Sensory abnormalities and masticatory function after microvascular decompression or balloon compression for trigeminal neuralgia compared with carbamazepine and healthy controls

OBJECT Idiopathic trigeminal neuralgia (iTN) is a neurological condition treated with pharmacotherapy or neurosurgery. There is a lack of comparative papers regarding the outcomes of neurosurgery in patients with iTN. The objective of this study was to investigate sensory thresholds and masticatory function in 78 patients with iTN who underwent microvascular decompression (MVD) or balloon compression (BC), and compare these treatments with carbamazepine and 30 untreated healthy controls. METHODS The authors conducted a case-controlled longitudinal study. Patients were referred to 1 of 3 groups: MVD, BC, or carbamazepine. All patients were evaluated before and after treatment with a systematic protocol composed of a clinical orofacial questionnaire, Research Diagnostic Criteria for temporomandibular disorders, Helkimo indices, and a quantitative sensory-testing protocol (gustative, olfactory, cold, warm, touch, vibration, superficial, and deep pain thresholds). RESULTS Both MVD and BC were effective at reducing pain intensity (p = 0.012) and carbamazepine doses (p < 0.001). Myofascial and articular complaints decreased in both groups (p < 0.001), but only the patients in the MVD group showed improvement in Helkimo indices (p < 0.003). Patients who underwent MVD also showed an increase in sweet (p = 0.014) and salty (p = 0.003) thresholds. The sour threshold decreased (p = 0.003) and cold and warm thresholds increased (p < 0.001) in patients after MVD and BC, but only the patients who underwent BC had an increase in touch threshold (p < 0.001). CONCLUSIONS Microvascular decompression and BC resulted in a reduction in myofascial and jaw articular complaints, and the impact on masticatory function according to Helkimo indices was greater after BC than MVD. MVD resulted in more gustative alterations, and both procedures caused impairment in thermal thresholds (warm and cold). However, only BC also affected touch perception. The sensorial and motor deficits after BC need to be included as targets directly associated with the success of the surgery and need to be assessed and relieved as goals in the treatment of iTN.

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NUMERIC RATING SCALE ANALYSIS OF TRIGEMINAL NEURALGIA PATIENTS BEFORE AND AFTER MICROVASCULAR DECOMPRESSION

MNJ (Malang Neurology Journal) ◽

10.21776/ub.mnj.2021.007.01.4 ◽

2021 ◽

Vol 7 (1) ◽

pp. 17-19

Author(s):

Elena Ghentilis Fitri Amelia ◽

Agus Turchan ◽

Nancy Margarita Rehatta ◽

Hanik Badriyah Hidayati

Keyword(s):

Trigeminal Neuralgia ◽

General Hospital ◽

Microvascular Decompression ◽

Facial Pain ◽

Rating Scale ◽

Numeric Rating Scale ◽

Facial Reduction ◽

Normality Test ◽

Before And After ◽

Numeric Rating

Background: Trigeminal Neuralgia is a common condition of facial pain and its significantly affect patients’ daily life. Microvascular decompression is one of the interventional pain management for trigeminal neuralgia. There is still a little data obtained on evaluation of facial pain after microvascular decompression in Indonesia. Objective: This research aimed to evaluate facial pain after microvascular decompression of trigeminal neuralgia patients in Dr. Soetomo General Hospital, PHC Hospital, and Bangil General Hospital, Indonesia. Methods: The research design was a pretest-posttest with total sampling. Data were obtained from medical records from January 2018 until June 2019. Researches used Numeric Rating Scale (NRS) as pain measurement. The data obtained were analyzed by descriptive statistical test, normality test, and paired t-test. Results: Trigeminal Neuralgia patients that has been treated with microvascular decompression have an average facial reduction from 7.33±2.29 to 1.89±3.41 with p = 0.001. This result showed that the microvascular decompression has significantly reduce facial pain in patients with trigeminal neuralgia. Conclusion: Microvascular decompression significantly reduce the facial pain of trigeminal neuralgia patients.

