Computed Tomography-guided Percutaneous Trigeminal Tractotomy-nucleotomy

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS147-ONS155 ◽  
Author(s):  
Yucel Kanpolat ◽  
Gokmen Kahilogullari ◽  
Hasan C. Ugur ◽  
Atilla H. Elhan
Keyword(s):  
Computed Tomography ◽  
Trigeminal Neuralgia ◽  
Cancer Pain ◽  
Facial Pain ◽  
Karnofsky Performance Scale ◽  
Atypical Facial Pain ◽  
Minimal Invasiveness ◽  
Pain Syndromes ◽  
Scale Scores ◽  
Vagoglossopharyngeal Neuralgia

Abstract Objective: The destruction of the descending trigeminal tractus in the medulla is known as trigeminal tractotomy (TR), whereas the lesioning of the nucleus caudalis is known as trigeminal nucleotomy (NC). Trigeminal TR and/or NC procedures can be used in a large group of pain syndromes, such as glossopharyngeal, vagal, and geniculate neuralgias, atypical facial pain, craniofacial cancer pain, postherpetic neuralgias, and atypical forms of trigeminal neuralgia. Methods: In this study, anatomic and technical details of the procedure and the experience gained from 65 patients over the course of 20 years are discussed. Patients’ pain scores and Karnofsky Performance Scale scores were evaluated pre- and postoperatively (postoperative Day 1). Results: The best results were obtained in the second-largest group (vagoglossopharyngeal neuralgia, n = 17) and in geniculate neuralgia (n = 4). Patients with atypical facial pain (n = 21; 13 women, eight men) accounted for the largest group to undergo computed tomography-guided TR-NC surgery; pain relief was achieved in 19 of these patients. In the third-largest group (craniofacial and oral cancer pain, n = 13), 11 of 13 patients were successfully treated with TR-NC. Four of five patients with failed trigeminal neuralgia were also effectively treated with TR-NC. Conclusion: We propose that computed tomography-guided TR-NC provides direct visualization of the target-electrode relation and can be considered a first-step procedure in patient management. In view of its high efficacy, low complication rate, and minimal invasiveness, computed tomography-guided trigeminal TR-NC is a safe and effective procedure in the treatment of intractable facial pain syndromes.

Facial pain and palsy

2005 ◽  
pp. 185-211
Author(s):  
Patricia Sylla
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Glossopharyngeal Neuralgia ◽  
Atypical Facial Pain ◽  
Temporomandibular Dysfunction ◽  
Anatomy And Physiology ◽  
Tic Douloureux ◽  
Pain Syndromes ◽  
Idiopathic Pain

Anatomy and physiology of pain 186 Anatomy and physiology of oro-facial pain 187 Oro-facial (idiopathic) pain syndromes 188 Overview of oro-facial pain 190 Assessment and measurement of pain 192 Temporomandibular dysfunction (TMJPDS) 196 Atypical facial pain 202 Trigeminal neuralgia ('tic douloureux') 204 Glossopharyngeal neuralgia 206...

scholarly journals Trigeminal neuralgia: definition and classification

2005 ◽  
Vol 18 (5) ◽  
pp. 1-3 ◽  
Author(s):  
Jorge L. Eller ◽  
Ahmed M. Raslan ◽  
Kim J. Burchiel
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Classification Scheme ◽  
Unintentional Injury ◽  
Atypical Facial Pain ◽  
Trigeminal Neuropathic Pain ◽  
Somatoform Pain Disorder ◽  
Pain Syndromes ◽  
Specific Objective ◽  
Patient’S History

