scholarly journals Internal Neurolysis for the Treatment of Trigeminal Neuralgia: Systematic Review

2021 ◽  
Author(s):  
Victor Sabourin ◽  
Pascal Lavergne ◽  
Jacob Mazza ◽  
Fadi Al-Saiegh ◽  
Jeffrey Head ◽  
...  
Keyword(s):  
Systematic Review ◽  
Trigeminal Neuralgia ◽  
Treatment Options ◽  
Vascular Compression ◽  
Internal Neurolysis ◽  
Pain Outcomes ◽  
Facial Numbness ◽  
Percutaneous Rhizotomy ◽  
The Impact

Introduction Trigeminal neuralgia remains a challenging disease with significant debilitating symptoms and variable efficacy in terms of treatment options, namely microvascular decompression (MVD), stereotactic radiosurgery (SRS), and percutaneous rhizotomy. Internal neurolysis (IN) is an alternative treatment that may be provide patient benefit but has limited understanding. We performed a systematic review of IN treatment of trigeminal neuralgia. Methods Studies from 2000 to 2021 that assessed IN in trigeminal neuralgia were aggregated and independently reviewed. Weighted averages for demographics, outcomes and complications were generated. Results A total of 520 patients in 12 studies were identified with 384 who underwent IN (mean age 53.8 years, range 46-61.4 years). A mean follow-up time of 36.5 months (range 12-90 months) was seen. Preoperative symptoms were present for about 55.0 months before treatment and pain was predominantly in V2/3 (26.8%) followed by other distributions. An excellent to good outcome (Barrow Neurological Institute Pain Score [BNI-PS] I-III) was seen in 83.7% of patients (range 72-93.8%). Pain outcomes at 1 year were excellent in 58-78.4%, good or better in 77-93.75% and fair or better in 80-93.75% of patients. On average facial numbness following IN was seen in 96% of patients however at follow-up remained in only 1.75-10%. The vast majority of remaining numbness was not significantly distressing to patients. Subgroup comparisons of IN vs. recurrent MVD, IN vs. radiofrequency ablation, the impact of IN during the absence of vascular compression as well as IN with and without MVD were also evaluated. Conclusions IN represents a promising approach for surgical treatment of trigeminal neuralgia in the absence of vascular compression or in potential cases of recurrence. Complications were limited in general. Further study is required to evaluate the impact of IN via higher quality prospective studies.

Efficacy of Internal Neurolysis for Trigeminal Neuralgia without Vascular Compression

2021 ◽  
Author(s):  
Ming-Wu Li ◽  
Xiao-feng Jiang ◽  
Chaoshi Niu
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Chart Review ◽  
Vascular Compression ◽  
Internal Neurolysis ◽  
Facial Numbness ◽  
Relief Rate

Abstract Background and Objective Trigeminal neuralgia is a common neurologic disease that seriously impacts a patient's quality of life. We retrospectively investigated the efficacy and safety of internal neurolysis (nerve combing) for trigeminal neuralgia without vascular compression. Patients and Methods This study was a retrospective review of all patients with trigeminal neuralgia who were admitted between January 2014 and February 2019. A subgroup of 36 patients had no vascular compression at surgery and underwent internal neurolysis. Chart review and postoperative follow-up were performed to assess the overall outcomes of internal neurolysis. Results Thirty-six patients were identified, with a mean age of 44.89 ± 7.90 (rang: 31–65) years and a disease duration of 5.19 ± 2.61 years. The immediate postoperative pain relief (Barrow Neurological Institute [BNI] pain score of I or II) rate was 100%. The medium- to long-term pain relief rate was 91.7%. Three patients experienced recurrence. Facial numbness was the primary postoperative complication. Four patients with a score of III on the BNI numbness scale immediately after surgery had marked improvement at 6 months. No serious complications occurred. Conclusion Internal neurolysis is a safe and effective treatment for trigeminal neuralgia without vascular compression or clear responsible vessels.