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Secondary Trigeminal Neuralgia (Balloon Compression Rhizolysis)

Pain Neurosurgery ◽

10.1093/med/9780190887674.003.0003 ◽

2019 ◽

pp. 13-22

Author(s):

Jeffrey A. Brown

Keyword(s):

Multiple Sclerosis ◽

Neuropathic Pain ◽

Trigeminal Neuralgia ◽

Success Rate ◽

Microvascular Decompression ◽

Trigeminal Neuropathic Pain ◽

Simple Treatment ◽

Balloon Compression ◽

One Year ◽

Surgical Option

Multiple sclerosis is a common secondary cause of trigeminal neuropathic pain. It occurs because of the presence of sclerotic plaque within the highly myelinated trigeminal pathway. Patients with multiple sclerosis (MS) may also have a vascular compressive etiology; however, the two-year success rate for microvascular decompression is merely 15%. Ablative treatment also has a high pain recurrence rate that is as high as 50% in one year regardless of the surgical option selected. Balloon compression rhizotomy is a simple treatment option in MS patients. When done, the balloon compression site is at the retrogasserian portion of the trigeminal nerve and not the trigeminal ganglion. Balloon compression is associated with a trigeminal depressor response for which one must be prepared to treat with iv atropine.

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Value-based neurosurgery: the example of microvascular decompression surgery

Journal of Neurosurgery ◽

10.3171/2013.9.jns13663 ◽

2014 ◽

Vol 120 (2) ◽

pp. 462-472 ◽

Cited By ~ 14

Author(s):

Nancy McLaughlin ◽

Farzad Buxey ◽

Karen Chaw ◽

Neil A. Martin

Keyword(s):

Trigeminal Neuralgia ◽

Outcome Measures ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Surgical Care ◽

Decompression Surgery ◽

The Mean ◽

Group 2 ◽

The Impact ◽

Group 1

Object Value of care is emerging as a promising framework to restructure health care, emphasizing the importance of reporting multiple outcomes that encompass the entire care episode instead of isolated outcomes specific to care points during a patient's care. The authors assessed the impact of coordinated implementation of processes across the episode of surgical care on value of neurosurgical care, using microvascular decompression (MVD) as an example. Methods This study is a retrospective review of consecutive cases involving patients with either trigeminal neuralgia or hemifacial spasm undergoing first-time MVD. Patients were divided into 2 groups: Group 1 included patients who underwent surgery between February 2008 and November 2009 and Group 2 included those who underwent surgery between January 2011 and October 2012. The authors collected data on outcome measures spanning the entire surgical episode of care according to the Outcome Measures Hierarchy. Results Forty-nine patients were included: 20 patients in Group 1 and 29 patients in Group 2. Thirty-one patients underwent MVD for trigeminal neuralgia and 18 for hemifacial spasm. A zero mortality rate and high degree of symptom resolution were achieved in both groups. Group 2 benefited from a reduction in the average total operating room time, a decrease in the mean and median postoperative length of hospital stay, a decrease in the mean length of stay on the floor, and a reduction in the rates of complications and readmissions. Conclusions Comprehensive implementation of improvement processes throughout the continuum of care resulted in improved global outcome and greater value of delivered care. Enhanced-recovery perioperative protocols and diagnosis-specific clinical pathways are two avenues built around global care delivery that can help achieve an “optimal episode of surgical care” in every case.

