Anatomoradiological Landmarks for Accuracy of Radiofrequency Thermorhizotomy in the Treatment of Trigeminal Neuralgia

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS129-ONS138 ◽  
Author(s):  
Mehmet Tatli ◽  
Marc Sindou
Keyword(s):  
Side Effects ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Study Groups ◽  
X Rays ◽  
Preoperative Pain ◽  
Paired Samples ◽  
Percutaneous Procedures ◽  
Trigeminal Root ◽  
Mean Differences

Abstract Objective: The correct positioning of the electrode is of prime importance for effectiveness and selectivity of percutaneous trigeminal radiofrequency thermorhizotomy (RF-TR) for the treatment of trigeminal neuralgia (TN). The aim of our study was to establish some anatomoradiological landmarks for the purpose of accurate placement of the electrode tip in RF-TR. Methods: Of 1000 patients who underwent RF-TR, 100 were retrospective and randomly selected and divided into study groups according to postoperative hypoesthesia in the trigeminal nerve divisions. The patients’ petroclival angle, petroelectrodal angle, electrode tip, and the petroelectrodal angle/petroclival angle ratio were calculated on lateral cranial x-rays. These measurements were then correlated with the topography of hypoesthesia obtained by the RF-TR to define the anatomoradiological x-ray landmarks corresponding to the divisions of the trigeminal root. The postoperative hypoesthesia groups were correlated with their respective preoperative pain topography to check the accuracy of the thermolesion. In addition, the intraoperatively evoked paresthesia responses and the side effects were evaluated. The results were analyzed using a paired-samples Student's ttest, the χ2 test, and one-way analysis of variance, followed by Bonferroni and Tamhane post hoc tests. Results: All study groups were comparable with respect to age, sex, side effects, electrode tip location, side of TN, and values of petroclival angle. The lowest values of petroelectrodal angle/orbitomeatal electrodal angle and petroelectrodal angle/ petroclival angle were detected in patients with V3 TN, whereas the greatest values were in patients who had TN in all branches of the trigeminal nerve. The greatest height of the electrode was in patients who had TN in all branches, whereas the least height was in patients with V3TN. When the results were compared with each other, the mean differences were found to be statistically significant between V3 TN patients and the other groups with different Pvalues. There was no statistical difference between the postoperative hypoesthesia data and the preoperative pain topography, which demonstrated evidence of the accuracy of the thermolesion in our series. Conclusion: Our data suggest that the determination of the presented landmarks allows customization to individual patient anatomy and may help the surgeon achieve a more selective effect with a variety of percutaneous procedures for each branch of the trigeminal root.

ANALYSIS OF THE RESULTS OF SURGICAL TREATMENT OF PRIMARY TRIGEMINAL NEURALGIA USING LASER DESTRUCTION OF THE SENSITIVE ROOT IN ELDERLY AND SENILE PATIENTS

2021 ◽  
pp. 1122-1129
Author(s):  
В. А. Бывальцев ◽  
А. А. Калинин ◽  
А. К. Оконешникова ◽  
А. В. Егоров ◽  
В. Ю. Голобородько ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Adverse Effects ◽  
Trigeminal Neuralgia ◽  
Preoperative Pain ◽  
Results Of Treatment ◽  
Sf 36 ◽  
Trigeminal Root ◽  
Perioperative Complication ◽  
Primary Trigeminal Neuralgia

