Alternative option for osteogenesis imperfecta and trigeminal neuralgia

Summary Osteogenesis imperfecta (OI) is a bone disorder that can lead to skull base deformities such as basilar invagination, which can cause compression of cranial nerves, including the trigeminal nerve. Trigeminal neuralgia in such cases remains a challenge, given distorted anatomy and deformities. We present an alternative option, consisting in cannulation of the foramen ovale and classical percutaneous treatment. Percutaneous balloon microcompression was performed in a 28 year-old woman with OI and severe trigeminal neuralgia using computed tomography (CT) and radiographic-guided cannulation of the Gasserian ganglion without neuronavigation or stereotactic devices. The patient developed hypoesthesia on the left V1, V2 and V3 segments with good pain control. This alternative technique with a CT-guided puncture, using angiosuite without the need of any Mayfield clamp, neuronavigation systems, frame or frameless stereotactic devices can be a useful, safe and efficient alternative for patients with trigeminal neuralgia with other bone deforming diseases that severely affect the skull base.

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Precise Cannulation of the Foramen Ovale in Trigeminal Neuralgia Complicating Osteogenesis Imperfecta with Basilar Invagination: Technical Case Report

Neurosurgery ◽

10.1227/00006123-200004000-00049 ◽

2000 ◽

Vol 46 (4) ◽

pp. 1005-1008 ◽

Cited By ~ 1

Author(s):

Daniel Hajioff ◽

Neil L. Dorward ◽

John P. Wadley ◽

H. Alan Crockard ◽

James D. Palmer

Keyword(s):

Case Report ◽

Trigeminal Neuralgia ◽

Osteogenesis Imperfecta ◽

Basilar Invagination ◽

Foramen Ovale

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Percutaneous Balloon Compression vs Percutaneous Retrogasserian Glycerol Rhizotomy for the Primary Treatment of Trigeminal Neuralgia

Neurosurgery ◽

10.1227/neu.0000000000001059 ◽

2015 ◽

Vol 78 (3) ◽

pp. 421-428 ◽

Cited By ~ 35

Author(s):

Pär Asplund ◽

Patric Blomstedt ◽

A. Tommy Bergenheim

Keyword(s):

Side Effects ◽

Pain Relief ◽

Trigeminal Neuralgia ◽

Percutaneous Treatment ◽

Primary Treatment ◽

Balloon Compression ◽

Percutaneous Balloon ◽

Percutaneous Balloon Compression ◽

Sensory Disturbances ◽

Glycerol Rhizolysis

Abstract BACKGROUND: Despite >30 years of clinical use, the literature is still sparse when it comes to comparisons between percutaneous balloon compression (PBC) and percutaneous retrogasserian glycerol rhizolysis (PRGR) as treatments for trigeminal neuralgia. OBJECTIVE: To perform a retrospective cohort comparison between PBC and PRGR with regard to therapeutic effect, side effects, and complications. METHODS: Medical records and follow-up data from 124 primary PRGRs performed from 1986 to 2000 and 82 primary PBCs performed from 2000 to 2013 were reviewed. All patients had undergone clinical sensory testing and assessment of sensory thresholds. Analyses were performed to compare duration of pain relief, frequency of sensory disturbances, and side effects. RESULTS: Median duration of pain relief was 21 months after PRGR and 20 months after PBC. Both methods carried a high risk of hypesthesia/hypalgesia (P < .001) that was partly reversed with time. Decreased corneal sensibility was common after PRGR (P < .001) but not after PBC. Dysesthesia was more common after PRGR (23%) compared after PBC (4%; P < .001). Other side effects were noted but uncommon. CONCLUSION: PBC and PRGR are both effective as primary surgical treatment of trigeminal neuralgia. Both carry a risk of postoperative hypesthesia, but in this series, the side effect profile favored PBC. Furthermore, PBC is technically less challenging, whereas PRGR requires fewer resources. Between these 2 techniques, we propose PBC as the primary surgical technique for percutaneous treatment of trigeminal neuralgia on the basis of its lower incidence of dysesthesia, corneal hypesthesia, and technical failures.

