scholarly journals Invisible compression, anterior fossa tumor causing trigeminal neuralgia

2021 ◽  
Vol 12 ◽  
pp. 106
Author(s):  
Jesus Manuel Esteban Garcia ◽  
David Mato Mañas ◽  
Enrique Marco De Lucas ◽  
Guillermo Garcia Catalan ◽  
Patricia Lopez Gomez ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Anterior Skull Base ◽  
Definitive Treatment ◽  
Gasserian Ganglion ◽  
Neurovascular Conflict ◽  
Radiological Findings ◽  
Skull Base Lesions ◽  
Anterior Fossa ◽  
Other Neoplasms

Background: Trigeminal neuralgia secondary to posterior and middle fossae tumors, whether ipsilateral or contralateral, has been well described. However, this disabling disease has never been reported in the context of anterior fossa neoplasms. Case Description: A 75-year-old female with right hemifacial pain was diagnosed with an anterior clinoid meningioma. Despite neuroimaging did not show any apparent anatomical or neurovascular conflict, a detailed MRI analysis revealed a V3 hyperintensity. Not only symptoms completely resolved after surgical resection but also this radiological sign disappeared. Nowadays, the patient remains asymptomatic and V3 hyperintensity has not reappeared during her follow-up. Conclusion: A surgical definitive treatment can be offered to patients suffering from trigeminal neuralgia secondary to lesions adjacent to Gasserian ganglion or trigeminal branches. In this respect, posterior and middle fossae tumors are well-reported etiologies. Nevertheless, in the absence of evident compression, other neoplasms located in the vicinity of these critical structures and considered as radiological findings may be involved in trigeminal pain. Microvascular and pressure gradient changes could be an underlying cause of these symptoms in anterior skull base lesions. Here, we report the case of a patient with uncontrollable hemifacial pain resolved after anterior clinoid meningioma removal.

Unconventional Facial Entry Points Confirmed Using a 3D CT Reconstruction–Guided Stereotactic Approach to Radiofrequency Thermocoagulation for the Treatment of Trigeminal Neuralgia: A Series of Case Reports

Pain Medicine ◽  
2018 ◽  
Vol 20 (8) ◽  
pp. 1551-1558 ◽  
Author(s):  
Zhigang Guo ◽  
Zhijia Wang ◽  
Kai Li ◽  
Chao Du ◽  
Xingli Zhao ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Anatomical Variation ◽  
Preoperative Imaging ◽  
Gasserian Ganglion ◽  
Ct Reconstruction ◽  
Foramen Ovale ◽  
Radiofrequency Thermocoagulation ◽  
Patient Reported ◽  
Entry Points

Abstract Objectives Patients with trigeminal neuralgia who are refractory to medical therapy may choose to undergo Gasserian ganglion percutaneous radiofrequency thermocoagulation. However, in cases where the foramen ovale is difficult to access due to various anatomical anomalies, the typical estimation of the facial entry point is suboptimal. Methods Three-dimensional computed tomography reconstruction imaging performed before surgery revealed anatomical variations in each of the four adult patient cases that made it more difficult to successfully access the foramen ovale (FO) for percutaneous radiofrequency thermocoagulation. Using measurements collected from preoperative imaging that showed each specific anatomical variation in the FO, researchers marked alternate facial entry points that would allow successful probe placement into the FO and recorded the arc angle data in the stereotactic instrument. Results Patients were evaluated during follow-up visits ranging from seven to 26 months after surgery and asked to rate postoperative pain using a visual analog scale. These scores decreased from 10 to 3 in all four patients by the third day after the procedure. There were no permanent complications or morbidities from the surgery. One patient experienced mild facial numbness; however, this side effect subsided within three months after surgery. During the follow-up period, no patient reported pain recurrence. Conclusions The expectation for clinicians approaching trigeminal nerve block using a peri-oral approach should be to expect a great degree of potential variability in terms of both distances from the corner of the mouth and needle angle taken to successfully navigate the anatomy and access the foramen ovale.

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

Quantitative Sensory Changes Following Gasserian Ganglion Radiofrequency Thermocoagulation in Patients with Medical Refractory Trigeminal Neuralgia: A Prospective Consecutive Case Series

2020 ◽  
Vol 81 (05) ◽  
pp. 423-429
Author(s):  
Torge Huckhagel ◽  
Lars Bohlmann ◽  
Manfred Westphal ◽  
Jan Regelsberger ◽  
Iris-Carola Eichler ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Short Form ◽  
Research Network ◽  
Treatment Modalities ◽  
Mcgill Pain Questionnaire ◽  
Gasserian Ganglion ◽  
Radiofrequency Thermocoagulation ◽  
Before And After

