsaicin patch (Qutenza) for postherpetic neuralgia.

    Science.gov (United States)

    2011-05-30

    The FDA has approved a topical 8% patch formulation of capsaicin (Qutenza-NeurogesX), available only by prescription, for local treatment of postherpetic neuralgia. Postherpetic neuralgia occurs after herpes zoster in about one third of patients ≥60 years old and can persist for months or even years.

  5. Endosurgical repair of an iatrogenic facial arteriovenous fistula due to percutaneous trigeminal balloon rhizotomy.

    Science.gov (United States)

    Lesley, W S

    2007-12-01

    A 56-year-old woman with right-sided trigeminal neuralgia (TN), who underwent technically uneventful percutaneous balloon rhizotomy, developed significant bilateral pulsatile tinnitus on the first post-operative day. Although the patient reported significantly improved neuralgia, auscultation revealed a right facial bruit. Magnetic resonance angiography (MRA) of the face and brain demonstrated prominent right facial and jugular venous vascularity. Catheter angiography confirmed the suspected facial arteriovenous fistula (AVF). A transarterial approach was used to explore the AVF which arose from a laceration of the right internal maxillary artery and which fistulized directly with the pterygoid venous plexus. Endosurgical repair utilizing three non-fibered platinum coils was done under conscious sedation at the same setting as the diagnostic angiogram. Angiographically, the fistula was obliterated, and the patient's bruit and tinnitus immediately resolved. Follow-up MRA at 3.5 months was normal, and, the patient had no clinical symptoms of recurrent AVF. In conclusion facial AVF can complicate percutaneous trigeminal rhizotomy. Iatrogenic facial AVF can be repaired via an endovascular approach.

  6. MR volumetry of the trigeminal nerve in patients with unilateral facial pain; MR-Volumetrie des N. trigeminus bei Patienten mit einseitigen Gesichtsschmerzen

    Energy Technology Data Exchange (ETDEWEB)

    Kress, B.; Fiebach, J.; Sartor, K.; Stippich, C. [Abt. Neuroradiologie, Neurologische Klinik, Universitaetsklinikum Heidelberg (Germany); Rasche, D.; Tronnier, V. [Neurochirurgische Klinik, Universitaetsklinikum Heidelberg (Germany)

    2004-05-01

    Purpose: to assess whether MRI can detect atrophy of the trigeminal nerve in patients with trigeminal neuralgia. Materials and methods: a prospective MRI study was conducted in 39 patients (trigeminal neuralgia, trigeminal neuropathy, or atypical facial pain) and 25 volunteers. Using a coronal orientation (T1 flash 3D; T2 CISS 3D), regions of interest were delineated in the cisternal part of the trigeminal nerve along the border of the nerve to calculate the volume of the nerve. The volume of the nerve was compared side-by-side in each patient (t-test, p < 0.05) and the volume difference compared between patients and volunteers. Results: the volume of the compromised trigeminal nerve in patients with trigeminal neuralgia was lower than on the contralateral healthy side, with the difference between healthy and compromised side statistically significant (p < 0.05). In all other patients and in all volunteers, no significant difference was found between the volume of the healthy and compromised nerve. The volume difference between the healthy and compromised side in patients with trigeminal neuralgia was significantly higher (p < 0.05) than in all other patients and volunteers. Conclusion: atrophy of the trigeminal nerve caused by a nerve-vessel conflict can be detected by MRI. Only patients with trigeminal neuralgia show this unilateral atrophy. Therefore, it is possible to demonstrate the result of the nerve-vessel conflict and to determine the consequences of such a conflict. (orig.) [German] Ziel: Die Studie wurde mit der Frage durchgefuehrt, ob die bei Patienten mit Trigeminusneuralgie durch einen Gefaess-Nerven-Konflikt bedingte Atrophie des Nervs magnetresonanztomographisch darstellbar ist. Methodik: 39 Patienten (Trigeminusneuralgie, Trigeminusneuropathie, atypischer Gesichtsschmerz) und 25 Probanden wurden prospektiv magnetresonanztomographisch untersucht. In koronaren T1- und T2-Gradientenechosequenzen wurde der zisternale Abschnitt des N. trigeminus mittels

  7. Role of laser therapy in post herpetic neuralgia

    Directory of Open Access Journals (Sweden)