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The Long-Term Outcome of 3-Dimensional CT-Guided Percutaneous Radiofrequency Thermocoagulation for Tumor-Related Trigeminal Neuralgia

January 2018 - Pain Physician ◽

10.36076/ppj/2019.22.e467 ◽

2019 ◽

Vol 5 (22;5) ◽

pp. E467-E475

Author(s):

Luo Fang

Keyword(s):

Pain Relief ◽

Trigeminal Neuralgia ◽

Small Sample ◽

Cochrane Library ◽

Gasserian Ganglion ◽

Term Outcome ◽

Long Term Outcome ◽

Ct Guided ◽

Radiofrequency Thermocoagulation

Background: Percutaneous radiofrequency thermocoagulation (PRFT) has been widely used to treat trigeminal neuralgia. By querying MEDLINE, EMBASE, and the Cochrane Library, no study has reported the long-term outcome of PRFT for tumor-related trigeminal neuralgia (TRTN). Objectives: In this study, we aimed to evaluate the long-term efficacy and safety of PRFT as an alternative treatment for TRTN. Study Design: A retrospective study. Setting: The interventional pain management center in Beijing Tiantan hospital. Methods: We retrospectively analyzed data of all patients who underwent PRFT applied to the Gasserian ganglion under computed tomography guidance for TRTN through a combination of available institutional electronic medical records, patient notes, and radiologic images. Results: Among 38 patients with PRFT treated between March 2007 and February 2018, 13 patients were men and 25 were women. All patients were evaluated as modified Barrow Neurological Institute (BNI) IV-V before the operation and had a total symptom duration of 45.55 ± 23.31 months. The mean operation duration was 59.63 ± 16.89 minutes. All patients experienced satisfactory pain relief defined as a classification of BNI I-IIIb within 3 days after PRFT. The median remission length with satisfactory pain relief was 33 (range, 4-132) months. No serious intraoperative complications, except bradycardia in 6 patients, were recorded. Postprocedure complications, including masticatory muscle weakness, were reported in 5 patients. Although all 38 patients experienced facial dysesthesia, the patients’ Likert scale rating represented that quality of life significantly increased after the procedure. Limitations: The small sample size may have unavoidably caused selection bias in our study. Larger prospective, randomized, multicenter trials are necessary to validate our outcomes. Conclusions: PRFT is an effective and safe treatment that should be considered as an alternative for pain control in the treatment of TRTN. Key words: Pain, secondary trigeminal neuralgia, radiofrequency thermocoagulation, trigeminal neuralgia

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Computed Tomography Guidance for Percutaneous Glycerol Rhizotomy for Trigeminal Neuralgia

Operative Neurosurgery ◽

10.1093/ons/opz400 ◽

2019 ◽

Vol 19 (2) ◽

pp. E117-E121

Author(s):

Bradley T Schmidt ◽

Conrad D Pun ◽

Wendell B Lake ◽

Daniel K Resnick

Keyword(s):

Computed Tomography ◽

Trigeminal Neuralgia ◽

Radiation Exposure ◽

Skull Base ◽

Ct Guidance ◽

Foramen Ovale ◽

Ct Scanner ◽

Ct Guided ◽

Needle Position ◽

Scout Image

Abstract Background Percutaneous glycerol rhizotomy (PGR) is a well-described treatment for trigeminal neuralgia; however, the technique in using surface landmarks and fluoroscopy has not drastically changed since being first introduced. In this paper, we describe a protocol for PGR using computed tomography (CT) guidance based on an experience of over 7 yr and 200 patients. Objective To introduce an approach for PGR using CT guidance and, in doing so, demonstrate possible benefits over the traditional fluoroscopic technique. Methods Using a standard CT scanner, patients are placed supine with head in extension. Barium paste and a CT scout image are used to identify and plan a trajectory to the foramen ovale. A laser localization system built into the CT scanner helps to guide placement of the spinal needle into the foramen ovale. The needle position in the foramen is confirmed with a short-sequence CT scan. Results CT-guided PGR provides multiple benefits over standard fluoroscopy, including improved visualization of the skull base and significant reduction in radiation exposure to the surgeon and staff. Side benefits include improved procedure efficiency, definitive imaging evidence of correct needle placement, and potentially increased patient safety. We have had no significant complications in over 200 patients. CONCLUSION CT-guided PGR is a useful technique for treating trigeminal neuralgia based on better imaging of the skull base, better efficiency of the procedure, and elimination of radiation exposure for the surgeon and staff compared to traditional fluoroscopic based techniques.