Abstract Background and Objective Microsurgical vascular nerve decompression and percutaneous ablative interventions aiming at the Gasserian ganglion are promising treatment modalities for patients with medical refractory trigeminal neuralgia (TN). Apart from clinical reports on a variable manifestation of facial hypoesthesia, the long-term impact of trigeminal ganglion radiofrequency thermocoagulation (RFT) on sensory characteristics has not yet been determined using quantitative methods. Material and Methods We performed standardized quantitative sensory testing according to the established protocol of the German Research Network on Neuropathic Pain in a cohort of patients with classical (n = 5) and secondary (n = 11) TN before and after percutaneous Gasserian ganglion RFT (mean follow-up: 6 months). The test battery included thermal detection and thermal pain thresholds as well as mechanical detection and mechanical pain sensitivity measures. Clinical improvement was also assessed by means of renowned pain intensity and impairment questionnaires (Short-Form McGill Pain Questionnaire, Pain Disability Index, and Pain Catastrophizing Scale), pain numeric rating scale, and anti-neuropathic medication reduction at follow-up. Results All clinical parameters developed favorably following percutaneous thermocoagulation. Only mechanical and vibration detection thresholds of the affected side of the face were located below the reference frame of the norm population before and after the procedure. Statistically significant persistent changes in quantitative sensory variables caused by the intervention could not be detected in our patient sample. Conclusion Our data suggest that TN patients improving considerably after RFT do not undergo substantial long-term alterations regarding quantitative sensory perception.

scholarly journals Radiosurgical treatment of trigeminal neuralgia: experience of the Radiosurgery Center of the N.V. Sklifosovsky Research Institute for Emergency Medicine

2019 ◽  
Vol 21 (3) ◽  
pp. 12-20
Author(s):  
A. S. Tokarev ◽  
M. V. Sinkin ◽  
E. N. Rozhnova ◽  
V. N. Stepanov ◽  
V. A. Rak
Keyword(s):  
Multiple Sclerosis ◽  
Emergency Medicine ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Type I ◽  
Drug Resistant ◽  
Neurovascular Conflict ◽  
Study Objective ◽  
Research Institute

The study objective is to evaluate early results of radiosurgical treatment (RST) of drug-resistant trigeminal neuralgia (TN) of various etiology.Materials and methods. Between 01.01.2016 and 01.07.2018 at the Radiosurgery Center of the N.V. Sklifosovsky Research Institute for Emergency Medicine, 14 patients with drug-resistant TN underwent RST. Per magnetic resonance imaging, prior to treatment 7 patients had neurovascular conflict, 2 had demyelination of the root of the trigeminal nerve due to multiple sclerosis, and 5 patients showed no pathologies of the brain. Irradiation of the cisternal portion of the trigeminal nerve at the distance of 7.5 mm from the entry into the brainstem with prescribed dose of 90 Gy was performed. Follow-up period was 8–20 months. The difference in fractional anisotropy (FA) at the affected and healthy sides was evaluated in patients with TN prior to RST to divide them into 2 groups: with significant FA decrease and with moderate FA decrease.Results. All patients who underwent RST with PD >80 Gy (85.7 %) noted decreased level of pain or its full disappearance. In 11 (78.5 %) patients, anesthetic effect manifested itself 3–6 weeks after RST, in 1–3 months after RST. Full analgesic effect was achieved in a patient with idiopathic type II TN (PD 84 Gy) 3 months after RST, in a patient with neurovascular conflict and type I TN (PD 86 Gy) 6 weeks after RST, in a patient with multiple sclerosis and type I TN (PD 81 Gy) 3 weeks after RST. In the last-mentioned patient, pain returned 12 months after RST but with lower intensity. In 2 (14.3 %) patients (PD 80 Gy), no positive effect was observed in 6 months of follow up. Hypesthesia of a face area (RST complication) was diagnosed in only 1 (7.2 %) patient 8 months after RST, and it persisted for 6 weeks gradually regressing. There was no statistically significant correlation between FA decrease and RST outcome, but it was observed that outcome was more favorable in patients with moderately decreased FA.Conclusion. RST of drug-resistant forms of TN with PD >80 Gy significantly reduces pain syndrome 3–6 weeks after treatment and is characterized by low risk of complications.

Bilateral trigeminal neuralgia

1987 ◽  
Vol 67 (1) ◽  
pp. 44-48 ◽  
Author(s):  
Ronald Brisman
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Morbidity Rate ◽  
Gasserian Ganglion ◽  
Predisposing Factor ◽  
Content Type ◽  
Bilateral Involvement ◽  
Prior Surgery ◽  
Fine Print

✓ Bilateral trigeminal neuralgia occurred in 32 (11.9%) of 269 consecutive patients who were treated with radiofrequency electrocoagulation (RFE). This is a higher incidence than has been reported before and may be explained by the prospective nature of the present study, the long follow-up period, and the inclusion of patients with mild bilateral symptoms. Multiple sclerosis is the most common predisposing factor and occurred in 18% of those with bilateral trigeminal neuralgia. Although patients with bilateral trigeminal neuralgia were more likely to have had prior surgery than those with unilateral neuralgia, they did not have a higher recurrence rate following treatment. Percutaneous RFE of the retrogasserian rootlets and gasserian ganglion, with or without glycerol, is effective in managing patients whose pain is intractable to medical therapy. The preservation of most trigeminal sensory and motor functions, the low morbidity rate, and the ability to repeat the procedure are particularly advantageous for patients with bilateral involvement.