Цель исследования - анализ результатов хирургического лечения первичной невралгии тройничного нерва при использовании лазерной деструкции чувствительного корешка у пациентов пожилого и старческого возраста. Проспективно изучены результаты лечения 25 пациентов старше 65 лет с устойчивой к консервативному лечению тригеминальной болью, которым была проведена лазерная деструкция чувствительного корешка тройничного нерва (970 нм, частота 9 Гц и мощность 3 Вт в суммарной дозе 100 Дж) в период 2018-2019 гг. Средний катамнез наблюдения составил 12 мес. В результате установлено значительное снижение интенсивности болевых ощущений по шкале лицевой боли с 87 (83,5; 91,5) до 15,5 (12,5; 18,5) мм ( р =0,002) в отдаленном периоде. В среднем через 12 мес после операции выявлено значимое увеличение показателей физического и психологического компонентов здоровья по опроснику SF-36 ( p =0,02 и p =0,01 соответственно). В катамнезе по шкале Macnab отмечены преимущественно отличные ( n =23; 92 %) и хорошие ( n =2; 8 %) результаты лечения. Зарегистрировано одно (4 %) периоперационное осложнение и два (8 %) неблагоприятных последствия анестезиологического пособия. Таким образом, применение лазерной денервации чувствительного корешка при первичной невралгии тройничного нерва у пациентов пожилого и старческого возраста позволяет значительно снизить уровень дооперационного болевого синдрома и улучшить качество жизни при низком риске формирования неблагоприятных последствий. The aim of the study was to analyze the results of surgical treatment of primary trigeminal neuralgia using laser destruction of the sensitive root in elderly and senile patients. The results of treatment of 25 patients older than 65 years with conservative treatment-resistant trigeminal pain who underwent laser destruction of the sensitive trigeminal root (970 nm, 9 Hz and 3 W power in a total dose of 100 J) in the period from 2018-2019 were prospectively studied. The average follow-up was 12 months. As a result, a significant decrease in the intensity of pain on the scale of facial pain was found from 87 (83,5; 91,5) mm to 15,5 (12,5; 18,5) mm ( p =0,002) in the long-term period. On average, 12 months after the operation, a significant improvement in the indicators of the physical and psychological components of health was revealed on the SF-36 questionnaire ( p =0,02 and p =0,01, respectively). In the follow-up on the Macnab scale, predominantly excellent ( n =23; 92 %) and good ( n =2; 8 %) treatment results were noted. Registered 1 (4 %) perioperative complication and 2 (8 %) adverse effects of anesthesiology benefits. Thus, the use of laser denervation of the sensitive root in primary trigeminal neuralgia in elderly and senile patients can significantly reduce the level of preoperative pain and improve the quality of life, with low risks of adverse effects.

scholarly journals MICROVASCULAR DECOMPRESSION IN THE TREATMENT OF PATIENTS WITH TRIGEMINAL NEURALGIA

2019 ◽  
Vol 19 (1-2) ◽  
pp. 101-106
Author(s):  
D. M Lazarchuk ◽  
G. N Alekseev ◽  
O. O Kamadey ◽  
S. N Chemidronov
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Nerve Root ◽  
Treatment Method ◽  
Neurovascular Conflict ◽  
Neurosurgical Department ◽  
Trigeminal Nerve Root ◽  
Trigeminal Root ◽  
Cranial Fossa

This work highlights the main variant treatment of patients with trigeminal neuralgia, with a proven neurovascular conflict, microvascular decompression of the trigeminal root. Microvascular decompression is the main radical treatment method which allows to relieve hyperfunctional syndrome manifested by prosopalgia. In the course of this study, the variant anatomy of the neurovascular conflict in patients with trigeminal neuralgia was described in detail. The group of patients whose clinical diagnosis at the stage of selection was based on a neurological examination and taking into account the progression of symptoms as well as the performed instrumental examination (CT angiography). The results are described in the article. Atrophic changes of the root of the trigeminal nerve are visualized and described. The nature of its blood supply is classified according to the type of the origin of the artery or arterial branches of the trigeminal nerve root. The main types of neurovascular conflict classified according to the type of blood vessel are presented. Variant neuroanatomy of the trigeminal nerve root as well as the interaction with the arteries of the vertebrobasilar basin and the veins of the posterior cranial fossa are described. The course of microvascular decompression of the trigeminal nerve root, used in the neurosurgical department of Samara Regional Clinical Hospital n.a. V.D. Seredavin is described

scholarly journals An Animal Model for Trigeminal Neuralgia by Compression of the Trigeminal Nerve Root

