scholarly journals Percutaneous Microcompression for Idiopathic Trigeminal Neuralgia: curative effects and complications

2020 ◽  
Author(s):  
yi ma ◽  
Yan-feng Li ◽  
Hai-tao Huang ◽  
Bin Wang ◽  
Quan-cai Wang
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Intracranial Hemorrhage ◽  
Long Term Results ◽  
Base Line ◽  
Intracranial Infection ◽  
Idiopathic Trigeminal Neuralgia

Abstract Background. We aimed to present the immediate and long term effect of percutaneous balloon compression (PBC) for idiopathic trigeminal neuralgia (ITN). Methods. ITN patients who underwent PBC for the first time in the past seven years were enrolled. Base line data and immediate postoperative outcomes were collected by reviewing the medical records and long term results. Kaplan-Meier curve, life-table analysis proportional-hazards analysis were utilized to assess the long term results and the likelihood of tic recurrence. Results. 12,797 patients were enrolled. Immediate after the PBC procedure, complete and partial pain relief were achieved in 95.6% and 1.1% patients respectively, with no relief in 1.7 % patients; the common side effects on the affected side of face included the sense loss in 98.9% patients, with 3.8% of them experienced sense loss combined abnormal sense; masseter weakness in 90.6%, herpes eruption in 51.4%, corneal reflex weakness or loss in 12.7% patients. The fewer perioperative complications covered diplopia in 139 patients (1.1%), partial hearing loss in 190 patients (1.5%), vascular complications in 5 patients (0.05%), brainstem hematoma in one patient (0.01%), ischemic stroke in two patients (0.02%), intracranial hemorrhage in 11 patents (0.09%), and intracranial infection in one patient (0.01%) patients. Of three deaths happened in the perioperative period, two died of intracranial hemorrhage, and the other one died of intracranial infection. 5794 (49.2%) patients, who were followed than one year after the procedure, were included in the follow-up study, with the median follow-up period of 7.2 years. Complete and partial pain relief were obtained in 82.9% and 6.8% patients respectively, while the pain recurrence occurred in 8.5% patients. Side effects included sense loss without abnormal sense in 54.3%, with acceptable abnormal sense in 6.0%, and with severe abnormal sense in 2.0% patients. Masseter weakness was reported by 7.5% patients. 96.4% patients were satisfied with the procedure. Conclusion. Our study shows PBC is a safe, simple and effective procedure, with both immediate and long-term success rates, acceptable side effects and fewer deadly complications, should be considered as one of the best choice for the treatment of ITN patients.

Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression

2002 ◽  
Vol 96 (3) ◽  
pp. 527-531 ◽  
Author(s):  
Elizabeth C. Tyler-Kabara ◽  
Amin B. Kassam ◽  
Michael H. Horowitz ◽  
Louise Urgo ◽  
Constantinos Hadjipanayis ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Long Term Results ◽  
Content Type ◽  
Significant Pain ◽  
Fine Print

Object. Microvascular decompression (MVD) has become one of the primary treatments for typical trigeminal neuralgia (TN). Not all patients with facial pain, however, suffer from the typical form of this disease; many patients who present for surgical intervention actually have atypical TN. The authors compare the results of MVD performed for typical and atypical TN at their institution. Methods. The results of 2675 MVDs in 2264 patients were reviewed using information obtained from the department database. The authors examined immediate postoperative relief in 2003 patients with typical and 672 with atypical TN, and long-term follow-up results in patients for whom more than 5 years of follow-up data were available (969 with typical and 219 with atypical TN). Outcomes were divided into three categories: excellent, pain relief without medication; good, mild or intermittent pain controlled with low-dose medication; and poor, no or poor pain relief with large amounts of medication. The results for typical and atypical TN were compared and patient history and pain characteristics were evaluated for possible predictive factors. Conclusions. In this study, MVD for typical TN resulted in complete postoperative pain relief in 80% of patients, compared with 47% with complete relief in those with atypical TN. Significant pain relief was achieved after 97% of MVDs in patients with typical TN and after 87% of these procedures for atypical TN. When patients were followed for more than 5 years, the long-term pain relief after MVD for those with typical TN was excellent in 73% and good in an additional 7%, for an overall significant pain relief in 80% of patients. In contrast, following MVD for atypical TN, the long-term results were excellent in only 35% of cases and good in an additional 16%, for overall significant pain relief in only 51%. Memorable onset and trigger points were predictive of better postoperative pain relief in both atypical and typical TN. Preoperative sensory loss was a negative predictor for good long-term results following MVD for atypical TN.