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The predictive power of balloon shape and change of sensory functions on outcome of percutaneous balloon compression for trigeminal neuralgia

Journal of Neurosurgery ◽

10.3171/2010.2.jns091466 ◽

2010 ◽

Vol 113 (3) ◽

pp. 498-507 ◽

Cited By ~ 18

Author(s):

Pär Asplund ◽

Bengt Linderoth ◽

A. Tommy Bergenheim

Keyword(s):

Electrical Stimulation ◽

Pain Relief ◽

Trigeminal Neuralgia ◽

Therapeutic Effect ◽

Sensory Function ◽

Careful Study ◽

Balloon Compression ◽

Percutaneous Balloon ◽

Percutaneous Balloon Compression ◽

The Impact

Object Percutaneous balloon compression is a simple and effective treatment of trigeminal neuralgia. However, results between and within different series are varying. To further improve the results in terms of pain relief, the authors believe that a careful study of the surgical procedure is important. The object of this study was to analyze the impact of balloon shape, balloon position, balloon volume, and compression time on duration of the therapeutic effect following percutaneous balloon compression. Furthermore, they analyzed the sensory side effects associated with this treatment, and how these relate to surgical parameters. Methods Medical records and intraoperative radiographs from 87 balloon compressions were reviewed, and different surgical parameters were categorized. Univariate and multivariate analyses were performed to correlate surgical parameters to pain relief. Sensory testing with a transcutaneous electrical stimulation technique and clinical examination data were reviewed to analyze changes in sensory function. Results The balloon shape had a significant impact on time to recurrence of pain. A pear-shaped balloon resulted in a far better surgical result than a non–pear-shaped balloon (p < 0.001). The difference between a distinct and a less distinct pear shape was not significant (p = 0.14). Statistical significance was not reached for any of the other parameters in relation to duration of therapeutic effect. A pear-shaped balloon was also significantly associated with increased thresholds for percutaneous electrical stimulation in the immediate postoperative period, but the perception thresholds were normalized at the late follow-up at 3–9 months. A similar outcome was found for clinical testing with light touch and pinprick. Conclusions The authors have demonstrated that using a pear-shaped balloon when performing percutaneous balloon compression for trigeminal neuralgia results in longer pain relief than non–pear-shaped balloons. Other surgical parameters seemed less important with respect to pain relief. Balloon compression also, in many cases, results in hypesthesia.

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Trigeminal neuralgia recurrence: a comparison of microvascular decompression and percutaneous balloon compression: a five years follow-up study

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x-anp-2020-0115 ◽

2021 ◽

Vol 79 (1) ◽

pp. 51-55

Author(s):

Jennyfer Paulla Galdino CHAVES ◽

Tatiana Von Hertwig Fernandes DE OLIVEIRA ◽

Alexandre Novick FRANCISCO ◽

Mariana de Oliveira TRINTINALHA ◽

Niels Vinicius Pádua CARVALHO

Keyword(s):

Retrospective Study ◽

Pain Relief ◽

Trigeminal Neuralgia ◽

Recurrence Rate ◽

Microvascular Decompression ◽

Recurrence Time ◽

Type I ◽

Balloon Compression ◽

Percutaneous Balloon ◽

Percutaneous Balloon Compression

ABSTRACT Background: About 50% of patients that suffer from trigeminal neuralgia do not experience sustained benefit from the use of oral medication. For their adequate management, a few surgical procedures are available. Of these, percutaneous balloon compression (PBC) and microvascular decompression (MD) are two of the most performed worldwide. In this retrospective study, we present the outcomes of these techniques through estimation of initial pain relief and subsequent recurrence rate. Methods: Thirty-seven patients with medically refractory trigeminal pain surgically treated at Hospital Cajuru, Curitiba, Brazil, with PBC, MD or both between 2013 and 2018 were enrolled into this retrospective study. The post-procedural rate for pain relief and recurrence and associations between patient demographics and outcomes were analyzed. Results: MD had an earlier recurrence time than balloon compression. Of the 37 patients, the mean age was 61.6 years, approximately one third were male and most had type I neuralgia. The most affected branch was the maxillary (V2). The time for recurrence after surgery was on average 11.8 months for PBC and 9.0 months for MD. Complications were seen only with microsurgery. Conclusions: MD presented with a more precocious recurrence of pain than PBC in this article. Moreover, it had a higher recurrence rate than described in the literature as well, which is possibly explained by the type of graft (muscle) that was used to separate the neurovascular structures.