The Treatment of Trigeminal Neuralgia in Patients with Multiple Sclerosis using Percutaneous Radiofrequency Rhizotomy

2003 ◽  
Vol 30 (3) ◽  
pp. 220-223 ◽  
Author(s):  
Caglar Berk ◽  
Constantine Constantoyannis ◽  
Christopher R. Honey
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Recurrence Rate ◽  
Pain Control ◽  
Bilateral Presentation ◽  
Facial Numbness ◽  
Poor Tolerance ◽  
Percutaneous Rhizotomy ◽  
Pain Distribution

ABSTRACT:Background:Trigeminal neuralgia (TN) has a higher incidence among patients with multiple sclerosis (MS) than in the general population. This cohort of MS patients with TN presents a series of management challenges including poor tolerance of antineuralgic medications and occasional bilateral presentation. We analyzed our surgical series of MS patients presenting with TN who were treated with percutaneous radiofrequency rhizotomy to estimate the success, failure and recurrence rate of this procedure for those patients.Methods:Surgical reports were retrospectively reviewed between the years 1996-2000. Patients with MS and TN who received a percutaneous rhizotomy during that time were included in the study and followed until the end of 2002. Data regarding age, sex, duration of MS and pain, response to medical treatment, pain distribution and surgical outcome were evaluated.Results:There were thirteen patients with MS and medically refractory TN treated with percutaneous radiofrequency rhizotomy. The average age at diagnosis for MS was 41 with TN beginning an average of eight years later. Following rhizotomy, complete pain relief without the need for any medication was achieved in 81% of the patients. The addition of medications resulted in pain control in the remaining patients. During a mean follow-up period of 52 months, there was a 50% recurrence rate. There were no complications related to the procedure and the associated facial numbness was well-tolerated.Conclusions:Percutaneous radiofrequency rhizotomy is a safe and effective method for the treatment of TN in patients with MS. The unique susceptibility of this cohort to the side effects of antineuralgic medications may require early consideration of rhizotomy.

Gamma Knife radiosurgery for trigeminal neuralgia: the impact of magnetic resonance imaging–detected vascular impingement of the affected nerve

2010 ◽  
Vol 113 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Jason P. Sheehan ◽  
Dibyendu Kumar Ray ◽  
Stephen Monteith ◽  
Chun Po Yen ◽  
James Lesnick ◽  
...  
Keyword(s):  
Pain Relief ◽  
Mr Imaging ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Trigeminal Nerve ◽  
Gamma Knife Radiosurgery ◽  
Vascular Compression ◽  
Pain Intensity Score ◽  
The Impact

Object Trigeminal neuralgia is believed to be related to vascular compression of the affected nerve. Radiosurgery has been shown to be reasonably effective for treatment of medically refractory trigeminal neuralgia. This study explores the rate of occurrence of MR imaging–demonstrated vascular impingement of the affected nerve and the extent to which vascular impingement affects pain relief in a population of trigeminal neuralgia patients undergoing Gamma Knife radiosurgery (GKRS). Methods The authors performed a retrospective analysis of 106 cases involving patients treated for typical trigeminal neuralgia using GKRS. Patients with or without single-vessel impingement on CISS MR imaging sequences and with no previous surgery were included in the study. Pain relief was assessed according to the Barrow Neurological Institute (BNI) pain intensity score at the last follow-up. Degree of impingement, nerve diameter preand post-impingement, isocenter placement, and dose to the point of maximum impingement were evaluated in relation to the improvement of BNI score. Results The overall median follow-up period was 31 months. Overall, a BNI pain score of 1 was achieved in 59.4% of patients at last follow-up. Vessel impingement was seen in 63 patients (59%). There was no significant difference in pain relief between those with and without vascular impingement following GKRS (p > 0.05). In those with vascular impingement on MR imaging, the median fraction of vessel impingement was 0.3 (range 0.04–0.59). The median dose to the site of maximum impingement was 42 Gy (range 2.9–79 Gy). Increased dose (p = 0.019) and closer proximity of the isocenter to the site of maximum vessel impingement (p = 0.012) correlated in a statistically significant fashion with improved BNI scores in those demonstrating vascular impingement on the GKRS planning MR imaging Conclusions Vascular impingement of the affected nerve was seen in the majority of patients with trigeminal neuralgia. Overall pain relief following GKRS was comparable in those with and without evidence of vascular compression on MR imaging. In subgroup analysis of those with MR imaging evidence of vessel impingement of the affected trigeminal nerve, pain relief correlated with a higher dose to the point of contact between the impinging vessel and the trigeminal nerve. Such a finding may point to vascular changes affording at least some degree of relief following GKRS for trigeminal neuralgia.

