Diffusivity signatures characterize trigeminal neuralgia associated with multiple sclerosis

2015 ◽  
Vol 22 (1) ◽  
pp. 51-63 ◽  
Author(s):  
David Q Chen ◽  
Danielle D DeSouza ◽  
David J Hayes ◽  
Karen D Davis ◽  
Paul O’Connor ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Pain Syndrome ◽  
Neurovascular Compression ◽  
Neuropathic Pain Syndrome ◽  
Entry Zone ◽  
Non Invasive ◽  
Root Entry Zone ◽  
Mr Diffusion ◽  
3T Mr

Background: Trigeminal neuralgia secondary to multiple sclerosis (MS-TN) is a facial neuropathic pain syndrome similar to classic trigeminal neuralgia (TN). While TN is caused by neurovascular compression of the fifth cranial nerve (CN V), how MS-related demyelination correlates with pain in MS-TN is not understood. Objectives: We aim to examine diffusivities along CN V in MS-TN, TN, and controls in order to reveal differential neuroimaging correlates across groups. Methods: 3T MR diffusion weighted, T1, T2 and FLAIR sequences were acquired for MS-TN, TN, and controls. Multi-tensor tractography was used to delineate CN V across cisternal, root entry zone (REZ), pontine and peri-lesional segments. Diffusion metrics including fractional anisotropy (FA), and radial (RD), axial (AD), and mean diffusivities (MD) were measured from each segment. Results: CN V segments showed distinctive diffusivity patterns. The TN group showed higher FA in the cisternal segment ipsilateral to the side of pain, and lower FA in the ipsilateral REZ segment. The MS-TN group showed lower FA in the ipsilateral peri-lesional segments, suggesting differential microstructural changes along CN V in these conditions. Conclusions: The study demonstrates objective differences in CN V microstrucuture in TN and MS-TN using non-invasive neuroimaging. This represents a significant improvement in the methods currently available to study pain in MS.

scholarly journals Neurovascular Compression at the Root Entry Zone Correlates with Trigeminal Neuralgia and Early Microvascular Decompression Outcome

2016 ◽  
Vol 95 ◽  
pp. 208-213 ◽  
Author(s):  
Akshitkumar M. Mistry ◽  
Kurt J. Niesner ◽  
Wendell B. Lake ◽  
Jonathan A. Forbes ◽  
Chevis N. Shannon ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Neurovascular Compression ◽  
Entry Zone ◽  
Root Entry Zone

Cluster Headache-Like Pain in Multiple Sclerosis

Cephalalgia ◽  
1999 ◽  
Vol 19 (8) ◽  
pp. 732-734 ◽  
Author(s):  
M Leandri ◽  
G Craccu ◽  
A Gottlieb
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Cluster Headache ◽  
Evoked Potentials ◽  
Simultaneous Occurrence ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Trigeminal Root

We describe a case with simultaneous occurrence of cluster headache-like pain and multiple sclerosis. Both neuroimaging and neurophysiology (trigeminal evoked potentials) revealed a demyelination plaque in the pons, at the trigeminal root entry zone, on the side of pain. Although that type of lesion is usually associated with trigeminal neuralgia pain, we hypothesize that in this case it may be linked with the concomitant cluster headache, possibly by activation of trigemino-vascular mechanisms.

Trigeminal Neuralgia and Multiple Sclerosis

Neurosurgery ◽  
1979 ◽  
Vol 5 (6) ◽  
pp. 711-717 ◽  
Author(s):  
Martin L. Lazar ◽  
Joel B. Kirkpatrick
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Nerve Root ◽  
Superior Cerebellar Artery ◽  
Electron Microscopic ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Cerebellar Artery ◽  
Microsurgical Approach ◽  
Electron Microscopic Demonstration

Abstract Trigeminal neuralgia is unique to humans. The most common cause seems to be an injury to the myelin of the trigeminal nerve root entry zone as it extends for several millimeters lateral to the pons. Jannetta has developed an elegant retromastoid microsurgical approach to this region. He has identified a compression-distortion phenomenon of this nerve root entry zone, usually from an anomalous position of the superior cerebellar artery. Trigeminal neuralgia can also occur in association with multiple sclerosis, when the plaque lies in this same location. The historical evidence for this explanation is reinforced by the electron microscopic demonstration of the plaque in this region in a patient with multiple sclerosis who was suffering from tic douloureux.