2012 ◽  
Vol 2;15 (2;3) ◽  
pp. 187-196
Author(s):  
Yun-Qing Li
Keyword(s):  
Animal Model ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Nerve Root ◽  
Sham Operation ◽  
Calcitonin Gene ◽  
Trigeminal Nerve Root ◽  
Trigeminal Root ◽  
Isolectin B4 ◽  
Heat Hyperalgesia

Background: Microvascular compression of the trigeminal nerve root is a major cause of most trigeminal neuralgia (TN) in patients; however, no reliable animal model to further study the pathogenesis of TN currently exists. Objective: Our objective was to establish a novel and practical animal model for TN by chronic compression of the trigeminal (CCT) nerve root in rats, which would provide a better animal model to mimic the clinical feature of TN on the research of the pathogenesis of TN. Study Design: A randomized, double blind, controlled animal trial. Methods: Sixteen adult male Sprague-Dawley rats (200-220 g) were randomly divided into 2 groups: one group that received chronic compression of the trigeminal nerve root (the CCT group, n=8) and another group that received sham operation without compression (the sham operation group, n=8). A small plastic filament was retrogressively inserted into the intracalvarium from the inferior orbital fissure until it reached the trigeminal nerve root for compression in CCT group. Animal behaviors were observed for 4 weeks after operation. Immunohistochemistry of glial fibrillary acidic protein (GFAP), isolectin B4 (IB4), substance P (SP) and calcitonin gene-related peptide (CGRP) were performed in the trigeminal root entry zone (TREZ) and medullary dorsal horn (MDH). Results: The orofacial mechanical allodynia and heat hyperalgesia in the CCT rats were obviously increased after the operation and lasted for 28 days. Increased facegrooming behavior was also observed in the CCT rats and continued for over 21 days, returning to baseline by day 28. Immunohistochemistry for GFAP in the TREZ revealed a progressive extension of astrocytic processes in the ipsilateral TREZ of rats in the CCT group. Furthermore, the IB4 positive immunoreactive nonpeptidergic C-fiber terminals in the MDH were reduced for 4 weeks after the operation. Both SP and CGRP, expressed in the peptidergic C-fiber terminals, were found to be decreased in the ipsilateral MDH of CCT animals after the trigeminal nerve root injury. Limitations: CCT animal model with a plastic filament only imitated the mechanical compression of the trigeminal root but not to display the complex vascular physiological feature as the microvascular in the TN patient. Conclusions: The chronic compression of the trigeminal nerve root in rats effectively induced persistent orofacial neuropathic pain behaviors, and it would provide a novel and practical animal model for future research on the pathogenesis of TN. Key words: trigeminal neuralgia, nerve root compression, animal model, mechanical allodynia, heat hyperalgesia, substance P, calcitonin gene-related peptide, isolectin B4

Basilar Artery Ectasia Causing Trigeminal Neuralgia: An Evolved Technique of Transpositional Suture-Pexy

2017 ◽  
Vol 14 (2) ◽  
pp. 194-199 ◽  
Author(s):  
Harminder Singh ◽  
Harley Brito da Silva ◽  
Mehdi Zeinalizadeh ◽  
Turki Elarjani ◽  
David Straus ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Basilar Artery ◽  
Case Series ◽  
Magnetic Resonance Imaging Scan ◽  
Large Artery ◽  
Suboccipital Craniotomy ◽  
Arterial Complications ◽  
Long Term Follow Up ◽  
Trigeminal Root

