Idiopathic Trigeminal Neuralgia in the Healthy Patient

2019 ◽  
pp. 1-8
Author(s):  
Oren Sagher
Keyword(s):  
Health Status ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Operative Management ◽  
Differential Diagnoses ◽  
Healthy Patient ◽  
Pain Syndromes ◽  
Idiopathic Trigeminal Neuralgia

Abstract: Idiopathic trigeminal neuralgia is one of the most common pain syndromes encountered in a typical neurosurgical practice. The approach to these patients is nuanced, and is based on their overall health status, the characteristics of their pain, and the distribution of symptoms. This chapter describes the assessment of a healthy patient with trigeminal neuralgia and provides key differential diagnoses of this pain syndrome. The counseling of the patient regarding treatment options is also described. Finally, the chapter outlines the operative management of a healthy patient using a microvascular decompression (MVD), including surgical pearls and strategies for complication avoidance and management.

scholarly journals Gamma Knife Radiosurgery for Primary and Secondary Trigeminal Neuralgia

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Sunil K Gupta
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Treatment Modality ◽  
Pain Control ◽  
Treatment Options ◽  
Gamma Knife Radiosurgery ◽  
Clinical Criteria ◽  
Grade Iii

Abstract INTRODUCTION Trigeminal neuralgia has always been a disease of conflict from pathological and management perspectives. Despite advances in the radiological imaging, evidence from autopsy studies, and intraoperative findings, concrete answers are not in sight. GKRS has been a strong contender among available treatment options for the management of trigeminal neuralgia. METHODS All patients were evaluated on clinical criteria, BNI scale for intensity of pain, and facial hypoesthesia (if any) in a protocol-based manner. Only patients with BNI III to V were offered GKRS as a treatment modality. The Marseille point was targeted with a 70 to 90 Gy dose at 50% isodose. Patients were informed about all available treatment options with long-term prognosis and pain control rates. Patients in need of an immediate pain relief, in failed GKRS, and in a severe pain jeopardizing routine life and eating habits were not offered GKRS and were managed with microvascular decompression. RESULTS A total of 108 (65 males, 43 females) patients received GKRS with the Perfexion model since 2009. Eighty-two percent of the patients received GKRS for primary trigeminal neuralgia, while the rest received GKRS for secondary trigeminal neuralgia due to skull base lesions (meningioma, schwannoma, cerebellar AVM, etc). A total of 78% of the patients had preoperative BNI scale IV, while 19% and 3% of the patients had grade III and V scale pain, respectively. Ninety-four percent patients gained BNI scale III intensity pain within 3 mo of GKRS. The 3-yr pain control rate (BNI I-II) could be attained in 81% of the patients. Twelve percent of the patients remained in BNI grade III. Two patients needed redo GKRS for their pain recurrence. CONCLUSION It remains uncontested that MVD provides the best long-term pain-free control in patients of trigeminal neuralgia; however, GKRS remains a valuable feasible option for a selected group of patients. GKRS should be offered as an alternative treatment modality in patients not in urgent need of pain relief. In failed GKRS, authors did not encounter any difficulty in microvascular decompression.

Preoperative evaluation of neurovascular relationships for microvascular decompression in the cerebellopontine angle in a virtual reality environment

2010 ◽  
Vol 113 (3) ◽  
pp. 479-485 ◽  
Author(s):  
Zhuo-Ying Du ◽  
Xiang Gao ◽  
Xiao-Luo Zhang ◽  
Zhi-Qiu Wang ◽  
Wei-Jun Tang
Keyword(s):  
Virtual Reality ◽  
Trigeminal Neuralgia ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Cerebellopontine Angle ◽  
Surgical Simulation ◽  
Preoperative Evaluation ◽  
Spatial Understanding ◽  
Idiopathic Trigeminal Neuralgia ◽  
And Training