    Mann S

    1999-01-01

    Full Text Available The efficacy of combi laser therpay was evaluated in fifty cases of post neuralgia (PHN of different age groups (31 to 81 years and with varying duration of illness from 2 months to 4 and a half years in the present study. The affected areas were irradiated from a distance of 5 cms. using the probe of 12x70 watts at a frequency of 1000 Hz. each area being exposed for a time period of 5 minutes and 6 seconds. In each case the combi laser therapy was given for 15 consecutive days and therapeutic effect of the therapy was evaluated after 5th, 10th and 15th laser application during the treatment with the help of visual analouge scale (VAS. Patients started responding to the therapy after an average of 3.28 laser applications and VAS steadily decreased as the therapy progressed. After completion of therapy, 43 (86% out of 50 cases showed excellent relief (76-100% and remaining 7 (14% cases showed partial relief, 4(8% cases with good relief (51-75%, 2 (4% cases with fair relief (26-50% and 1(2% case with poor relief (1-25%. Partial relief in our 7 cases could be due to multiple factors like prolonged duration of illness, involvement of ophthalmic division of trigeminal nerve and formation of scarring and keloids. No side effects were observed during the treatment as well as duing the follow up period of 8 weeks.

  8. [Scalp neuralgia and headache elicited by cranial superficial anatomical causes: supraorbital neuralgia, occipital neuralgia, and post-craniotomy headache].

    Science.gov (United States)

    Shimizu, Satoru

    2014-01-01

    Most scalp neuralgias are supraorbital or occipital. Although they have been considered idiopathic, recent studies revealed that some were attributable to mechanical irritation with the peripheral nerve of the scalp by superficial anatomical cranial structures. Supraorbital neuralgia involves entrapment of the supraorbital nerve by the facial muscle, and occipital neuralgia involves entrapment of occipital nerves, mainly the greater occipital nerve, by the semispinalis capitis muscle. Contact between the occipital artery and the greater occipital nerve in the scalp may also be causative. Decompression surgery to address these neuralgias has been reported. As headache after craniotomy is the result of iatrogenic injury to the peripheral nerve of the scalp, post-craniotomy headache should be considered as a differential diagnosis.

  9. [Natural history of non specific neuralgias of the limbs. Exponential kinetics of the root pain recovery in sciatica and femoral neuralgia; uncertain kinetics for brachial neuralgia].

    Science.gov (United States)

    Paolaggi, Jean-Baptiste

    2003-01-01

    Very few studies are dedicated to the natural history of sciatica, and none to femoral neuralgia or brachial neuralgia natural course. Hence, the results of a collection of five studies on these topics appear worth being published. A rheumatology department. The first study was a retrospective comparison of sciatica (145 patients) and femoral neuralgia (63 patients). The second study was a retrospective study concerning 107 patients with sciatica observed in a second different period. A third and a fourth retrospective studies were carried out on 38 femoral neuralgia and 69 brachial neuralgia patients. The fifth study was a prospective cohort study on patients with sciatica. As there are no diagnosis criteria for non specific neuralgias, the diagnosis was based on seniors' opinion. Neuralgia due to specific causes were carefully excluded. As there are no relevant outcomes measures specially dedicated to idiopathic acute root pain, the full recovery of root pain was used as endpoint. The kinetics of sciatica and of femoral neuralgia recoveries are related Plotted as neuralgia survival sciatica as well as femoral neuralgia exhibited a decreasing, exponential kinetics curve. Half sciatica disappear each 6 to 7 weeks. Half femoral neuralgia disappear each 5 to 6 weeks. The brachial neuralgia survival exhibited a more complex kinetics. These pilot studies, do not allow definitive conclusions. Nevertheless, given the scarcity of available data, they may be used as a factual basis for perfectly designed prospective inception cohort studies.

  10. [Cardiovascular manifestations of chemical rhysolisis of the trigeminal nerve].

    Science.gov (United States)

    Igartua García, L; Sánchez Torres, G; González Mariscal, G; Etulain Maldonado, F; Méndez Venegas, J

    1979-01-01

    Twelve chemical rhyzolisis (surgical instilation of 10 c.c. of 15% NaCl solution) of trigeminal nerve were performed in 11 patients with trigeminal neuralgia resistent to medical treatment. Before and at least in the first 30 minutes after instilation the following parameters were monitorized: electrocardiogram, electroencephalogram, intrarradial arterial pressure and venous central pressure. In 10 cases after a 2.8 +/- 2.4 seg. latency period the following arrhythmias appeared (in paragraphs number of cases): sinus bradicardia, sinoauricular block, sinus arrest, atrial-ventricular block and atrial pacemaker migration. During sinus arrest (8 episodes in 4 cases; mean duration 17.6 secs.) slow, high voltage waves appeared in the electroencephalographic tracings. Ventricular scapes were not seen at the end of the sinus pauses. In 6 cases after this slow arrhythmic phase the following arrhythmias were observed: ventricular premature beats, atrial premature beats, sinus tachycardia, bidirectional ventricular tachycardia, and nodal tachycardia. All cases exhibited an elevation of mean arterial pressure after instilation of the nerve which was preceded by a short period of hypertension in 4 occasions. Average and standard deviations changes of systolic, diastolic and mean blood pressure (mm of Hg), pulse (beats/minute) and central venous pressure (cms of H2O) during the procedure were 46.7 +/- 29.3, 23.0 +/- 13.3, 34.1 +/- 16.4, 25.8 +/- 16.2 and 6.6 +/- 5.8, respectively (p less than or equal to 0.001) in all changes but the last ones, less than or equal to 0.05). Physiopathologic considerations of this autonomic crises are done.