Abstract BACKGROUND Microvascular decompression for patients with trigeminal neuralgia (TGN) is widely accepted as one of the modalities of treatment. The standard approach has been retrosigmoid suboccipital craniotomy with placement of a Teflon pledget to cushion the trigeminal nerve from the offending artery, or cauterize and divide the offending vein(s). However, in cases of severe compression caused by a large artery, the standard decompression technique may not be effective. OBJECTIVE To describe a unique technique of vasculopexy of the ectatic basilar artery to the tentorium in a patient with TGN attributed to a severely ectatic and tortuous basilar artery. A case series of patients who underwent this technique of vasculopexy for arterial compression is presented. METHODS The patient underwent a subtemporal transtentorial approach and the basilar artery was mobilized away from the trigeminal nerve. A suture was then passed through the wall of the basilar artery (tunica media) and secured to the tentorial edge, to keep the artery away from the nerve. RESULTS The neuralgia was promptly relieved after the operation, with no complications. A postoperative magnetic resonance imaging scan showed the basilar artery to be away from the trigeminal root. In a series of 7 patients who underwent this technique of vasculopexy, no arterial complications were noted at short- or long-term follow-up. CONCLUSION Repositioning and vasculopexy of an ectatic basilar artery for the treatment of TGN is safe and effective. This technique can also be used for other neuropathies that result from direct arterial compression.

scholarly journals Peripheral Nerve Pulsed Radiofrequency For Trigeminal Neuralgia Treatment: Is It An Effective Method?

2021 ◽  
Author(s):  
Tuba Tanyel ◽  
Ayten Bilir ◽  
Sacit Gulec
Keyword(s):  
Side Effects ◽  
Trigeminal Neuralgia ◽  
Medical Treatment ◽  
Trigeminal Nerve ◽  
Treatment Options ◽  
Percutaneous Technique ◽  
Pulsed Radiofrequency ◽  
Safe Method ◽  
Duration Of Efficacy ◽  
Effect Duration

Abstract ObjectiveTrigeminal neuralgia is a paroxysmal and shock-like pain in the trigeminal nerve area. Various treatment options have been used for trigeminal neuralgia such as medical treatment, interventional procedures and surgical operations. Pulsed radiofrequency (PRF) is a minimally invasive percutaneous technique which seems to be safer and easier to perform.This retrospective study aims to evaluate the analgesic effect, duration of efficacy and side effects of PRF procedures in the peripheral branches of the trigeminal nerve.Methods and MaterialThe data of the patients with trigeminal neuralgia who were followed up in our hospital's algology clinic from 2016 to 2018 were reviewed retrospectively. Patients aged between 18-70 who didn’t respond to medical treatment or couldn’t use medication due to side effects, were treated with PRF procedure for peripheral branches of trigeminal nerve were selected for this study. Demographic profile, clicinal presentation, pain intensity, duration of efficacy and complications were evaluated from their files.Results21 patients who underwent ultrasonography (USG) guided PRF procedures were included the study.Mean visual analog scale (VAS) value of the patients was found to have decreased from 9.25 ± 0.63 to 1.55 ± 0.88 at the end of the first month (p<0.001). The painless period for the patients lasted up to 12 (9-21) months and no complications occurred.ConclusionPRF procedure seems to be an effective and safe method in patients who respond to block of the peripheral branches of the trigeminal nerve.Key message: The use of pulsed radiofrequency method for the treatment of trigeminal neuralgia seems to be an effective and safe method. In addition, being easily applicable and repeatable is another advantage of the method.

scholarly journals Trigeminal Neuralgy

2018 ◽  
Vol 1 (4) ◽  
pp. 353-358
Author(s):  
Bélgica Vásquez
Keyword(s):  
Surgical Treatment ◽  
Side Effects ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Facial Pain ◽  
Relevant Information ◽  
Detailed Knowledge ◽  
Neurovascular Compression ◽  
Present Information ◽  
Facial Area

The objective of this review was to present information on the main causes, possible treatments and morpho-quantitative aspects of trigeminal neuralgia. Trigeminal neuralgia is a condition characterized by intense facial pain, severe throbbing or stabbing; it is usually unilateral and recurrent and is located in the facial area innervated by the trigeminal nerve. The causes of this disease are varied and include neurovascular compression stresses. Medical treatment of choice is carbamazepine, reserving surgical treatment for cases resistant to medical therapy or cases when side effects of drugs used, outweigh the risks and disadvantages of surgery. In this context a detailed knowledge of the structure of the trigeminal nerve and its morphoquantitative characteristics could provide relevant information to make type of treatment more effective.