Long-Term Results of Percutaneous Retrogasserian Thermorhizotomy for “Essential” Trigeminal Neuralgia: Considerations in 1000 Consecutive Patients

Neurosurgery ◽  
1990 ◽  
Vol 26 (5) ◽  
pp. 783-787 ◽  
Author(s):  
Giovanni Broggi ◽  
Angelo Franzini ◽  
Giovanni Lasio ◽  
Cesare Giorgi ◽  
Domenico Servello
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Recurrence Rate ◽  
Sensory Deficit ◽  
Long Term Results ◽  
Cure Rate ◽  
Corneal Reflex ◽  
Permanent Morbidity

Abstract Long-term results (average follow-up, 9.3 years) obtained in 1000 consecutive patients suffering from cryptogenetic (“essential”) trigeminal neuralgia treated with percutaneous thermorhizotomy are analyzed. Pain relief was obtained in 95% of the treated patients. Permanent morbidity was as follows: masseter weakness in 105 patients; oculomotor palsies in 5 patients; weakening of the corneal reflex in 197 patients, 6 of whom requested an ocular operation for keratitis; and painful dysesthesia in 52 patients, 15 of whom developed a painful anesthesia syndrome. There was a recurrence rate of 18.1%, and a correlation between postoperative sensory deficit and the cure rate was found. These results are discussed and compared to the results obtained with different techniques.

scholarly journals Long-Term Results after Glycerol Rhizotomy for Multiple Sclerosis-Related Trigeminal Neuralgia

1994 ◽  
Vol 21 (2) ◽  
pp. 137-140 ◽  
Author(s):  
Douglas Kondziolka ◽  
L. Dade Lunsford ◽  
David J. Bissonette
Keyword(s):  
Multiple Sclerosis ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Surgical Procedures ◽  
Pain Control ◽  
Long Term Results ◽  
Sensory Loss ◽  
Single Patient

Abstract:Percutaneous retrogasserian glycerol rhizotomy (PRGR) was used during an 11-year interval in 53 patients with typical trigeminal neuralgia associated with multiple sclerosis. All patients had failed extensive medical trials prior to PRGR. Long-term (median follow-up, 36 months) complete pain relief (no further medication) was achieved in 29 (59%) of 49 evaluable patients. Eight patients (16%) had satisfactory pain control but required occasional medication. Twelve patients (25%) had initial unsatisfactory results with inadequate pain relief; nine underwent alternative surgical procedures. Sixteen patients (30%) subsequently required repeat glycerol rhizotomies to reachieve pain control. Twenty-seven patients (60% of 45 patients evaluated for this finding) retained normal trigeminal sensation after injection. Major trigeminal sensory loss developed in a single patient who had four glycerol rhizotomies over a 25-month interval. No patient developed deafferentation pain. We believe that PRGR is a low-morbidity, effective, and repeatable surgical procedure for the management of trigeminal neuralgia in the setting of multiple sclerosis.

scholarly journals CyberKnife radiosurgery for idiopathic trigeminal neuralgia

2005 ◽  
Vol 18 (5) ◽  
pp. 1-7 ◽  
Author(s):  
Michael Lim ◽  
Alan T. Villavicencio ◽  
Sigita Burneikiene ◽  
Steven D. Chang ◽  
Pantaleo Romanelli ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Treatment Option ◽  
Pain Control ◽  
Rocky Mountain ◽  
Idiopathic Trigeminal Neuralgia ◽  
Cyberknife Radiosurgery ◽  
Control Response