  11. Neuralgia

    Science.gov (United States)

    ... rule out dental disorders that may cause facial pain (such as a tooth abscess ). Other symptoms (such as redness or swelling) may help rule out conditions such as infections, bone fractures, or rheumatoid ... of the pain: Blood tests to check blood sugar , kidney function, ...

  12. he etiology and mechanism of trigeminat neuralgia%三叉神经痛的病因和发病机制

    Institute of Scientific and Technical Information of China (English)

    姜军; 谷志远

    2001-01-01

    三叉神经痛(trigeminal neuralgia)的病因及发病机理目前尚不明确,认识也不一致。本文对近年一些学者根据临床实践,颅脑手术所见,病理解剖和动物实验模型研究等,对其发病机制的一些推断和假说做一综述,重点介绍了神经压迫学说。

  13. Multimodality Management of Trigeminal Schwannomas.

    Science.gov (United States)

    Niranjan, Ajay; Barnett, Samuel; Anand, Vijay; Agazzi, Siviero

    2016-08-01

    Patients presenting with trigeminal schwannomas require multimodality management by a skull base surgical team that can offer expertise in both transcranial and transnasal approaches as well as radiosurgical and microsurgical strategies. Improvement in neurologic symptoms, preservation of cranial nerve function, and control of mass effect are the primary goals of management for trigeminal schwannomas. Complete surgical resection is the treatment of choice but may not be possible in all cases. Radiosurgery is an option as primary management for small- to moderate-sized tumors and can be used for postoperative residuals or recurrences. Planned surgical resection followed by SRS for residual tumor is an effective option for larger trigeminal schwannomas. The endoscopic resection is an excellent approach for patients with an extradural tumor or tumors isolated to the Meckel cave. A detailed analysis of a tumor and its surroundings based on high-quality imaging can help better estimate the expected outcome from each treatment. An expert skull base team should be able to provide precise counseling for each patient's situation for selecting the best option.

  14. Botulinum neurotoxin type-A when utilized in animals with trigeminal sensitization induced a antinociceptive effect

    Directory of Open Access Journals (Sweden)

    Elcio J Piovesan

    2016-06-01

    Full Text Available ABSTRACT Purpose of the study was evaluate the possible antinociceptive effect of botulinum neurotoxin type-A (BoNT/A in an experimental model of trigeminal neuralgia. Method Neuropathic pain was induced by surgical constriction of the infraorbital nerve in rats. A control group underwent a sham procedure consisting of surgical exposure of the nerve. Subgroups of each group received either BoNT/A or isotonic saline solution. The clinical response was assessed with the -20°C test. Animals that underwent nerve constriction developed sensitization; the sham group did not. Results The sensitization was reversed by BoNT/A treatment evident 24 hours following application. Pronociceptive effect was observed in the sham group following BoNT/A. Conclusion BoNT/A has an antinociceptive effect in sensitized animals and a pronociceptive effect in non-sensitized animals.

  15. Sudden blindness as a complication of percutaneous trigeminal procedures: mechanism analysis and prevention.

    Science.gov (United States)

    Agazzi, Siviero; Chang, Stanley; Drucker, Mitchell D; Youssef, A Samy; Van Loveren, Harry R

    2009-04-01

    The authors describe the case of a 76-year-old man in whom reversible sudden blindness developed after a percutaneous balloon compression rhizotomy for trigeminal neuralgia. His eye became tense and swollen with intraocular pressures of 66 mm Hg. Acetazolamide was administered, and visual acuity (20/50) returned within several months. Despite correct needle placement, the intraocular pressure rose acutely because of transient occlusion of the orbital venous drainage through the cavernous sinus; this was reversed with aggressive medical treatment. In cadaveric studies (dried skull and formalin-fixed head), the authors studied the mechanism of optic nerve penetration. Their findings showed that excessive cranial angulation of the needle with penetration of the inferior orbital fissure can directly traumatize the optic nerve in the orbital apex. Direct trauma to the optic nerve can therefore be prevented by early and repeated confirmation of the needle trajectory with lateral fluoroscopy before penetration of the foramen ovale.