Based on specific, objective, and reproducible criteria, a classification scheme for trigeminal neuralgia (TN) and related facial pain syndromes is proposed. Such a classification scheme is based on information provided in the patient's history and incorporates seven diagnostic criteria, as follows. 1) and 2) Trigeminal neuralgia Types 1 and 2 (TN1 and TN2) refer to idiopathic, spontaneous facial pain that is either predominantly episodic (as in TN1) or constant (as in TN2) in nature. 3) Trigeminal neuropathic pain results from unintentional injury to the trigeminal nerve from trauma or surgery. 4) Trigeminal deafferentation pain results from intentional injury to the nerve by peripheral nerve ablation, gangliolysis, or rhizotomy in an attempt to treat either TN or other related facial pain. 5) Symptomatic TN results from multiple sclerosis. 6) Postherpetic TN follows a cutaneous herpes zoster outbreak in the trigeminal distribution. 7) The category of atypical facial pain is reserved for facial pain secondary to a somatoform pain disorder and requires psychological testing for diagnostic confirmation. The purpose of a classification scheme like this is to advocate a more rigorous, standardized natural history and outcome studies for TN and related facial pain syndromes.

scholarly journals Neuralgias of the Trigeminal Nerve

2000 ◽  
Vol 5 (1) ◽  
pp. 107-113 ◽  
Author(s):  
Allan S Gordon
Keyword(s):  
Neuropathic Pain ◽  
Differential Diagnosis ◽  
Trigeminal Neuralgia ◽  
Clinical Features ◽  
Trigeminal Nerve ◽  
Postherpetic Neuralgia ◽  
Facial Pain ◽  
The Other ◽  
Atypical Facial Pain ◽  
Trigeminal Neuropathic Pain

Practitioners are often presented with patients who complain bitterly of facial pain. The trigeminal nerve is involved in four conditions that are sometimes mixed up. The four conditions - trigeminal neuralgia, trigeminal neuropathic pain, postherpetic neuralgia and atypical facial pain - are discussed under the headings of clinical features, differential diagnosis, cause and treatment. This article should help practitioners to differentiate one from the other and to manage their care.

Idiopathic Trigeminal Neuralgia Associated with a Severe Atypical Facial Pain Exacerbated by Hydrocephalus 

1999 ◽  
Vol 91 (6) ◽  
pp. 1968-1968 ◽  
Author(s):  
Masako Iseki ◽  
Hiromasa Mitsuhata ◽  
Yutaka Tanabe ◽  
Toyo Miyazaki
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Atypical Facial Pain ◽  
Idiopathic Trigeminal Neuralgia

scholarly journals Vertebrobasilar dolichoectasia as a cause of trigeminal neuralgia: the role of microvascular decompression. Case report

2006 ◽  
Vol 64 (1) ◽  
pp. 128-131 ◽  
Author(s):  
Jorge Luiz Kraemer ◽  
Arthur de Azambuja Pereira Filho ◽  
Gustavo de David ◽  
Mario de Barros Faria
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Facial Pain ◽  
Successful Outcome ◽  
Mechanical Compression ◽  
Suboccipital Craniotomy ◽  
Vertebrobasilar Dolichoectasia

Our purpose is to report a case of trigeminal neuralgia caused by vertebrobasilar dolichoectasia treated with microvascular decompression. A 63-year-old man sought treatment for a recurrent lancinating left facial pain in V2 and V3 trigeminal territories. The computed tomography angiography revealed a mechanical compression of the left trigeminal nerve due to vertebrobasilar dolichoectasia. The patient was submitted to a left suboccipital craniotomy. Shredded Teflon® was introduced in the conflicting neurovascular area, achieving a satisfactory decompression. The patient’s pain resolved immediately. Vertebrobasilar dolichoectasia is a rare cause of trigeminal neuralgia and a successful outcome can be achieved with microvascular decompression.