Object Gamma knife surgery is an accepted treatment option for trigeminal neuralgia (TN). The safety and efficacy of CyberKnife radiosurgery as a treatment option for TN, however, has not been established. Methods Forty-one patients were treated between May 2002 and September 2004 for idiopathic TN at Stanford University and the Rocky Mountain CyberKnife Center. Patients with atypical pain, multiple sclerosis, or previous radiosurgical treatment or a follow-up duration of less than 6 months were excluded. Patients were evaluated for the level of pain control, response rate, time to pain relief, occurrence of hypesthesia, and time to pain recurrence with respect to the length of the nerve treated and the maximum and the minimum dose to the nerve margin. Thirty-eight patients (92.7%) experienced initial pain relief at a median of 7 days after treatment (range < 24 hours–4 months). Pain control was ranked as excellent in 36 patients (87.8%), moderate in two (4.9%), and three (7.3%) reported no change. Six (15.8%) of the 38 patients with initial relief experienced a recurrence of pain at a median of 6 months (range 2–8 months). Long-term response after a mean follow-up time of 11 months was found in 32 (78%) of 41. Twenty-one patients (51.2%) experienced numbness after treatment. Conclusions CyberKnife radiosurgery for TN has high rates of initial pain control and short latency to pain relief compared with those reported for other radiosurgery systems. The doses used for treatment were safe and effective. Higher prescribed doses were not associated with improvement in pain relief or recurrence rate. The hypesthesia rate was related to the length of the trigeminal nerve treated.

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.

Long-term Follow-up of Patients Treated with Percutaneous Radiofrequency Thermocoagulation via the Foramen Rotundum for Isolated Maxillary Nerve Idiopathic Trigeminal Neuralgia

Pain Medicine ◽  
2019 ◽  
Vol 20 (7) ◽  
pp. 1370-1378 ◽  
Author(s):  
Bing Ran ◽  
Jun Wei ◽  
Qiong Zhong ◽  
Min Fu ◽  
Jun Yang ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Sagittal Plane ◽  
Ct Guided ◽  
Radiofrequency Thermocoagulation ◽  
Complete Pain Relief ◽  
Idiopathic Trigeminal Neuralgia ◽  
Foramen Rotundum ◽  
The Mean

Abstract Objective The purpose of this study is to evaluate the effectiveness and safety of percutaneous radiofrequency thermocoagulation (PRT) via the foramen rotundum (FR) for the treatment of isolated maxillary (V2) idiopathic trigeminal neuralgia (ITN) and assess the appropriate puncture angle through the anterior coronoid process to reach the FR. Methods Between January 2011 and October 2016, 87 patients with V2 ITN refractory to conservative treatment were treated by computed tomography (CT)–guided PRT via the FR at our institution. The outcome of pain relief was assessed by the visual analog scale (VAS) and Barrow Neurological Institute (BNI) pain grade and grouped as complete pain relief (BNI grades I–III) or unsuccessful pain relief (BNI grades IV–V). Recurrence and complications were also monitored and recorded. The puncture angle for this novel approach was assessed based on intraoperative CT images. Results Of the 87 treated patients, 85 (97.7%) achieved complete pain relief, and two patients (2.3%) experienced unsuccessful pain relief immediately after operation. During the mean follow-up period of 44.3 months, 15 patients (17.2%) experienced recurring pain. No severe complications occurred, except for hypoesthesia restricted to the V2 distribution in all patients (100%) and facial hematoma in 10 patients (11.5%). The mean puncture angle to reach the FR was 33.6° ± 5.7° toward the sagittal plane. Discussion CT-guided PRT via the FR for refractory isolated V2 ITN is effective and safe and could be a rational therapy for patients with V2 ITN.

Long Term Results of Stereotactic Thalamotomy for Cerebral Palsy

Neurosurgery ◽  
1983 ◽  
Vol 12 (2) ◽  
pp. 195-202 ◽  
Author(s):  
G. Broggi ◽  
L. Angelini ◽  
R. Bono ◽  
C. Giorgi ◽  
N. Nardocci ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Side Effects ◽  
Clinical Picture ◽  
Clinical Results ◽  
Long Term Results ◽  
Abnormal Movements ◽  
Average Intelligence ◽  
Stereotactic Thalamotomy

Abstract A group of 33 patients (between 10 and 30 years old and with average intelligence) underwent stereotactic surgery for abnormal movements due to cerebral palsy. Neurological, neurofunctional, and neuropsychological examinations were performed pre- and postoperatively. The length of follow-up ranged between 1 and 4 years. The clinical results are reported and discussed in relation to the targets, the side of the lesion, and the clinical picture. Our data show that better results are obtained in patients with tremor and hyperkinesias; dystonia is improved to a lesser extent, whereas spasticity tends to recur. Operation is more effective for patients with unilateral signs than for patients with bilateral symptoms. The clinical results are stable in time, and the side effects fade away after a few months.