  16. MR findings of trigeminal neurinoma

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hong Suk; Han, Moon Hee; Chang, Kee Hyun; Yoo, In Kyu; Kim, Sam Soo; Lee, Kyoung Won; Jung, Hee Won; Yeon, Kyung Mo [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-08-01

    To describe the MRI findings of trigeminal neurinoma. We retrospectively analyzed the MRI findings of 19 patients with trigeminal neurinomas proven by surgery and pathologic examination. Axial T1- and T2-weighted MR images in all patients and gadolinium-enhanced T1-weighted images in 14 patients were obtained at 2.0T(8 cases), 1.5T(6 cases) or 0.5T(5 cases). These were analyzed in terms of tumor size, signal intensity, degree of contrast enhancement, the presence or absence of cystic change and denervation atrophy of the masticator muscles. Clinical manifestations included sensory abnormality or pain(n=12), headache(n=10), impaired visual acuity or diplopia(n=6), hearing loss or tinnitus(n=3), weakness of masticator muscles(n=2), and mass or nasal obstruction(n=2). On MR images, tumor size was seen to average 4.2(range 1.5-6)cm;tumors were located in the posterior cranial fossa(n=8), middle cranial fossa(n=4), ophthalmic nerve(n=2), maxillary nerve(n=1), and mandibular nerve(n=1), and in three cases were dumbbell-shaped and extended into both the middle and posterior cranial fossa. On T1-weighted images, signals were isointense with cortical grey matter, in ten cases(53%), and of low intensity in nine (47%);on T2-weighted images, signals were of high intensity in 15cases(79%) and were isointense in four (21%). Cystic change was seen in 12 cases(63%). After enhancement, all (14/14) the tumors enhanced. Denervation atrophy was seen in nine cases(47%) and all of these involved the trigeminal ganglion or mandibular nerve. A trigeminal neurinoma shows similar signal intensity and enhancement to other cranial neurinomas with a higher incidence of cystic degeneration. Its location and shape are characteristic, and where there is involvement of the trigeminal ganglion or mandibular nerve, denervation atrophy may be seen.

  17. Influence of anatomic location of lidocaine patch 5% on effectiveness and tolerability for postherpetic neuralgia

    Directory of Open Access Journals (Sweden)

    Nalamachu S

    2013-06-01

    Full Text Available Srinivas Nalamachu,1 Matthew Wieman,2 Leah Bednarek,2 Surya Chitra21International Clinical Research Institute, Overland Park, KS, 2Endo Pharmaceuticals Inc, Malvern, PA, USAPurpose: Lidocaine patch 5% is recommended as a first-line therapy for postherpetic neuralgia pain in neuropathic pain guidelines. Postherpetic neuralgia can occur anywhere on the body but often follows acute herpes zoster occurring in trigeminal and brachial plexus dermatomes. An analysis was conducted to determine whether the anatomic location of lidocaine patch 5% is associated with variations in effectiveness or tolerability in patients with postherpetic neuralgia.Methods: This was a post hoc analysis by anatomic site of patch placement (head [including neck], trunk [chest, abdomen, back, hips], and extremities [arm, leg] of a 4-week, multicenter, open-label study that enrolled patients with persistent pain following herpes zoster infection. Effectiveness was measured by Brief Pain Inventory (BPI average pain intensity (0 [no pain] to 10 [worst imaginable pain] and the BPI subscale for pain relief (0% [no relief] to 100% [complete relief]. Tolerability was assessed on the basis of patient-reported adverse events.Results: Of 332 enrolled patients (59.6% women [n = 198]; 92.5% white [n = 307]; mean [standard deviation] age, 71.2 [13.9] years, those (n = 203 who applied lidocaine patch 5% to a single anatomic site only and had baseline and postbaseline pain score data were analyzed (trunk, n = 130; head, n = 41; extremities, n = 32. The frequency of adverse events differed significantly by anatomic location, with significantly more adverse events reported with patch placement on the head versus the extremities (P = 0.006 or trunk (P = 0.02. BPI average pain improved significantly from baseline in each of the three anatomic areas (mean score decrease, 1.50–2.04; P ≤ 0.002, with no significant difference in effectiveness by patch location.Conclusion: Lidocaine 5% patch was

  18. Role of Botulinum Toxin Type-A (BTX-A) in the Management of Trigeminal Neuralgia

    National Research Council Canada - National Science Library

    Verma, Gaurav

    2013-01-01

    .... Newer methods were tried in search of permanent cure or long-lasting pain relief. The purpose of this paper is to present the review of the literature regarding the use of botulinum toxin type-A (BTX...

  19. Association between neurovascular contact and clinical characteristics in classical trigeminal neuralgia

    DEFF Research Database (Denmark)

    Maarbjerg, Stine; Wolfram, Frauke; Gozalov, Aydin

    2015-01-01

    and severe NVC. METHODS: Clinical characteristics were prospectively collected from consecutive TN patients using semi-structured interviews in a cross-sectional study design. We evaluated 3.0 Tesla MRI blinded to the symptomatic side. RESULTS: We included 135 TN patients. Severe NVC was more prevalent...