scholarly journals Surgical Outcomes After Microvascular Decompression With Internal Neurolysis and Partial Neurectomy for Patients With Trigeminal Neuralgia and Negative Neurovascular Compression

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Amanda Carpenter ◽  
James K Liu
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Neurovascular Compression ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Root Entry Zone ◽  
Internal Neurolysis ◽  
Facial Numbness

Abstract INTRODUCTION Microvascular decompression (MVD) is an effective and durable treatment for patients with trigeminal neuralgia (TN) due to neurovascular compression (NVC). In the absence of NVC, the traditional MVD is less effective in achieving long-term pain relief. Internal neurolysis at the root entry zone (REZ) of the trigeminal nerve has been described in the literature; however, there are few reports of long-term outcome after this procedure. Furthermore, this is the first study to combine this procedure with additional partial neurectomy. METHODS This is a retrospective review of the senior author's patients with TN who underwent retrosigmoid craniectomy for MVD with internal neurolysis and partial neurectomy. Primary indications were patients with TN and no evidence of NVC intraoperatively. A total of 9 patients were included in the analysis. Three cases were of recurrent TN. The technique was performed with an 11-blade or arachnoid knife to open the perineurium in a longitudinal fashion at the REZ. A disc dissector was used to comb the fascicles along the longitudinal course, and a partial neurectomy was performed with a microscissors to make three selective cuts into the fascicles at the REZ. Barrow Neurological Institute (BNI) facial pain and numbness scales were used as postoperative assessment. RESULTS At median follow up of 12 mo (range: 2 to 34), 8 of 9 patients (89%) had a BNI-pain score of I (no trigeminal pain, no medications). Two of nine patients (22%) had a BNI-numbness score of I (no numbness); seven (78%) had a BNI-numbness score of II (mild facial numbness that is not bothersome). CONCLUSION Internal neurolysis with partial neurectomy appears to be an effective and potentially durable treatment option for patients with TN (primary or recurrent) without NVC. Larger series with longer follow-up is indicated to further evaluate the utility of this procedure.

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

2017 ◽  
Vol 126 (5) ◽  
pp. 1676-1684 ◽  
Author(s):  
John Y. K. Lee ◽  
John T. Pierce ◽  
Sukhmeet K. Sandhu ◽  
Dmitriy Petrov ◽  
Andrew I. Yang
Keyword(s):  
Trigeminal Neuralgia ◽  
Pain Intensity ◽  
Endoscopic Surgery ◽  
Microvascular Decompression ◽  
Cerebellopontine Angle ◽  
Group Versus ◽  
Complication Rates ◽  
Internal Neurolysis ◽  
Pain Outcomes

OBJECTIVEEndoscopic 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.METHODSThe 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.RESULTSIn 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 < 0.05). There was a trend toward not finding neurovascular conflict at the time of surgery more frequently in the M-MVD than in the E-MVD group (11% vs 7%, p = 0.052). Internal neurolysis was more often performed in the E-MVD group (26% vs 7%, p = 0.001). The 2 groups did not significantly differ in the length of the MVD procedure (approximately 2 hours). Self-reported headaches at 1 month postoperatively were present in 21% of the patients in the M-MVD group versus 7% in the E-MVD group (p = 0.01). Pain outcomes at the most recent followup were equivalent, with patients reporting a 5- to 6-point (70%–80%) improvement in pain intensity, a 5-point (85%) improvement in pain interference with ADLs, and a 6-point (85%) improvement in interference with facial-specific ADLs. Actuarial freedom from pain recurrence was equivalent in the 2 groups, with 80% pain control at 3 years.CONCLUSIONSBoth 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.