Balloon Compression Rhizolysis in the Surgical Management of Trigeminal Neuralgia

Neurosurgery ◽  
1987 ◽  
Vol 20 (6) ◽  
pp. 908-913 ◽  
Author(s):  
Carl J. Belber ◽  
Richard A. Rak
Keyword(s):  
Trigeminal Neuralgia ◽  
Operative Time ◽  
Surgical Approaches ◽  
Gasserian Ganglion ◽  
Fogarty Catheter ◽  
Short Operative Time ◽  
Balloon Compression ◽  
Patients Experience ◽  
Endotracheal Anesthesia

Abstract To overcome some of the disadvantages of the current percutaneous surgical approaches to trigeminal neuralgia, we offer balloon compression rhizolysis (BCR) as an alternative. Guided by fluoroscopy, a 4 French Fogarty catheter is introduced into Meckl's cave, and its balloon is inflated tightly for a few minutes with soluble contrast agent to compress the gasserian ganglion and rootlets, under light endotracheal anesthesia. All patients experience immediate pain relief, with mild numbness in all three divisions, but with corneal sparing. Often, weakness of ipsilateral mastication appears transiently. In 33 procedures performed in 25 patients aged 48 to 86, with a follow-up period of 6 months to 7 years, there were 25 long-lasting cures (76%) and 8 recurrences. These results are fully comparable to those of other “destructive” procedures. There was no anesthetic complication and no mortality. The advantages of this procedure, besides its efficacy and low rate of dysesthesia, include absence of discomfort for the patient, short operative time, technical ease for the neurosurgeon, minimal morbidity, and no risk to corneal sensation. We think that microvascular decompression (MVD) should be the first operation considered for trigeminal neuralgia, but we advocate BCR as the procedure of choice in the aged and medically infirm, especially when V1 pain is present, in patients with multiple sclerosis, for recurrences after other procedures, and in virtually any situation in which MVD is, for some reason, not feasible.

Management of Petrous Endostosis in Posterior Fossa Procedures for Trigeminal Neuralgia

2007 ◽  
Vol 60 (suppl_2) ◽  
pp. ONS-63-ONS-69 ◽  
Author(s):  
Emad F. Shenouda ◽  
Hugh B. Coakham
Keyword(s):  
Trigeminal Neuralgia ◽  
Posterior Fossa ◽  
Trigeminal Nerve ◽  
Nerve Root ◽  
Preoperative Imaging ◽  
Neurovascular Conflict ◽  
Trigeminal Nerve Root ◽  
Air Cells ◽  
Posterior Fossa Procedures

Abstract Objective: Within a series of 440 consecutive patients who underwent posterior fossa procedures for trigeminal neuralgia (TN), the site of neurovascular conflict was obscured by petrous endostosis in 15 patients. The surgical management and clinical outcomes of these patients are presented. Methods: We retrospectively analyzed the prospectively collected data of all patients with a diagnosis of TN from 1980 to 2005. Clinical presentation, preoperative imaging, intraoperative findings, surgical technique, and outcomes were recorded. A postal follow-up questionnaire and a visual analog scale of 100 points were used for outcome assessment and patient satisfaction. Results: All 15 patients presented with typical TN, had preoperative imaging suggestive of vascular compression of the trigeminal nerve root, and underwent standard retro-mastoid craniotomy. The juxta-petrous portion of the trigeminal nerve root was obscured by petrous endostosis. The neurovascular conflict was revealed and dealt with after drilling of the endostosis in 11 patients, and four patients had endoscopic-assisted exploration of the region of the endostosis. A pontotrigeminal vein caused compression in most cases. Three patients had endoscopic-assisted division of the vein. All patients had immediate relief of pain and were 100% satisfied with the results of surgery after a mean follow-up period of 38.6 months. Four patients developed a cere-brospinal fluid leak, and five patients experienced postoperative headaches. Conclusion: Petrous endostosis is an uncommon finding in posterior fossa procedures for TN (3.4%). However, it can obscure the region of neurovascular conflict, which is venous compression in these cases. We have found that drilling away endos-tosis or using endoscopic-assisted microsurgery increases the chances of good outcome and avoids unnecessary rhizotomy. All magnetic resonance imaging scans should be inspected for evidence of petrous endostosis and, when present, a bone window computed tomographic scan should be performed to clarify the image and check for the presence of petrous air cells. If the endostosis is drilled, failure to detect and to seal these air cells thoroughly can result in postoperative cerebrospinal fluid rhinorrhea. Attention to these details will optimize the surgical results. However, the use of an angled endoscope avoids this problem and is now our preferred method.