  20. Evaluation of a novel mouse model of intracisternal strychnine-induced trigeminal allodynia.

    Science.gov (United States)

    Lee, Il-Ok; Whitehead, Ryan A; Ries, Craig R; Schwarz, Stephan K W; Puil, Ernest; MacLeod, Bernard A

    2013-08-01

    Intractable neuropathic dynamic allodynia remains one of the major symptoms of human trigeminal neuropathy and is commonly accepted to be the most excruciatingly painful condition known to humankind. At present, a validated animal model of this disorder is necessary for efficient and effective development of novel drug treatments. Intracisternal strychnine in rats has been shown to result in localized trigeminal dynamic allodynia, thus representing a possible model of trigeminal neuralgia. The purpose of this study was to validate a mouse model of trigeminal glycinergic inhibitory dysfunction using established positive (carbamazepine epoxide) and negative (morphine) controls. The actions of conventional first-line treatment (carbamazepine epoxide [CBZe]) and clinically ineffective morphine were tested for trigeminal dynamic mechanical allodynia produced by intracisternal strychnine. In mice under halothane anesthesia, we injected either strychnine (0.3 μg), strychnine with CBZe (4 ng), or artificial cerebrospinal fluid (aCSF) intracisternally (i.c.). In a separate set of experiments, subcutaneous morphine (3 mg·kg(-1) sc) was injected with intracisternal strychnine. Dynamic mechanical allodynia was induced by stroking the fur with polyethylene (PE-10) tubing. The response of each mouse was rated to determine its allodynia score, and scores of each group were compared. In addition, in a separate dichotomous disequilibrium study, pairs of mice were injected with strychnine/saline, strychnine/strychnine-CBZe, or strychnine/strychnine-morphine. A blinded observer recorded which mouse of each pair had the greater global pain behaviour. Strychnine (i.c.) produced higher quantitative allodynia scores in the trigeminal distribution (mean 81.5%; 95% confidence interval [CI] 76.4 to 86.6) vs the aCSF group (mean 11.3%; 95% CI 8.1 to 14.4) (P strychnine (mean 83.2%; 95% CI 78.1 to 88.4) vs strychnine alone (mean 3.2%; 95% CI -0.9 to 7.2) (P strychnine did not result in

  1. Can treatment success with 5% lidocaine medicated plaster be predicted in cancer pain with neuropathic components or trigeminal neuropathic pain?

    Science.gov (United States)

    Kern, Kai-Uwe; Nalamachu, Srinivas; Brasseur, Louis; Zakrzewska, Joanna M

    2013-01-01

    An expert group of 40 pain specialists from 16 countries performed a first assessment of the value of predictors for treatment success with 5% lidocaine-medicated plaster in the management of cancer pain with neuropathic components and trigeminal neuropathic pain. Results were based on the retrospective analysis of 68 case reports (sent in by participants in the 4 weeks prior to the conference) and the practical experience of the experts. Lidocaine plaster treatment was mostly successful for surgery or chemotherapy-related cancer pain with neuropathic components. A dose reduction of systemic pain treatment was observed in at least 50% of all cancer pain patients using the plaster as adjunct treatment; the presence of allodynia, hyperalgesia or pain quality provided a potential but not definitively clear indication of treatment success. In trigeminal neuropathic pain, continuous pain, severe allodynia, hyperalgesia, or postherpetic neuralgia or trauma as the cause of orofacial neuropathic pain were perceived as potential predictors of treatment success with lidocaine plaster. In conclusion, these findings provide a first assessment of the likelihood of treatment benefits with 5% lidocaine-medicated plaster in the management of cancer pain with neuropathic components and trigeminal neuropathic pain and support conducting large, well-designed multicenter studies.

  2. Can treatment success with 5% lidocaine medicated plaster be predicted in cancer pain with neuropathic components or trigeminal neuropathic pain?