Improved Outcome in the Treatment of Trigeminal Neuralgia by Percutaneous Stereotactic Rhizotomy with a New, Curved Tip Electrode

Neurosurgery ◽  
1983 ◽  
Vol 12 (3) ◽  
pp. 313-317 ◽  
Author(s):  
William D. Tobler ◽  
John M. Tew ◽  
Eric Cosman ◽  
Jeffrey T. Keller ◽  
Barbara Quallen
Keyword(s):  
Side Effects ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Electrode Placement ◽  
Improve Treatment ◽  
Infinite Variety ◽  
Motor Root ◽  
Improved Outcome

Abstract Percutaneous stereotactic rhizotomy (PSR) as a method of treatment of trigeminal neuralgia has gained popularity in recent years as techniques of electrode placement and lesion production have improved. However, undesirable side effects including major and minor paresthesias, trigeminal motor root weakness, diplopia, and keratitis continue to occur even in cases where the neuralgia is treated successfully. In an attempt to improve treatment further, we have developed an electrode with a flexible curved tip for PSR of the trigeminal nerve. Once the electrode and the cannula are positioned in the retrogasserian portion of the trigeminal nerve with a standardized technique, manipulation of the electrode about its 360° axis readily enables an infinite variety of position adjustments of the electrode tip. This capability enables easier and more precise electrode placement and lesion production. Undesirable lesions of the motor root may be avoided. A curved electrode has been used in 150 patients. The incidence of masseter weakness is 7.3% in this series, compared to 24% in our series of 700 patients treated with a straight electrode. The incidence of undesirable paresthesias has decreased from 27% to 10.6%. The immediate results obtained in patients with the curved electrode have improved. Excellent results (no pain, no side effects) have been achieved in 88% of patients, in contrast to 76% treated with the straight electrode. Application of stereotactic principles and the use of the curved electrode have enhanced the appeal of PSR for the treatment of trigeminal neuralgia.

Partial sensory trigeminal rhizotomy at the pons for trigeminal neuralgia

1993 ◽  
Vol 79 (5) ◽  
pp. 680-687 ◽  
Author(s):  
Jacob N. Young ◽  
Robert H. Wilkins
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Vascular Compression ◽  
Neurovascular Compression ◽  
Recurrent Pain ◽  
Preoperative Pain ◽  
Content Type ◽  
Additional Surgery

✓ Microvascular decompression is preferred among open procedures for the treatment of trigeminal neuralgia. However, in some cases the decompression cannot be performed, either because no significant vascular compression of the trigeminal nerve is found at surgery or because a patient's vascular anatomy makes it unsafe. Partial sensory rhizotomy is a commonly used alternative in these instances. The outcome after partial sensory rhizotomy was reviewed retrospectively in 83 patients with an average follow-up period of 72 months. Sixty-four (77%) of these patients had no evidence of vascular contact at operation. The remaining 19 patients (23%) had vascular structures in proximity to the trigeminal nerve but still underwent partial sensory rhizotomy in place of or in addition to microvascular decompression either because the offending vessel could not be moved adequately (11 cases) or because the vascular contact was considered insignificant (eight cases). Outcome was classified as: excellent if there was no trigeminal neuralgia postoperatively; good if pain persisted or recurred but was less severe than preoperatively; and poor if persistent or recurrent pain was equal to or greater than the preoperative pain in severity and was refractory to medication, or was severe enough to require additional surgery. The outcome was excellent in 40 patients (48%), good in 18 (22%), and poor in 25 (30%); follow-up durations were similar for the three outcome categories. The failure rate was 17% for the 1st year and averaged 2.6% each year thereafter. Two variables were predictive of a poor outcome: prior surgery and lack of preoperative involvement of the third trigeminal division. Major complications occurred in 4% of cases and minor complications in 11%. The authors conclude that partial sensory rhizotomy is a safe and effective alternative to microvascular decompression when neurovascular compression is not identified at operation or when microvascular decompression cannot be performed for technical reasons.

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

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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