Object In this paper the authors' goal was to evaluate the feasibility and efficacy of a virtual reality (VR) system in preoperative planning for microvascular decompression (MVD) procedures treating idiopathic trigeminal neuralgia and hemifacial spasm. The system's role in surgical simulation and training was also assessed. Methods Between May 2008 and April 2009, the authors used the Dextroscope system to visualize the neurovascular complex and simulate MVD in the cerebellopontine angle in a VR environment in 16 patients (6 patients had trigeminal neuralgia and 10 had hemifacial spasm). Reconstructions were carried out 2–3 days before MVD. Images were printed in a red-blue stereoscopic format for teaching and discussion and were brought into the operating room to be compared with real-time intraoperative findings. Results The VR environment was a powerful aid for spatial understanding of the neurovascular relationship in MVD for operating surgeons and trainees. Through an initial series of comparison/confirmation experiences, the senior neurosurgeon became accustomed to the system. He could predict intraoperative problems and simulate surgical maneuvering, which increased his confidence in performing the procedure. Conclusions The Dextroscope system is an easy and rapid method to create a stereoscopic neurovascular model for MVD that is highly concordant with intraoperative findings. It effectively shortens the learning curve and adds to the surgeon's confidence.

scholarly journals Historical aspects of the problem of treatment of trigeminal neuralgia and the role of neurosurgical methods in its solution (literature review)

2021 ◽  
Vol 6 (4) ◽  
pp. 123-136
Author(s):  
A. N. Zhurkin ◽  
A. V. Semenov ◽  
V. A. Sorokovikov ◽  
N. V. Bartul
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Surgical Techniques ◽  
Pain Syndrome ◽  
World Health ◽  
Vascular Compression ◽  
Neurogenic Pain ◽  
Surgical Methods ◽  
The Face

The trigeminal nerve is a mixed fifth cranial nerve, consisting of motor and sensory components. The sensitive component receives somesthetic information from the skin and mucous membranes of the face into the central nervous system, and the motor component is responsible for the innervation of chewing muscles. One of the manifestations of the pathology of the trigeminal nerve is pain syndrome. Trigeminal neuralgia occupies the main place among neurogenic pain syndrome in the face, is characterized by а severe course and the absence of sufficiently effective methods of treatment. According to the World Health Organization (WHO), the prevalence of trigeminal neuralgia in different countries is 2–5 cases per 100 thousand people per year. Trigeminal neuralgia is classified into 3 etiologic categories. Idiopathic trigeminal neuralgia occurs without apparent cause. Classical trigeminal neuralgia is caused by vascular compression of the trigeminal nerve root. Secondary trigeminal neuralgia is the consequence of a major neurologic disease, e. g., a tumor of the cеrеbеllоpоntine angle or multiple sclerosis. Today, there are many different options for the surgical treatment of trigeminal neuralgia. microvascular decompression of the root, radiosurgical destruction of the Gasser’s node, radiofrequency destruction, glycerol rhizotomy, balloon microcompression are considered the main effective and proven surgical methods for treating trigeminal neuralgia. But the questions of diagnosing the cause of the disease and choosing an adequate surgical method for treating therapeutically resistant trigeminal neuralgia for a particular patient remain open. The development of surgical methods begins from ancient times to the present day. The main stages in the development of neurosurgical treatment methods are presented. The following surgical techniques are described: open method – microvascular decompression, and closed percutaneous destructive methods – radiofrequency destruction, glycerol rhizotomy, balloon compression, radiosurgery, cryodestruction, laser destruction, botulinum toxin injections.

Microvascular Decompression for Trigeminal Neuralgia in the Elderly: A Review of the Safety and Efficacy

Neurosurgery ◽  
2004 ◽  
Vol 55 (4) ◽  
pp. 840-850 ◽  
Author(s):  
Keyoumars Ashkan ◽  
Henry Marsh
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Older Patients ◽  
Treatment Options ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Outcome Data ◽  
Control Group ◽  
Control Groups ◽  
And Control

