Surgical Skills of Adhesions and Transposition of Trigeminal Nerve for Primary Trigeminal Neuralgia

Object The purpose of this study was to evaluate the long-term efficacy of microvascular decompression (MVD) and to identify the factors affecting outcome in patients treated for primary trigeminal neuralgia (TN). Only the cases with a clear-cut neurovascular conflict (vascular contact and/or compression of the root entry zone of the trigeminal nerve) found at surgery and treated with “pure” MVD (decompression of the root without any additional lesioning or cutting of the adjacent rootlets) were retained. Methods The study included 362 patients who were followed up over a period of 1 to 18 years (median follow-up 7.2 years). A Kaplan–Meier survival analysis was generated at 1 and 15 years of follow-up for all of the considered factors. According to Kaplan–Meier analysis, the success rate (defined as pain-free patients without any medication) was 91% at 1 year and estimated to be 73.38% after 15 years of follow-up. Results None of the following patient-related factors played any significant role in prognosis: sex, patient age at surgery, history of systemic hypertension, duration of neuralgia before surgery, or history of failed trigeminal surgery. Patients with atypical neuralgia (a baseline of permanent pain) had the same outcome as those with a typical (purely spasmodic) presentation. In addition, the side and topography of the trigeminal nerve did not play a role, whereas involvement of all three divisions of the nerve had a negative effect on outcome. Concerning anatomical factors, neither the type of the compressive vessel nor its location along or around the root was found to be significant. However, the severity of compression was important—the more severe the degree of compression, the better the outcome (p = 0.002). The authors also found that presence of focal arachnoiditis had a negative influence on outcome (p = 0.002). Conclusions Pure MVD can offer patients affected by a primary TN a 73.38% probability of long-term (15 years) cure of neuralgia. The presence of a clear-cut and marked vascular compression at surgery (and possibly—although not yet reliably—on preoperative magnetic resonance imaging) is the guarantee of a higher than 90% success rate.

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Correlation between nerve atrophy, brain grey matter volume and pain severity in patients with primary trigeminal neuralgia

Cephalalgia ◽

10.1177/0333102418793643 ◽

2018 ◽

Vol 39 (4) ◽

pp. 515-525 ◽

Cited By ~ 10

Author(s):

Yuan Wang ◽

Qian Yang ◽

Dongyuan Cao ◽

David Seminowicz ◽

Bethany Remeniuk ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Mediation Analysis ◽

Grey Matter ◽

Anterior Cingulate ◽

Grey Matter Volume ◽

Matter Volume ◽

Clinical Pain ◽

Trigeminal Nerves ◽

Primary Trigeminal Neuralgia

Background Recent neuroimaging studies have reported grey matter alterations in primary trigeminal neuralgia patients. However, few studies have focused on quantitative measurements of trigeminal nerves and the interaction between trigeminal nerve volume and brain morphology, particularly grey matter volume. In this study, we investigated the link between trigeminal nerves and grey matter volume changes in primary trigeminal neuralgia patients compared to healthy controls. Moreover, we explored the association of structure of trigeminal nerves and grey matter to collected pain clinical variables. Methods Eighty participants (40 patients and 40 controls) were recruited for the study. All participants underwent MRI sessions and clinical pain assessment. Trigeminal nerve volume and whole brain grey matter volume were evaluated using quantitative imaging techniques. Sensory and affective pain rating indices were assessed using the visual analog scale and short-form McGill Pain Questionnaire. Mediation analysis was conducted to investigate the relationship between clinical pain variables and volumetric changes in trigeminal nerves and grey matter. Results Decreased trigeminal nerve volume was detected in primary trigeminal neuralgia patients compared to controls. Additionally, reduced grey matter volume was found in several regions associated with pain in primary trigeminal neuralgia subjects, including the insula, secondary somatosensory cortex, hippocampus, dorsal anterior cingulate cortex, precuneus, and several areas of the temporal lobe. Mediation analysis revealed that decreased trigeminal nerve volume drove grey matter volume abnormality of the left insula, and further led to increased pain ratings. Conclusion This study showed a predominantly direct effect of trigeminal nerve atrophy on clinical pain variables in primary trigeminal neuralgia patients, providing new insight into the pathophysiology of the disease. Trial registration ClinicalTrials.gov ID: NCT02713646