    Science.gov (United States)

    Kern, Kai-Uwe; Nalamachu, Srinivas; Brasseur, Louis; Zakrzewska, Joanna M

    2013-01-01

    An expert group of 40 pain specialists from 16 countries performed a first assessment of the value of predictors for treatment success with 5% lidocaine-medicated plaster in the management of cancer pain with neuropathic components and trigeminal neuropathic pain. Results were based on the retrospective analysis of 68 case reports (sent in by participants in the 4 weeks prior to the conference) and the practical experience of the experts. Lidocaine plaster treatment was mostly successful for surgery or chemotherapy-related cancer pain with neuropathic components. A dose reduction of systemic pain treatment was observed in at least 50% of all cancer pain patients using the plaster as adjunct treatment; the presence of allodynia, hyperalgesia or pain quality provided a potential but not definitively clear indication of treatment success. In trigeminal neuropathic pain, continuous pain, severe allodynia, hyperalgesia, or postherpetic neuralgia or trauma as the cause of orofacial neuropathic pain were perceived as potential predictors of treatment success with lidocaine plaster. In conclusion, these findings provide a first assessment of the likelihood of treatment benefits with 5% lidocaine-medicated plaster in the management of cancer pain with neuropathic components and trigeminal neuropathic pain and support conducting large, well-designed multicenter studies. PMID:23630431

  3. Diagnostic and therapeutic errors in trigeminal autonomic cephalalgias and hemicrania continua: a systematic review.

    Science.gov (United States)

    Viana, Michele; Tassorelli, Cristina; Allena, Marta; Nappi, Giuseppe; Sjaastad, Ottar; Antonaci, Fabio

    2013-02-18

    Trigeminal autonomic cephalalgias (TACs) and hemicrania continua (HC) are relatively rare but clinically rather well-defined primary headaches. Despite the existence of clear-cut diagnostic criteria (The International Classification of Headache Disorders, 2nd edition - ICHD-II) and several therapeutic guidelines, errors in workup and treatment of these conditions are frequent in clinical practice. We set out to review all available published data on mismanagement of TACs and HC patients in order to understand and avoid its causes. The search strategy identified 22 published studies. The most frequent errors described in the management of patients with TACs and HC are: referral to wrong type of specialist, diagnostic delay, misdiagnosis, and the use of treatments without overt indication. Migraine with and without aura, trigeminal neuralgia, sinus infection, dental pain and temporomandibular dysfunction are the disorders most frequently overdiagnosed. Even when the clinical picture is clear-cut, TACs and HC are frequently not recognized and/or mistaken for other disorders, not only by general physicians, dentists and ENT surgeons, but also by neurologists and headache specialists. This seems to be due to limited knowledge of the specific characteristics and variants of these disorders, and it results in the unnecessary prescription of ineffective and sometimes invasive treatments which may have negative consequences for patients. Greater knowledge of and education about these disorders, among both primary care physicians and headache specialists, might contribute to improving the quality of life of TACs and HC patients.

  4. Chemokine CCL2 and its receptor CCR2 in the medullary dorsal horn are involved in trigeminal neuropathic pain

    Directory of Open Access Journals (Sweden)

    Zhang Zhi-Jun

    2012-07-01

    2 signaling may be involved in the maintenance of orofacial neuropathic pain via astroglial–neuronal interaction. Targeting CCL2-CCR2 signaling may be a potentially important new treatment strategy for trigeminal neuralgia.

  5. Glial involvement in trigeminal central sensitization

    Institute of Scientific and Technical Information of China (English)

    Yu-feng XIE

    2008-01-01

    Recent studies have indicated that trigeminal neurons exhibit central sensitization, an increase in the excitability of neurons within the central nervous system to the extent that a normally innocuous stimulus begins to produce pain after inflamma-tion or injury, and that glial activities play a vital role in this central sensitization. The involvement of glial cells in trigeminal central sensitization contains multiple mechanisms, including interaction with glutamatergic and purinergic receptors. A better understanding of the trigeminal central sensitization mediated by glial cells will help to find potential therapeutic targets and lead to developing new analge-sics for orofacial-specific pain with higher efficiency and fewer side-effects.

  6. Trigeminal neuromas: Assessment of MRI and CT

    Energy Technology Data Exchange (ETDEWEB)

    Beges, C.; Revel, M.P.; Gaston, A.; Brugieres, P. (Dept. of Neuroradiology, Hopital Henri Mondor, Creteil (France)); Meder, J.F. (Dept. of Neuroradiology, Hopital Sainte Anne, Paris (France)); Martin, N. (Dept. of Neuroradiology, Hopital de la Pitie-Salpetriere, Paris (France))

    1992-06-01

    We report four cases of trigeminal neuroma. One of the patients had von Recklinghausen's neurofibromatosis with plexiform neurofibromas of the branches of the trigeminal nerve. MRI provided more information than CT as regards the spread of tumor: extension to the mandibular and maxillary division of the trigeminal nerve was well demonstrated on sagittal and coronal sections. This examination yielded an accurate census of the intraocular plexiform neurofibromas and allowed a correct preoperative diagnosis to be obtained. With Gd-DOTA, better definition of the outline of the tumours and of cystic components was obtained. However, CT was better for demonstration of bone erosions. (orig.).