A 10-year experience in the treatment of trigeminal neuralgia

1982 ◽  
Vol 57 (6) ◽  
pp. 757-764 ◽  
Author(s):  
Harry van Loveren ◽  
John M. Tew ◽  
Jeffrey T. Keller ◽  
Mary A. Nurre
Keyword(s):  
Trigeminal Neuralgia ◽  
Neurovascular Compression ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Significant Difference ◽  
Technical Advances ◽  
Trigeminal Root ◽  
Fine Print

✓ Of 1000 patients with classic trigeminal neuralgia who were treated during the last 10 years, 90% had an initial favorable response to medical therapy, but 75% (750 patients) failed to achieve satisfactory long-term relief. Of these, 700 patients were treated by percutaneous stereotaxic rhizotomy (PSR) and 50 were selected for posterior fossa exploration (PFE). Of the 50 patients undergoing PFE, 82% had neurovascular contact at the trigeminal root entry zone, but only 46% were judged to have had significant neurovascular compression. Exploration was negative in 16% of patients and revealed neural compression by bone in 2%. Patients with neurovascular compression were treated by microvascular decompression (MVD); all other patients with exploratory surgery underwent partial sensory rhizotomy. At 3 years after PFE, 84% of patients are pain-free. Results are excellent in 68%, good in 12%, fair in 4%; 12% had a recurrence of their neuralgia. The 700 patients treated by PSR have been followed for 6 years. Results are excellent in 61%, good in 13%, fair in 5%, and poor in 1%; 20% had a recurrence. This study indicates that there is no significant difference in results between PSR and PFE in the treatment of trigeminal neuralgia. The concept that neurovascular compression is a mechanical factor in the etiology of trigeminal neuralgia was supported, but neurovascular compression was less common than previously reported. Percutaneous stereotaxic rhizotomy is a less formidable procedure than PFE, and is easily repeated. Recent technical advances have improved the results obtained with PSR. Therefore, PSR remains the procedure of choice for the majority of patients with trigeminal neuralgia.

scholarly journals Trigeminal interfascicular neurolysis (nerve combing) for refractory recurrent neuralgia in multiple sclerosis

2020 ◽  
Vol 3 (2) ◽  
pp. V3
Author(s):  
Paolo Ferroli ◽  
Ignazio G. Vetrano ◽  
Francesco Acerbi ◽  
Gabriella Raccuia ◽  
Marco Schiariti ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Medical Therapy ◽  
Myelin Sheath ◽  
Neurovascular Conflict ◽  
Entry Zone ◽  
Link Type ◽  
Root Entry Zone ◽  
Good Pain Relief

In multiple sclerosis (MS) patients, trigeminal neuralgia (TN) represents a challenging syndrome to treat, often refractory to medical therapy and percutaneous techniques. Despite the frequent lack of a neurovascular conflict, the trigeminal nerve’s axons are often damaged, with the myelin sheath permanently degenerated, thus explaining the difficulty in treating TN in MS.The authors illustrate trigeminal interfascicular neurolysis (the combing technique) to control refractory recurrent TN in MS: the nerve is longitudinally divided along its fibers from the root entry zone, determining good pain relief.The video can be found here: https://youtu.be/o1XksPW5fMY

scholarly journals Trigeminal Neuralgia and Multiple Sclerosis: A Historical Perspective

2017 ◽  
Vol 44 (5) ◽  
pp. 589-593 ◽  
Author(s):  
David B. Burkholder ◽  
Peter J. Koehler ◽  
Christopher J. Boes
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
English Language ◽  
Language Translation ◽  
Original Text ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Trigeminal Root ◽  
Early English ◽  
Hermann Oppenheim

AbstractTrigeminal neuralgia (TN) associated with multiple sclerosis (MS) was first described in Lehrbuch der Nervenkrankheiten für Ärzte und Studirende in 1894 by Hermann Oppenheim, including a pathologic description of trigeminal root entry zone demyelination. Early English-language translations in 1900 and 1904 did not so explicitly state this association compared with the German editions. The 1911 English-language translation described a more direct association. Other later descriptions were clinical with few pathologic reports, often referencing Oppenheim but citing the 1905 German or 1911 English editions of Lehrbuch. This discrepancy in part may be due to the translation differences of the original text.