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Effect of the gamma knife treatment on the trigeminal nerve root in chinese patients with primary trigeminal neuralgia

Turkish Neurosurgery ◽

10.5137/1019-5149.jtn.6709-12.1 ◽

2013 ◽

Author(s):

Wei Qian ◽

Si-qing Li ◽

Zhi-xiu Song ◽

Jun Yang ◽

Yu-quan Wu ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Gamma Knife ◽

Trigeminal Nerve ◽

Nerve Root ◽

Chinese Patients ◽

Trigeminal Nerve Root ◽

Primary Trigeminal Neuralgia

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Temporal disconnection between pain relief and trigeminal nerve microstructural changes after Gamma Knife radiosurgery for trigeminal neuralgia

Journal of Neurosurgery ◽

10.3171/2019.4.jns19380 ◽

2020 ◽

Vol 133 (3) ◽

pp. 727-735

Author(s):

Peter Shih-Ping Hung ◽

Sarasa Tohyama ◽

Jia Y. Zhang ◽

Mojgan Hodaie

Keyword(s):

Pain Relief ◽

Trigeminal Neuralgia ◽

Pain Intensity ◽

Gamma Knife ◽

Trigeminal Nerve ◽

Diffusion Tensor ◽

Gamma Knife Radiosurgery ◽

Time Points ◽

Microstructural Effect

OBJECTIVEGamma Knife radiosurgery (GKRS) is a noninvasive surgical treatment option for patients with medically refractive classic trigeminal neuralgia (TN). The long-term microstructural consequences of radiosurgery and their association with pain relief remain unclear. To better understand this topic, the authors used diffusion tensor imaging (DTI) to characterize the effects of GKRS on trigeminal nerve microstructure over multiple posttreatment time points.METHODSNinety-two sets of 3-T anatomical and diffusion-weighted MR images from 55 patients with TN treated by GKRS were divided within 6-, 12-, and 24-month posttreatment time points into responder and nonresponder subgroups (≥ 75% and < 75% reduction in posttreatment pain intensity, respectively). Within each subgroup, posttreatment pain intensity was then assessed against pretreatment levels and followed by DTI metric analyses, contrasting treated and contralateral control nerves to identify specific biomarkers of successful pain relief.RESULTSGKRS resulted in successful pain relief that was accompanied by asynchronous reductions in fractional anisotropy (FA), which maximized 24 months after treatment. While GKRS responders demonstrated significantly reduced FA within the radiosurgery target 12 and 24 months posttreatment (p < 0.05 and p < 0.01, respectively), nonresponders had statistically indistinguishable DTI metrics between nerve types at each time point.CONCLUSIONSUltimately, this study serves as the first step toward an improved understanding of the long-term microstructural effect of radiosurgery on TN. Given that FA reductions remained specific to responders and were absent in nonresponders up to 24 months posttreatment, FA changes have the potential of serving as temporally consistent biomarkers of optimal pain relief following radiosurgical treatment for classic TN.

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Target points: a discussion on acupuncture treatment of primary trigeminal neuralgia

Journal of Chinese Integrative Medicine ◽

10.3736/jcim20120902 ◽

2012 ◽

pp. 961-965 ◽

Cited By ~ 1

Author(s):

L He

Keyword(s):

Trigeminal Neuralgia ◽

Acupuncture Treatment ◽

Primary Trigeminal Neuralgia

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Proton MR spectroscopic features of the cisternal segment of the trigeminal nerve in patients with trigeminal neuralgia: A pilot study

Clinical Imaging ◽

10.1016/j.clinimag.2020.12.006 ◽

2021 ◽

Vol 74 ◽

pp. 93-99

Author(s):

Kemal Niyazi Arda ◽

Sinan Akay ◽

Omer Karadas ◽

Omer Kartal

Keyword(s):

Pilot Study ◽

Trigeminal Neuralgia ◽

Trigeminal Nerve

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MRI features of responsible contacts in vascular compressive trigeminal neuralgia and prediction modeling

Acta Radiologica ◽

10.1177/0284185120983971 ◽

2021 ◽

pp. 028418512098397

Author(s):