scholarly journals P.151 Repeat surgery for recurrent trigeminal neuralgia: a systematic review and meta-analysis

2021 ◽  
Vol 48 (s3) ◽  
pp. S63-S63
Author(s):  
AR Rheaume ◽  
C Ostertag ◽  
M Pietrosanu ◽  
T Sankar
Keyword(s):  
Systematic Review ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Meta Analysis ◽  
Repeat Surgery ◽  
Surgical Decision ◽  
Percutaneous Rhizotomy ◽  
Meta Analyses

Background: The success of repeat surgery for recurrent trigeminal neuralgia (TN)—with microvascular decompression (MVD), percutaneous rhizotomy (PR), or stereotactic radiosurgery (SRS)—is not well-studied. We performed a systematic review and meta-analysis of the literature on repeat surgery recurrent TN, focusing on the durability of pain relief and relative efficacy of MVD, PR, and SRS. Methods: A PRISMA systematic review of Medline/Embase/Pubmed identified studies of adults with unilateral idiopathic TN undergoing repeat surgery. The primary outcome of complete pain relief (CPR) at last follow-up was analyzed with a multivariate mixed-effects meta-analysis of proportions. Results: Seventy-eight studies met criteria; 61 were included in meta-analyses, containing 29/14/25 cohorts with 900/684/1353 patients undergoing MVD/PR/SRS respectively (mean age 64.7 years, 41% males). Initial CPR was 69% (74%/85%/52%). CPR at mean 39.7 month follow-up (38.3/38.8/41.0) was 48% (59%/60%/34%). Initial CPR for both MVD (CPR: 0.78 [0.70-0.85]) and PR (CPR: 0.93 [0.83-0.98]) was superior to SRS (CPR: 0.48 [0.35-0.61]). At follow-up, MVD (0.45 [0.32-0.58]) and PR (0.45 [0.30-0.60]) trended towards superior CPR versus SRS (0.25 [0.15-0.37]). Conclusions: Half of recurrent TN patients achieve good pain control 3 years after repeat surgery. MVD/PR showed superior initial pain relief and likely better long-term relief. These findings can inform surgical decision-making in this challenging population.

scholarly journals Fully endoscopic microvascular decompression for trigeminal neuralgia: technique review and early outcomes

2014 ◽  
Vol 37 (4) ◽  
pp. E18 ◽  
Author(s):  
Leif-Erik Bohman ◽  
John Pierce ◽  
James H. Stephen ◽  
Sukhmeet Sandhu ◽  
John Y. K. Lee
Keyword(s):  
Trigeminal Neuralgia ◽  
Brief Pain Inventory ◽  
Morbidity Rate ◽  
Vascular Compression ◽  
Preoperative Pain ◽  
Pain Status ◽  
Pain Outcomes ◽  
Before And After ◽  
The Mean

Object Fully endoscopicmicrovascular decompression (E-MVD) of the trigeminal nerve was initially described more than 1 decade ago, but has not yet gained wide acceptance. The authors present the experience of their first 47 consecutive E-MVDs for trigeminal neuralgia (TN). Methods All surgeries were performed by a single surgeon (J.Y.K.L.) at the Pennsylvania Hospital at the University of Pennsylvania. Patients prospectively completed pain scales before and after surgery by using the Brief Pain Inventory–Facial outcomes tool. All patients were called on the telephone, and the same outcome tool was administered without reference to their preoperative pain status. Results Forty-seven patients (17 men) were identified and enrolled. Forty (85%) had Burchiel Type 1 TN. Vascular compression was observed at surgery in 42 patients (89%). No surgery was aborted or converted to microscope. One patient suffered permanent hearing loss, for a permanent neurological morbidity rate of 2%. Overall improvement in pain outcomes was excellent, with a median maximum pain intensity preoperatively of 10 and postoperatively of 0 (p< 0.0001). The mean interference with global function scores were 6.2 preoperatively and reduced to 1.0 at last follow-up (p < 0.0001). The mean interference with facial function was 7.3 preoperatively and reduced to 1.2 at last follow-up (p < 0.0001). The mean follow-up period after surgery was 15 ± 8 months. Conclusions In experienced hands, E-MVD offers superb visualization and illumination and is both safe and effective, at least in the short term. Further longer-term study is needed to compare E-MVD to traditional microscopic MVD.