Abstract OBJECTIVE: To critically examine the efficacy and safety of microvascular decompression (MVD) for trigeminal neuralgia (TN) in elderly patients. METHODS: We performed a retrospective review of medical records, followed by prospective follow-up. The outcome data from 44 MVD operations for TN performed in 40 consecutive patients with a mean age of 65 years (range, 60–75 yr) in the period 1991 to 2001 were compared with those from 40 younger control subjects (mean age, 46 yr; range, 20–59 yr) operated on during the same period. RESULTS: The median time from diagnosis of TN to MVD in the older patients was 7 years (range, 1–22 yr), compared with 3 years (range, 3 mo to 20 yr) in the younger group (P = 0.02). With the exception of one, all patients in this study were classified as American Society of Anesthesiologist Grade 1 or 2. Initial pain relief was achieved in 98 and 100% of the patients in the study and control groups, respectively. There were no operative mortalities or life-threatening morbidities. Transient facial numbness and diplopia occurred in both groups. Headaches, nausea, and vomiting were more frequent in the younger patients, whereas wound infection and confusion were more common in the older patients. The mean length of hospital stay was 5.4 days (range, 3–10 d) for the older patients, compared with 5.3 days (range, 3–9 d) for the control group (P = 0.4). After average follow-ups of 30 and 33 months, the pain recurred in 24 and 27% of the patients in the elderly and control groups, respectively. CONCLUSION: MVD is underused in the elderly despite being both safe and effective. Fitness and not age should be the key in deciding the treatment options. It is proposed that any patient with medically refractory TN who is fit for general anesthesia should be given the opportunity to choose MVD.

scholarly journals Post Stroke Pain: Identification, Assessment, and Therapy

2015 ◽  
Vol 39 (3-4) ◽  
pp. 190-201 ◽  
Author(s):  
Rebecca A. Harrison ◽  
Thalia S. Field
Keyword(s):  
Quality Of Life ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Current Treatment ◽  
Best Interests ◽  
Common Complication ◽  
Post Stroke ◽  
Pain Syndromes ◽  
And Function

Background: Pain is a common complication after stroke and is associated with the presence of depression, cognitive dysfunction, and impaired quality of life. It remains underdiagnosed and undertreated, despite evidence that effective treatment of pain may improve function and quality of life. Summary: We provide an overview of the means for clinical assessment and risk factors for the development of post-stroke pain, then review the newest available literature regarding the commonest post-stroke pain syndromes, including central post-stroke pain, complex regional pain syndrome, musculoskeletal pain including shoulder subluxation, spasticity-related pain, and post-stroke headache, as well as the available epidemiology and current treatment options. Key Messages: In the best interests of optimizing quality of life and function after stroke, clinicians should be aware of pain as a common complication after stroke, identify those patients at highest risk, directly inquire as to the presence and characteristics of pain, and should be aware of the options for treatment for the various pain syndromes.

scholarly journals Five-year result of microvascular decompression using video endoscopy in the treatment of classic trigeminal neuralgia with paroxysmal pain syndrome

2021 ◽  
Author(s):  
Alexe Vinokurov ◽  
Alexandr Kalinkin
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Nerve Root ◽  
Facial Pain ◽  
Pain Syndrome ◽  
Long Term Results ◽  
Video Endoscopy ◽  
Trigeminal Nerve Root ◽  
Paroxysmal Pain

Background. The incidence of trigeminal neuralgia (TN) is 15 per 100,000 people per year. The effectiveness of the existing conservative methods of therapy does not exceed 50%. The use of carbamazepine doubles the frequency of depressive conditions, and 40% of suicidal thoughts. Purpose of the study. To evaluate the long-term results of microvascular decompression using video endoscopy in the treatment of patients with classical trigeminal neuralgia (cNTN) with paroxysmal facial pain. Methods. At the Federal Research and Clinical Center of the FMBA of Russia in the period from 2014 to 2019. 96 patients with cNTN were operated on in 62 (64%) of whom neuralgia was with paroxysmal facial pain, and in 34 (36%) - with constant pain. The average period from the onset of pain syndrome to surgery was 5 years (from 2 months to 15 years). The maximum pain intensity upon admission to the hospital according to the visual analogue scale (VAS) was 10 points, according to the BNI (Barrow Neurological Institute) pain syndrome scale - V. All patients underwent MIA of the trigeminal nerve root using Teflon, and in 9 patients during surgery used video endoscopic assistance. The average follow-up period after surgery was 3.4 1.7 years (from 1 to 5 years).Results. In all (100%) patients, pain was completely relieved after surgery (BNI - I). Excellent and good results after MVD within 5 years were achieved in 98% of patients (BNI - I-II). Facial hypesthesia, which does not bring discomfort and anxiety (BNI-II), developed in 8% (n = 5) of patients. The use of video endoscopy made it possible to identify vessels compressing the trigeminal nerve root with minimal traction of the cerebellum and cranial nerves. The development of cerebellar edema and ischemia occurred in one (1.6%) patient.Conclusion. The MVD method with video endoscopy is effective in the treatment of patients with cNTN with paroxysmal pain syndrome.