Yufei Zhao ◽

Jianhua Chen ◽

Rifeng Jiang ◽

Xue Xu ◽

Lin Lin ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Predictive Model ◽

Trigeminal Nerve ◽

Roc Curve ◽

Neurovascular Compression ◽

Diagnostic Efficiency ◽

Mri Features ◽

Vascular Origin ◽

Magnetic Resonance Imaging Mri ◽

Mri Characteristics

Background Multiple neurovascular contacts in patients with vascular compressive trigeminal neuralgia often challenge the diagnosis of responsible contacts. Purpose To analyze the magnetic resonance imaging (MRI) features of responsible contacts and establish a predictive model to accurately pinpoint the responsible contacts. Material and Methods Sixty-seven patients with unilateral trigeminal neuralgia were enrolled. A total of 153 definite contacts (45 responsible, 108 non-responsible) were analyzed for their MRI characteristics, including neurovascular compression (NVC) grading, distance from pons to contact (Dpons-contact), vascular origin of compressing vessels, diameter of vessel (Dvessel) and trigeminal nerve (Dtrigeminal nerve) at contact. The MRI characteristics of the responsible and non-responsible contacts were compared, and their diagnostic efficiencies were further evaluated using a receiver operating characteristic (ROC) curve. The significant MRI features were incorporated into the logistics regression analysis to build a predictive model for responsible contacts. Results Compared with non-responsible contacts, NVC grading and arterial compression ratio (84.44%) were significantly higher, Dpons-contact was significantly lower at responsible contacts ( P < 0.001, 0.002, and 0.033, respectively). NVC grading had a highest diagnostic area under the ROC curve (AUC) of 0.742, with a sensitivity of 64.44% and specificity of 75.00%. The logistic regression model showed a higher diagnostic efficiency, with an AUC of 0.808, sensitivity of 88.89%, and specificity of 62.04%. Conclusion Contact degree and position are important MRI features in identifying the responsible contacts of the trigeminal neuralgia. The logistic predictive model based on Dpons-contact, NVC grading, and vascular origin can qualitatively improve the prediction of responsible contacts for radiologists.

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TRIGEMINAL NERVE RADIOSURGICAL TREATMENT IN INTRACTABLE CHRONIC CLUSTER HEADACHE

Neurosurgery ◽

10.1227/01.neu.0000245612.86484.7 ◽

2006 ◽

Vol 59 (6) ◽

pp. 1252-1257 ◽

Cited By ~ 22

Author(s):

Anne Donnet ◽

Manabu Tamura ◽

Dominique Valade ◽

Jean Régis

Keyword(s):

Trigeminal Neuralgia ◽

Cluster Headache ◽

Trigeminal Nerve ◽

Chronic Cluster Headache ◽

High Rate ◽

Long Term Results ◽

Complete Relief ◽

Term Evaluation ◽

The One

Abstract OBJECTIVE We have previously reported short-term results of a prospective open trial designed to evaluate trigeminal nerve radiosurgical treatment in intractable chronic cluster headache (CCH). Medium- and long-term results have not yet been reported. METHODS Ten patients presenting with a severe and drug-resistant CCH were enrolled (nine men, one woman). The radiosurgical treatment was performed according to the technique usually used for trigeminal neuralgia in our department. A single 4-mm shot was positioned at the level of the cisternal portion of the trigeminal nerve. The median distance between the center of the shot and the emergence of the nerve was 9.35 mm (range, 7.5–13.3 mm). The median of this maximum dose to the brainstem was 8.0 Gy (range, 4.0–11.1 Gy). Mean age was 49.8 years (range, 32–77 yr). Mean duration of the CCH was 9 years (range, 2–33 yr). The mean follow-up period was 36.3 months (range, 24–48 mo). RESULTS Two patients had complete relief of CCH. One patient had a good result with evolution in an episodic form. Seven patients had no improvement. Nine patients developed a new trigeminal nerve disturbance: three developed paresthesia with no hypoesthesia and six developed hypoesthesia, including two patients with deafferentation pain. Only one patient had neither paresthesia nor hypoesthesia. CONCLUSION We confirmed, with medium- and long-term evaluation, the high rate of toxicity and failure of the technique. The high toxicity, despite a methodology identical to the one used in trigeminal neuralgia, leads us to suspect an underlying specificity of the nerve in CCH. We do not recommend radiosurgery for treatment of intractable CCH.

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