CYBERKNIFE RADIOSURGERY FOR TRIGEMINAL NEURALGIA TREATMENT

Neurosurgery ◽  
2008 ◽  
Vol 62 (3) ◽  
pp. 647-655 ◽  
Author(s):  
Alan T. Villavicencio ◽  
Michael Lim ◽  
Sigita Burneikiene ◽  
Pantaleo Romanelli ◽  
John R. Adler ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Radiation Doses ◽  
Maximal Dose ◽  
Median Length ◽  
Pain Medications ◽  
Idiopathic Trigeminal Neuralgia ◽  
Cyberknife Radiosurgery ◽  
The Mean

Abstract OBJECTIVE Radiosurgery has gained acceptance as a treatment option for trigeminal neuralgia. We report our preliminary multicenter experience treating trigeminal neuralgia with the CyberKnife (Accuray, Inc., Sunnyvale, CA). METHODS A total of 95 patients were treated for idiopathic trigeminal neuralgia between May 2002 and October 2005. Radiosurgical dose and volume parameters were retrospectively analyzed in relation to pain response, complications, and recurrence of symptoms. Optimal treatment parameters were identified for patients who had excellent and sustained pain relief with no complications, including severe or moderate hypesthesia. RESULTS Excellent pain relief was initially experienced by 64 out of 95 patients (67%). The median time to pain relief was 14 days (range, 0.3–180 d). Posttreatment numbness occurred in 45 (47%) of the patients treated. Using higher radiation doses and treating longer segments of the nerve led to both better pain relief and a higher incidence of hypesthesia. The presence of posttreatment numbness was predictive of better pain relief. The overall rate of complications was 18%. At the mean follow-up time of 2 years, 47 of the 95 patients (50%) had sustained pain relief, all of whom were completely off pain medications. CONCLUSION The results of this study suggest the following optimal radiosurgical treatment parameters for treatment of idiopathic trigeminal neuralgia: a median maximal dose of 78 Gy (range, 70–85.4 Gy) and a median length of the nerve treated of 6 mm (range, 5–12 mm).

scholarly journals Radiofrequency Thermoablation of the Gasserian Ganglion Versus the Peripheral Branches of the Trigeminal Nerve for Treatment of Trigeminal Neuralgia: A Randomized, Control Trial

2019 ◽  
Vol 2 (22.2) ◽  
pp. 147-154
Author(s):  
Neerja Bharti
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Facial Pain ◽  
Control Group ◽  
Study Group ◽  
Gasserian Ganglion ◽  
Idiopathic Trigeminal Neuralgia ◽  
Radiofrequency Thermoablation