The Effect of Microvascular Decompression in Patients With Multiple Sclerosis and Trigeminal Neuralgia

Neurosurgery ◽  
2010 ◽  
Vol 67 (3) ◽  
pp. 749-754 ◽  
Author(s):  
Tiril Sandell ◽  
Per Kristian Eide
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Senior Author ◽  
Preoperative Pain ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Constant Pain ◽  
First Time

Abstract BACKGROUND Trigeminal neuralgia (TN) in patients with multiple sclerosis (MS) is thought to be caused by demyelinating plaques within the nerve root entry zone, the trigeminal nucleus, or the trigeminal tracts. OBJECTIVE To review our experience of microvascular decompression (MVD) in patients with MS and symptomatic TN. METHODS All first-time MVDs for symptomatic trigeminal neuralgia in patients with MS performed by the senior author during an 8-year period (1999–2007) in this department were reviewed. The preoperative pain components were differentiated as being 100% episodic pain, > 50% episodic pain, or > 50% constant pain. At follow-up, pain relief was assessed with a standard mail questionnaire; those still having residual pain were further examined in the outpatient clinic or interviewed by phone. RESULTS Of the 19 MS patients, 15 were available for follow-up. The median observation period was 55 months (range, 17–99 months). At follow-up, 7 of 15 patients (47%) were completely free of their episodic pain, and an additional 4 (27%) had significant relief of episodic pain (ie, worst pain marked as 0 to 3 cm on a 10-cm visual analog scale). Among the subgroup of 8 patients with a constant pain component, all were free of their constant pain, and 4 (50%) were free of their episodic pain. CONCLUSION In our 8-year experience of doing MVD in MS patients with TN, we found complete and significant relief of episodic TN in a large proportion of patients. Even those with a constant pain component before MVD were completely relieved of their constant pain. Thus, in patients with TN (with or without a constant pain component), the presence of MS should not prevent patients from being offered MVD.

Pathophysiology of trigeminal neuralgia: new evidence from a trigeminal ganglion intraoperative microneurographic recording

2004 ◽  
Vol 101 (5) ◽  
pp. 872-873 ◽  
Author(s):  
Kim J. Burchiel ◽  
Thomas K. Baumann
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Ganglion ◽  
Physiological Mechanism ◽  
Vascular Compression ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Trigeminal Ganglion Neurons ◽  
Ganglion Neurons ◽  
New Evidence

✓ The origin of trigeminal neuralgia (TN) appears to be vascular compression of the trigeminal nerve at the root entry zone; however, the physiological mechanism of this disorder remains uncertain. The authors obtained intraoperative microneurographic recordings from trigeminal ganglion neurons in a patient with TN immediately before percutaneous radiofrequency-induced gangliolysis. Their findings are consistent with the idea that the pain of TN is generated, at least in part, by an abnormal discharge within the peripheral nervous system.

scholarly journals Trigeminal Root Entry Zone Lesions in Non-multiple Sclerosis

2018 ◽  
Vol 57 (22) ◽  
pp. 3339-3340
Author(s):  
Arifumi Matsumoto ◽  
Kinya Hisanaga ◽  
Isao Nagano
Keyword(s):  
Multiple Sclerosis ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Trigeminal Root

Pain

2016 ◽  
pp. 75-90
Author(s):  
Konstantin V. Slavin
Keyword(s):  
Dorsal Root ◽  
Pain Syndrome ◽  
Board Examination ◽  
Entry Zone ◽  
The Core ◽  
Root Entry Zone ◽  
Refractory Pain ◽  
Pain Syndromes ◽  
Pain Pump ◽  
Neurosurgical Education

Historically, surgery for pain has been a large part of general neurosurgical practice. A variety of destructive and decompressive interventions have been developed over the years, and a number of comprehensive textbooks have summarized neurosurgical involvement with management of all kinds of medically refractory pain syndromes. It is included in the core neurosurgical education curriculum and is an integral part of neurosurgical knowledge that is tested during the Oral Board Examination. Not surprisingly, cases involving complex pain conditions that require neurosurgical interventions routinely show up during examinations, and it is expected that examinees are comfortable performing these interventions and able to discuss indications, surgical details, outcomes, and complications. Cases include trigeminal neuralgia, plexopathy, cordotomy versus morphine pain pump for cancer pain, dorsal root entry zone myelotomy for brachial plexus avulsion, and complex regional pain syndrome.

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