scholarly journals Neurapraxia in patients with trigeminal neuralgia but no identifiable neurovascular conflict during microvascular decompression: a retrospective analysis of 26 cases

BMC Surgery ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Juan Li ◽  
Min Zhou ◽  
Yuhai Wang ◽  
Sze Chai Kwok ◽  
Jia Yin
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Herpes Labialis ◽  
Efficacy And Safety ◽  
Neurovascular Conflict ◽  
Aneurysm Clip ◽  
First Choice ◽  
Trigeminal Nerve Root

Abstract Background Microvascular decompression (MVD) is the first choice in patients with classic trigeminal neuralgia (TGN) that could not be sufficiently controlled by pharmacological treatment. However, neurovascular conflict (NVC) could not be identified during MVD in all patients. To describe the efficacy and safety of treatment with aneurysm clips in these situations. Methods A total of 205 patients underwent MVD for classic TGN at our center from January 1, 2015 to December 31, 2019. In patients without identifiable NVC upon dissection of the entire trigeminal nerve root, neurapraxia was performed using a Yasargil temporary titanium aneurysm clip (force: 90 g) for 40 s (or a total of 60 s if the process must be suspended temporarily due to bradycardia or hypertension). Results A total of 26 patients (median age: 64 years; 15 women) underwent neurapraxia. Five out of the 26 patients received prior MVD but relapsed. Immediate complete pain relief was achieved in all 26 cases. Within a median follow-up of 3 years (range: 1.0–6.0), recurrence was noted in 3 cases (11.5%). Postoperative complications included hemifacial numbness, herpes labialis, masseter weakness; most were transient and dissipated within 3–6 months. Conclusions Neurapraxia using aneurysm clip is safe and effective in patients with classic TGN but no identifiable NVC during MVD. Whether this method could be developed into a standardizable method needs further investigation.

Long-term results of Gasserian ganglion electrocoagulation

1975 ◽  
Vol 42 (2) ◽  
pp. 140-143 ◽  
Author(s):  
Jürgen Menzel ◽  
Wolfgang Piotrowski ◽  
Helmut Penzholz
Keyword(s):  
Trigeminal Neuralgia ◽  
Long Term Results ◽  
Gasserian Ganglion ◽  
Content Type ◽  
Follow Up Study ◽  
Fine Print

✓ This report is a follow-up study of 315 patients under 46 years old who suffered from trigeminal neuralgia and were treated by electrocoagulation of the Gasserian ganglion. The average follow-up period was 12.7 years, the maximum 33 years. Eighty percent had a return of pain, but 96.7% ultimately attained freedom from pain after repeat electrocoagulation.

Treatment of Trigeminal Neuralgia by Thermocoagulation, Glycerolization, and Percutaneous Compression of the Gasserian Ganglion and/or Retrogasserian Rootlets: Long-Term Results and Therapeutic Protocol

Neurosurgery ◽  
1989 ◽  
Vol 24 (2) ◽  
pp. 239-245 ◽  
Author(s):  
Bernardo Fraioli ◽  
Vincenzo Esposito ◽  
Beniamino Guidetti ◽  
Giorgio Cruccu ◽  
Mario Manfredi
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Open Surgery ◽  
Balloon Catheter ◽  
Long Term Results ◽  
Gasserian Ganglion ◽  
Percutaneous Procedures ◽  
Therapeutic Protocol

Abstract From 1976 to 1986, 681 patients with drug-refractory trigeminal neuralgia (TN)—typical in 641, symptomatic of multiple sclerosis in 23 and of tumor in 10, atypical in 5, and postherpetic in 2—were treated with various percutaneous procedures. Controlled differential thermocoagulation of the gasserian ganglion and/or retrogasserian rootlets was performed in 533 patients; glycerolization of the trigeminal cistern in 32; and compression of the gasserian ganglion by balloon catheter in 159, Results and complications of each procedure are assessed at a mean follow-up of 6.5 years for thermocoagulation, 5 years for glycerolization, and 3.5 years for compression. The following therapeutic protocol is proposed: 1) in TN patients at first operation: a) gasserian compression (or glycerolization, if experience warrants it) is indicated in all cases of typical TN, unless the 3rd division alone is affected; b) in the latter case and in symptomatic TN, we suggest thermocoagulation; 2) in recurrences: a) after glycerolization or gasserian compression, gasserian compression (or glycerolization) is indicated; b) after thermocoagulation or open surgery, thermocoagulation is suggested.

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