scholarly journals Results of a third Gamma Knife radiosurgery for trigeminal neuralgia

2020 ◽  
pp. 1-7
Author(s):  
Corbin A. Helis ◽  
Ryan T. Hughes ◽  
Michael T. Munley ◽  
J. Daniel Bourland ◽  
Travis Jacobson ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Treatment Success ◽  
Gamma Knife Radiosurgery ◽  
The Third ◽  
Significant Difference ◽  
Pain Outcomes ◽  
Facial Numbness

OBJECTIVEGamma Knife radiosurgery (GKRS) is a commonly used procedure for medically refractory trigeminal neuralgia (TN), with repeat GKRS routinely done in cases of pain relapse. The results of a third GKRS in cases of further pain relapse have not been well described. In this study, the authors report the largest series of patients treated with a third GKRS for TN to date.METHODSRetrospective review of institutional electronic medical records and a GKRS database was performed to identify patients who had been treated with a third GKRS at the authors’ institution in the period from 2010 to 2018. Telephone interviews were used to collect long-term follow-up data. Pain outcomes were measured using the Barrow Neurological Institute (BNI) pain intensity scale, with a score ≤ IIIb indicating successful treatment.RESULTSTwenty-two nerves in 21 patients had sufficient follow-up to determine BNI pain score outcomes. Eighteen of 22 cases had a successful third GKRS, with a median durability of pain relief of 3.88 years. There was no significant difference in the durability of pain relief after a third GKRS compared with those of institutional historical controls of prior series of first and second GKRS procedures. Ten cases had new or worsening facial numbness, with 1 case being bothersome. Four cases of toxicity other than facial numbness were reported, including 1 case of corneal abrasions and possible neurotrophic keratopathy. No cases of anesthesia dolorosa were reported. No factors predicting treatment success or the durability of pain relief were identified. Nonnumbness toxicity was more common in those with a proximally placed shot at the third GKRS.CONCLUSIONSA third GKRS is an effective treatment option for TN patients who have pain relapse after repeat GKRS. Pain outcomes of a third GKRS are similar to those following a first or second GKRS. Toxicity is tolerable in patients with a distally placed shot at the third GKRS.

scholarly journals Pharmacological interventions for drug-using offenders: an update to a systematic review and meta-analysis

2021 ◽  
Author(s):  
J. M. Glanville ◽  
A. E. Perry ◽  
M. Martyn-St James ◽  
C. Hewitt ◽  
S. Swami ◽  
...  
Keyword(s):  
Systematic Review ◽  
Drug Use ◽  
Meta Analysis ◽  
Treatment Options ◽  
Criminal Activity ◽  
Cochrane Collaboration ◽  
Pharmacological Interventions ◽  
Serious Adverse Events ◽  
Male Adult ◽  
The Impact

Abstract This updated systematic review assesses the effects of pharmacological interventions for drug-using offenders. Methods Systematic review protocols and conventions of the Cochrane Collaboration were followed to identify eligible studies. Studies were pooled in a meta-analysis to assess the impact of pharmacological interventions on drug use and criminal activity. An economic appraisal was conducted. Results The search strategies identified 22 studies containing 4372 participants. Meta-analyses revealed a small statistically significant mean difference favouring pharmacological interventions relative to psychological interventions in reducing drug use and criminal activity. When comparing the drugs to one another there were no significant differences between those included (methadone versus buprenorphine, naltrexone and cyclazocine). Conclusion Overall, the findings of this review suggest that methadone and naltrexone may have some impact on reducing drug use and reincarceration. Individual pharmacological drugs had differing (generally non-significant) effects. One study identified serious adverse events. Three studies reported cost and consequences information sufficient to conduct a full economic analysis but this was not comprehensive enough to be able to make judgements across all treatment options. Full economic analyses should be encouraged. The study findings were limited mainly to male adult offenders.

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