Trigeminal Neuropathic Pain

2019 ◽  
pp. 31-40
Author(s):  
Mandana A. Behbahani ◽  
Nauman S. Chaudhry ◽  
Konstantin V. Slavin
Keyword(s):  
Neuropathic Pain ◽  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Pulse Generator ◽  
Unintentional Injury ◽  
Pain Syndrome ◽  
Management Process ◽  
Trigeminal Neuropathic Pain ◽  
Pain Syndromes ◽  
Internal Pulse Generator

Trigeminal neuropathic pain (TNP) involves pain isolated to the distribution of one or more branches of the trigeminal nerve following unintentional injury to that nerve. It is important to distinguish this facial pain syndrome from trigeminal neuralgia, as the treatment is quite different. The diagnosis is typically clinical, although local anesthetic blocks may aid in the diagnosis. Psychological testing is often performed preoperatively. Like other neuropathic pain syndromes, TNP may be treated with peripheral nerve stimulation. This chapter discusses a typical presentation of TNP, as well as the evaluation and management process, including placement of subcutaneous electrodes and connection to an internal pulse generator.

Sensory effects of microvascular decompression in trigeminal neuralgia

1997 ◽  
Vol 86 (2) ◽  
pp. 193-196 ◽  
Author(s):  
John B. Miles ◽  
Paul R. Eldridge ◽  
Carol E. Haggett ◽  
David Bowsher
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Nerve Root ◽  
Content Type ◽  
Idiopathic Trigeminal Neuralgia ◽  
Sensory Effects ◽  
Tomographic Angiography ◽  
Fine Print ◽  
Von Frey Filaments

✓ Nineteen patients with “idiopathic” trigeminal neuralgia, who had not undergone any previous interventional procedures, possessed a vessel or vessels compressing the preganglionic nerve root that was demonstrated by magnetic resonance tomographic angiography. Pain was relieved immediately in all of these patients after they underwent microvascular decompression without observed nerve damage. Although preoperative measurement of sensory perception thresholds showed elevations in the thresholds for touch (von Frey filaments) and warmth and coolness sensations, these thresholds normalized during the postoperative period. An apparent deficit in the pinprick (sharpness) sensation appeared postoperatively, but the deficit gradually regressed and completely disappeared by 1 year after surgery; this phenomenon may have been a statistical anomaly. The patients' pain disappeared immediately postoperatively and remained absent throughout the follow-up period. The authors conclude that damage to the nerve or nerve root is not essential for the relief of trigeminal neuralgia.

Repeat microvascular decompression for recurrent idiopathic trigeminal neuralgia

2014 ◽  
Vol 121 (4) ◽  
pp. 936-939 ◽  
Author(s):  
Nicolaas A. Bakker ◽  
J. Marc C. Van Dijk ◽  
Steven Immenga ◽  
Michiel Wagemakers ◽  
Jan D. M. Metzemaekers
Keyword(s):  
Risk Factors ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Therapeutic Option ◽  
Significant Risk ◽  
Case Series ◽  
Binary Logistic Regression Analysis ◽  
Complication Rates ◽  
Idiopathic Trigeminal Neuralgia ◽  
Facial Numbness

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 underwent repeat MVD for recurrent TN, focusing on outcome, risk factors, and complication rates. Methods Between 1990 and 2012, a total of 33 consecutive patients underwent repeat MVD for recurrent TN at the University Medical Center Groningen. The authors performed a retrospective chart review and telephone interviews. Risk factors were analyzed by binary logistic regression analysis. Results After 12 months of follow-up, 22 (67%) operations were successful, of which 19 patients were completely free of pain without medication. With multivariate analysis significant risk factors for success were older age (OR 1.11, p < 0.01) and direct absence of pain after repeat MVD (OR 25.2, p < 0.01). Previous neurodestructive procedures did not influence success rates. Facial numbness occurred in 9 patients (27%), while other morbidity was minimal. There was no mortality. Conclusions This study demonstrates that repeat MVD is a feasible therapeutic option with good chances of success, even in patients who have undergone neurodestructive procedures. Complication rates, particularly facial numbness, can be avoided if only a limited neurolysis is performed.

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