  7. As neurectomias periféricas no tratamento das neuralgias do trigêmeo

    Directory of Open Access Journals (Sweden)

    José Zaclis

    1951-09-01

    Full Text Available The purpose of this report is to divulge peripheral neurectomy as a method for treatment of trigeminal neuralgia. This essay is based on 34 personal cases which have been operated upon, following a no scar producing method, during the period comprised between October, 1947 and December, 1950. Twenty patients of the series were submitted to neurectomy of the infra-orbital branches of one maxillary nerve; eight have undergone ipsilateral neurectomy of both infra-orbital and mentonian branches; in three cases the mentonian branches of one side were ressected the frontal branches were ressected in two cases and, in one case of bilateral neuralgia, ressection of the infra-orbital branches in both sides was performed. Five patients had to be reoperated upon after a painless period superior to one year, on account of return of pain. The follow-up period of 23 out of the 34 operated patients is superior to one year; in this group are included 10 cases with a follow-up period of over two years and 4 with more than three years. Except for six patients with whom no contact could be maintained (and whose present condition we ignore, the remaining were feeling no pain at the time of the last test. During the follow-up period all the patients experienced or are still having paresthesias. In no instance, however, such abnormal sensations were so annoying as to require any therapeutic care. The loss of sensation resulting from the nerve section has a tendency to disappear after a varying period of time, the cause of which (contrary to many authors, is the regeneration of the divided nerves themselves. The return of anesthesia following a second operation (at the time when sensibility was almost normalized is, we think, the best proof that progressive return of sensibility on the hitherto anesthetic area has nothing to do with the surrounding nerves. Facial palsy or any other serious complication were never observed; one patient had transient paralysis of the

  8. Laser therapy in post herpetic neuralgia

    Directory of Open Access Journals (Sweden)

    Mittal R

    1996-01-01

    Full Text Available Combi laser therapy was evaluated in 50 cases of established post herpetic neuralgia (PHN. Established PHN term was used when neuralgia persisted after 3 months of disappearance of herpes zoster (HZ vesicles. Twenty exposures were given and affected areas were irradiated from a distance of 2 cm at a frequency of 5000 Hz each area being exposed for a period of 1.23 minutes ie, 8J/cm2 of beam was given. Therapeutic evaluation was done on 4th, 8th, 12th, 16th, and 20th day. All 17 cases of established PHN of duration upto 3 months healed after 16 exposures and in the end 44/50 had cure, 5/50 had partial relief and one patient left trial after 2nd exposure.

  9. Neuralgia trójdzielna

    Directory of Open Access Journals (Sweden)

    Jan Kochanowski

    2016-06-01

    Full Text Available Neuralgia trójdzielna należy do najcięższych bólów w obrębie twarzy. Choć została opisana przez wielu badaczy, dzisiaj nazywa się ją chorobą Fothergilla, co upamiętnia przedstawienie neuralgii trójdzielnej przez tego uczonego w 1773 roku. Zachorowalność jest oceniana na 2–5/100 tys. osób, częściej chorują kobiety. Nerw trójdzielny to nerw czuciowo-ruchowy, który wspólnie z nerwami językowo-gardłowym i błędnym, nerwami podpotylicznym, potylicznymi mniejszymi i większymi oraz nerwem usznym wielkim unerwia skórę głowy. Włókna przewodzące bodźce bólowe przez zwój nerwu trójdzielnego kończą się w jądrze rdzeniowym, skąd przez jądra wzgórza docierają do kory czuciowej, układu limbicznego i wyspy. Przyczyn bólu w neuralgii upatruje się w uszkodzeniu włókien czuciowych grubych Aβ i powstałych ogniskach ektopowego pobudzenia – przenoszonego na uszkodzone strukturalnie włókna cienkie Aδ i C w obrębie połączeń zwanych efapsami. Neuralgię trójdzielną dzieli się na klasyczną i objawową. Obie postacie charakteryzują się napadami bólu o typie rażenia prądem elektrycznym, trwającymi od kilku sekund do dwóch minut. Ból najczęściej dotyczy obszaru unerwionego przez drugą i trzecią gałąź nerwu trójdzielnego, czyli nerw szczękowy i żuchwowy. Cechą charakterystyczną są strefy spustowe, których drażnienie przez bodźce niebólowe wywołuje napad neuralgii. Leczenie neuralgii trójdzielnej obejmuje postępowanie zachowawcze i chirurgiczne. W leczeniu zachowawczym złotym standardem jest stosowanie karbamazepiny lub okskarbazepiny. W przypadku niepowodzenia można włączyć baklofen, lamotryginę albo inny lek używany w leczeniu padaczki. Spośród metod chirurgicznych najczęściej stosuje się: odbarczenie konfliktu naczyniowo-nerwowego, ucisk zwoju troistego balonem, przezskórną blokadę zwoju Gassera glicerolem, przecięcie włókien zazwojowych nerwu tr