Association of vascular compression in trigeminal neuralgia versus other “facial pain syndromes” by magnetic resonance imaging

1991 ◽  
Vol 36 (6) ◽  
pp. 447-452 ◽  
Author(s):  
Nevan G. Baldwin ◽  
K.Singh Sahni ◽  
Mary E. Jensen ◽  
Daniel R. Pieper ◽  
Randy L. Anderson ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Vascular Compression ◽  
Resonance Imaging ◽  
Pain Syndromes

scholarly journals Ultrasound-Guided Trigeminal Nerve Block via the Pterygopalatine Fossa: An Effective Treatment for Trigeminal Neuralgia and Atypical Facial Pain

2013 ◽  
Vol 5;16 (5;9) ◽  
pp. E537-E545
Author(s):  
Mark C. Kendall
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Nerve Block ◽  
Trigeminal Nerve ◽  
Local Anesthetic ◽  
Facial Pain ◽  
Case Series ◽  
Pterygopalatine Fossa ◽  
Atypical Facial Pain ◽  
Ultrasound Guided

Background: Patients presenting with facial pain often have ineffective pain relief with medical therapy. Cases refractory to medical management are frequently treated with surgical or minimally invasive procedures with variable success rates. We report on the use of ultrasound-guided trigeminal nerve block via the pterygopalatine fossa in patients following refractory medical and surgical treatment. Objective: To present the immediate and long-term efficacy of ultrasound-guided injections of local anesthetic and steroids in the pterygopalatine fossa in patients with unilateral facial pain that failed pharmacological and surgical interventions. Setting: Academic pain management center. Design: Prospective case series. Methods: Fifteen patients were treated with ultrasound-guided trigeminal nerve block with local anesthetic and steroids placed into the pterygopalatine fossa. Results: All patients achieved complete sensory analgesia to pin prick in the distribution of the V2 branch of the trigeminal nerve and 80% (12 out of 15) achieved complete sensory analgesia in V1, V2, V3 distribution within 15 minutes of the injection. All patients reported pain relief within 5 minutes of the injection. The majority of patients maintained pain relief throughout the 15 month study period. No patients experienced symptoms of local anesthetic toxicity or onset of new neurological sequelae. Limitations: Prospective case series. Conclusion: We conclude that the use of ultrasound guidance for injectate delivery in the pterygopalatine fossa is a simple, free of radiation or magnetization, safe, and effective percutaneous procedure that provides sustained pain relief in trigeminal neuralgia or atypical facial pain patients who have failed previous medical interventions. Key words: Trigeminal nerve, ultrasound-guided, atypical facial pain, trigeminal neuralgia, tic douloureux.

A New Classification for Facial Pain

Neurosurgery ◽  
2003 ◽  
Vol 53 (5) ◽  
pp. 1164-1167 ◽  
Author(s):  
Kim J. Burchiel
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Classification Scheme ◽  
Unintentional Injury ◽  
Atypical Facial Pain ◽  
New Classification ◽  
Somatoform Pain Disorder ◽  
Constant Pain ◽  
Diagnostic Labels ◽  
Patient’S History

Abstract PURPOSE A patient-oriented classification scheme for facial pains commonly encountered in neurosurgical practice is proposed. CONCEPT This classification is driven principally by the patient's history. RATIONALE The scheme incorporates descriptions for so-called “atypical” trigeminal neuralgias and facial pains but minimizes the pejorative, accepting that the physiology of neuropathic pains could reasonably encompass a variety of pain sensations, both episodic and constant. Seven diagnostic labels result: trigeminal neuralgia Types 1 and 2 refer to patients with the spontaneous onset of facial pain and either predominant episodic or constant pain, respectively. Trigeminal neuropathic pain results from unintentional injury to the trigeminal nerve from trauma or surgery, whereas trigeminal deafferentation pain results from injury to the nerve by peripheral nerve ablation, gangliolysis, or rhizotomy in an intentional attempt to treat either trigeminal neuralgia or other facial pain. Postherpetic neuralgia follows a cutaneous herpes zoster outbreak (shingles) in the trigeminal distribution, and symptomatic trigeminal neuralgia results from multiple sclerosis. The final category, atypical facial pain, is synonymous with facial pain secondary to a somatoform pain disorder. Atypical facial pain can be suspected but not diagnosed by history and can be diagnosed only with detailed and objective psychological testing. CONCLUSION This diagnostic classification would allow more rigorous and objective natural history and outcome studies of facial pain in the future.

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