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Predictors of the Analgesic Efficacy of CT‐Guided Percutaneous Pulsed Radiofrequency Treatment of Gasserian Ganglion in Patients With Idiopathic Trigeminal Neuralgia

Pain Practice ◽

10.1111/papr.12910 ◽

2020 ◽

Vol 20 (8) ◽

pp. 850-858

Author(s):

Hao Ren ◽

Chunmei Zhao ◽

Zipu Jia ◽

Jiajia Bian ◽

Fang Luo

Keyword(s):

Trigeminal Neuralgia ◽

Analgesic Efficacy ◽

Gasserian Ganglion ◽

Pulsed Radiofrequency ◽

Ct Guided ◽

Radiofrequency Treatment ◽

Pulsed Radiofrequency Treatment ◽

Idiopathic Trigeminal Neuralgia

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Patulous eustachian tube after percutaneous balloon microcompression for trigeminal neuralgia: case report

The Journal of Laryngology & Otology ◽

10.1017/s0022215114000814 ◽

2014 ◽

Vol 128 (5) ◽

pp. 478-480 ◽

Cited By ~ 2

Author(s):

M Cresswell ◽

J Buckland ◽

P West ◽

O Sparrow

Keyword(s):

Trigeminal Neuralgia ◽

Eustachian Tube ◽

Specific Treatment ◽

Motor Deficits ◽

Gasserian Ganglion ◽

Case Review ◽

Retrospective Case ◽

Medicine Department ◽

Percutaneous Balloon ◽

Patulous Eustachian Tube

AbstractObjective:To report a case of patulous eustachian tube which occurred after percutaneous balloon microcompression of the Gasserian ganglion.Method:Retrospective case review.Results:A 41-year-old man was referred to our audiovestibular medicine department following episodes of autophony. These symptoms appeared two weeks after percutaneous balloon microcompression performed to treat severe trigeminal neuralgia secondary to multiple sclerosis. A diagnosis of patulous eustachian tube was indicated by clinical examination and tympanometry. The symptoms were present for less than six months and improved without any specific treatment.Conclusion:Percutaneous balloon microcompression is a procedure used for refractory trigeminal neuralgia that can cause transient sensory and motor deficits of any of the trigeminal nerve branches. It is proposed that injury to the mandibular division in this case caused temporary tensor veli palatini dysfunction with consequent patulous eustachian tube.

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Trigeminal neuralgia in nasopharyngeal carcinoma

The Journal of Laryngology & Otology ◽

10.1017/s0022215100133742 ◽

1996 ◽

Vol 110 (4) ◽

pp. 394-396 ◽

Cited By ~ 22

Author(s):

V. F. H. Chong

Keyword(s):

Nasopharyngeal Carcinoma ◽

Trigeminal Neuralgia ◽

Skull Base ◽

Pathological Process ◽

Mandibular Nerve ◽

Gasserian Ganglion ◽

Resonance Imaging ◽

Cranial Nerve Involvement ◽

Magnetic Resonance Imaging Mri ◽

Retrograde Spread

AbstractTumours at the skull base may show perineural infiltration of the mandibular nerve. Subsequent retrograde spread into the cavernous sinus, Gasserian ganglion, the trigeminal nerve and the pons may be seen. The patient, a known and treated case of nasopharyngeal carcinoma (NPC), complained of trigeminal neuralgia and difficulty in chewing. Magnetic resonance imaging (MRI) revealed a Gasserian ganglion and trigeminal infiltration with resultant atrophy of the muscles innervated by the mandibular nerve. Proximal cranial nerve involvement should be suspected in patients with skull base malignancy presenting with trigeminal neuralgia. MRI is the modality of choice in delineating the pathological process.

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