  10. Chemosensory properties of the trigeminal system.

    Science.gov (United States)

    Viana, Félix

    2011-01-19

    The capacity of cutaneous, including trigeminal endings, to detect chemicals is known as chemesthesis or cutaneous chemosensation. This sensory function involves the activation of nociceptor and thermoreceptor endings and has a protective or defensive function, as many of these substances are irritants or poisonous. However, humans have also developed a liking for the distinct sharpness or pungency of many foods, beverages, and spices following activation of the same sensory afferents. Our understanding of the cellular and molecular mechanisms of chemosensation in the trigeminal system has experienced enormous progress in the past decade, following the cloning and functional characterization of several ion channels activated by physical and chemical stimuli. This brief review attempts to summarize our current knowledge in this field, including a functional description of various sensory channels, especially TRP channels, involved in trigeminal chemosensitivy. Finally, some of these new findings are discussed in the context of the pathophysiology of trigeminal chemosensation, including pain, pruritus, migraine, cough, airway inflammation, and ophthalmic diseases.

  11. Aging of the trigeminal blink system.

    Science.gov (United States)

    Peshori, K R; Schicatano, E J; Gopalaswamy, R; Sahay, E; Evinger, C

    2001-02-01

    This study characterizes trigeminal blinks in normal human subjects between 20 and 80 years of age, 60-year-old Parkinson's disease patients, and young and old guinea pigs. In normal humans over 60 years of age, lid-closing duration, and the excitability and latency of the trigeminal reflex blink increase significantly relative to younger subjects. Aged guinea pigs appear to display similar increases in reflex blink duration and latency. Reflex blink amplitude, however, does not change consistently with age. For subjects less than 70 years of age, a unilateral trigeminal stimulus evokes a 37% larger blink in the eyelid ipsilateral to the stimulus than in the contralateral eyelid, but 70-year-olds exhibit blinks of equal amplitude. In all cases, blink duration is identical for the two eyelids. If normal, age-related loss of dopamine neurons explains these trigeminal blink modifications, then Parkinson's disease should exaggerate age-related changes in these blink parameters. Preliminary data show that Parkinson's disease increases blink duration and excitability relative to age-matched control subjects. Thus, it seems likely that normal, age-related loss of dopamine neurons accounts for increases in trigeminal blink excitability and duration. A previously uncharacterized type of trigeminally evoked blink appears after age 40 in humans and in aged guinea pigs. In subjects less than 40 years old, a single trigeminal stimulus elicits a single reflex blink. In subjects over age 40, however, a single stimulus frequently evokes a reflex blink and additional blinks that occur at a fixed interval relative to the preceding blink. These "blink oscillations" may arise from oscillatory processes within trigeminal reflex blink circuits. The presence of exaggerated blink oscillations in subjects with dry eye and benign essential blepharospasm suggests that an alteration of blink oscillation mechanisms plays a critical role in these disorders.

  12. Sleep in trigeminal autonomic cephalagias

    DEFF Research Database (Denmark)

    Barløse, Mads; Lund, Nunu; Jensen, Rigmor Højland

    2014-01-01

    PURPOSE OF REVIEW: Sleep and cluster headache (CH) are believed to be interconnected but the precise relation to the other trigeminal autonomic cephalalgias (TACs) is uncertain and complex. A better understanding of these relations may eventually lead to a clarification of the underlying mechanisms...... and eventually to more effective therapeutic regimens. This review aims to evaluate the existing literature on the subject of TACs and sleep. An association between episodic CH and distinct macrostructural sleep phases, especially the relation to rapid eye movement (REM) sleep, has been described in some older...... studies but could not be confirmed in other, more recent studies. Investigations into the microstructure of sleep in these patients are lacking. Only a few case reports exist on the relation between sleep and other TACs. SUMMARY: Recent studies do not find an association between CH and REM sleep. One...

  13. Geniculate neuralgia: clinical, radiologic, and intraoperative correlates.

    Science.gov (United States)

    Tubbs, R Shane; Mosier, Kristine M; Cohen-Gadol, Aaron A

    2013-12-01

    Geniculate neuralgia is an uncommon pain syndrome that can be severe and disabling and is difficult to diagnose. The literature was reviewed for geniculate neuralgia, including anatomy, presentation, and treatment. A case illustration was presented that demonstrates the novel brainstem functional imaging findings for geniculate neuralgia. A 39-year-old man presented with a history of left "deep" ear pain within his ear canal. He noted occasional pain on the left side of his face around the ear. He had been treated with neuropathic pain medications without relief. His wife described suicidal ideations discussed by her husband because of the intense pain. The patient's neurologic examination was normal, and otolaryngologic consultation revealed no underlying struct