Background: Trigeminal neuralgia is the most painful condition of facial pain leading to impairment of routine activities. Although radiofrequency thermoablation (RFT) of the Gasserian ganglion is widely used for the treatment of idiopathic trigeminal neuralgia in patients having ineffective pain relief with medical therapy, the incidence of complications like hypoesthesia, neuroparalytic keratitis, and masticatory muscles weakness is high. Recent case reports have shown the effectiveness of RFT of the peripheral branches of the trigeminal nerve for relief of refractory chronic facial pain conditions including trigeminal neuralgia. Objectives: This study was conducted to compare the efficacy and safety of RFT of the peripheral branches of the trigeminal nerve with RFT of the Gasserian ganglion for the management of idiopathic trigeminal neuralgia. Study Design: Prospective, randomized, observer-blinded, clinical trial. Setting: Tertiary care hospital and medical education and research institute. Methods: A total of 40 adult patients of idiopathic trigeminal neuralgia were randomly allocated into 2 groups. The control group received RFT of the Gasserian ganglion while the study group received RFT of the peripheral branches of trigeminal nerve. The procedures were performed in the operation room under all aseptic precautions with fluoroscopic guidance. Post-procedure, the patients were assessed for loss of sensation along the nerve distribution and the adequacy of pain relief on the Numerical Rating Scale (NRS). The patients were followed up for 3 month to assess the quality of pain relief by the NRS and the Barrow Neurological Institute (BNI) pain intensity scale. Improvement in pain was considered excellent if patients had complete pain relief without any medication, good if there was significant reduction in pain (> 50%) with or without medication, and poor if there was less than 50% reduction in pain with medications. Patients were also assessed for numbness and any other side effects. Patients’ satisfaction with the procedure was recorded. Results: Nineteen patients in the control group and 18 in study group had effective pain relief of up to 3 months. Their pain scores were comparable at all time intervals, though the number of patients receiving supplementary medications was more in study group at 2 months (P = 0.015). The patients showed overall satisfaction score of 8.5 (8-9) and 8 (7-9) in control and study groups respectively. The average procedure duration was 30 (30-38) minutes in the control group and 28 (25-40) minutes in the study group. Most of the patients in both groups had mild numbness after the procedure. One patient in the control group had lower eyelid swelling and another had mild weakness of the masseter muscle, which resolved few days later. No major complication was reported in the study group except for 1 patient who reported local ecchymosis. Limitations: The main limitation of the study is that the patients and the investigator performing the procedure were not blinded, though the person who assessed the patient during follow-up was blinded to the group assignment. Another limitation is that we could not follow up with the patients after 3 months due to time constraints. Conclusion: We found that radiofrequency thermoablation of the peripheral branches of the trigeminal nerve is an effective and safe procedure for the management of idiopathic trigeminal neuralgia. Key words: Idiopathic trigeminal neuralgia, radiofrequency thermoablation, Gasserian ganglion, peripheral nerve branches, pain, trigeminal nerve

scholarly journals Microvascular Decompression for Trigeminal Neuralgia: Our Experiences at Bir Hospital

2017 ◽  
Vol 14 (2) ◽  
pp. 3-7
Author(s):  
Gopal R Sharma ◽  
Rajiv Jha ◽  
Prakash Poudel ◽  
Dhrub R Adhikari ◽  
Prakash Bista
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Medical Treatment ◽  
Treatment Options ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Recurrent Pain ◽  
Cerebellar Artery

Trigeminal neuralgia (TGN) is a very peculiar disease, mostly characterized by unilateral paroxysmal facial pain, often described by patient as ‘one of the worst pain in my life’. This condition is also known as ‘Tic Douloureus’. The annual incidence of TN is about 4.7/100000 population, male and female are equally affected. The diagnosis is usually made by history, clinical fi ndings and cranial imaging is required to rule out compressing vascular loop, organic lesions and Multiple Sclerosis (MS) at Trigeminal nerve (TN). Treatment of TGN ranged from medical to surgical intervention. Between September 2007 and April 2015, 20 patients underwent micro vascular decompression (MVD) of TN for TGN who were refractory to medical treatment at department of Neurosurgery, Bir Hospital. All decompressions were performed using operating microscope. Follow up period ranged from 22 months to 8 years.There were 9 males and 11 females and age ranged from 30-70 years. The neuralgic pain was localized on right side in 13 patients and left on 7 patients. Pain distribution was on V3 (mandibular branch) dermatome in 11, V2( Maxillary branch ) in 4, V2-3 in 2 and V1- 2-3 in 3 patients respectively. On intraoperative fi ndings TN was compressed by superior cerebellar artery ( SCA ) in 8, tumors in 4, unidentifi ed vessels in 3, veins in 2, anterior inferior cerebellar artery ( AICA ) in 1 and no cause was found in 2 patients. 7 patients suffered postoperative complications which included hyposthesia in 3, pseudomeningocele in 3 and meningitis in 1. There was no mortality in this series. 20 patients felt pain relief immediately after procedure and 1 patients came after 3 years with recurrent pain requiring second surgery. In conclusion, MVD for TGN in younger patients who are refractory to medical treatment is one of the best treatment options which is safe and long term pain relief is achieved in majority of cases.Nepal Journal of Neuroscience, Vol. 14, No. 2,  2017 Page:11-15

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