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Sensorimotor functional connectivity in unilateral cerebral palsy: influence of corticospinal tract wiring pattern and clinical correlates

10.1101/515866 ◽

2019 ◽

Author(s):

Cristina Simon-Martinez ◽

Ellen Jaspers ◽

Kaat Alaerts ◽

Els Ortibus ◽

Joshua Balsters ◽

...

Keyword(s):

Cerebral Palsy ◽

Functional Connectivity ◽

Upper Limb ◽

Corticospinal Tract ◽

Motor Deficits ◽

Periventricular White Matter ◽

Healthy Controls ◽

Sensorimotor Network ◽

Unilateral Cerebral Palsy ◽

The Impact

ABSTRACTIn children with unilateral cerebral palsy (uCP), the corticospinal tract (CST) wiring patterns may differ (contralateral, ipsilateral or bilateral), partially determining motor deficits. However, the impact of such CST wiring on functional connectivity remains unknown. Here, we explored differences in functional connectivity of the resting-state sensorimotor network in 26 uCP with periventricular white matter lesions (mean age (SD): 12.87m (±4.5), CST wiring: 9 contralateral, 9 ipsilateral, 6 bilateral) compared to 60 healthy controls (mean age (SD): 14.54 (±4.8)), and between CST wiring patterns. Functional connectivity from each M1 to three bilateral sensorimotor regions of interest (primary sensory cortex, dorsal and ventral premotor cortex) and the supplementary motor area was compared between groups (healthy controls vs. uCP; and healthy controls vs. each CST wiring group). Results from the seed-to-voxel analyses from bilateral M1 were compared between groups. Additionally, relations with upper limb motor deficits were explored. Aberrant sensorimotor functional connectivity seemed to be CST-dependent rather than specific from all the uCP population: in the dominant hemisphere, the contralateral CST group showed increased connectivity between M1 and premotor cortices, whereas the bilateral CST group showed higher connectivity between M1 and somatosensory association areas. These results suggest that functional connectivity of the sensorimotor network is CST wiring-dependent, although the impact on upper limb function remains unclear.

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Comparison of first-time microvascular decompression with percutaneous surgery for trigeminal neuralgia: long-term outcomes and prognostic factors

Acta Neurochirurgica ◽

10.1007/s00701-021-04793-4 ◽

2021 ◽

Author(s):

Imran Noorani ◽

Amanda Lodge ◽

Andrew Durnford ◽

Girish Vajramani ◽

Owen Sparrow

Keyword(s):

Prognostic Factors ◽

Pain Relief ◽

Trigeminal Neuralgia ◽

Microvascular Decompression ◽

Percutaneous Surgery ◽

Long Term Outcomes ◽

Balloon Compression ◽

Percutaneous Procedures ◽

First Time

Abstract Objective Common surgical treatments for trigeminal neuralgia (TN) include microvascular decompression (MVD) and percutaneous procedures (glycerol rhizolysis; thermocoagulation; and balloon compression). Although the efficacy of each procedure has been documented, direct comparisons of their relative efficacies for TN are lacking. We aimed to directly compare long-term outcomes after first-time MVD with percutaneous surgery in primary (idiopathic and classical) TN and identify predictors of outcome. Methods We conducted a retrospective analysis of prospectively collected data on 185 patients undergoing MVD and 129 undergoing percutaneous surgery. Procedures were performed by one of two neurosurgeons in a single centre; an independent observer collected long-term follow-up data by interviews, using the same outcome measures for all procedures. Results MVD patients were younger than those undergoing percutaneous surgery (P <.001). MVD provided superior initial pain relief (P <.001): 87.0% had Barrow Neurological Institute class I or II pain scores after MVD compared with 67.2% after percutaneous surgery. The complication rate for percutaneous procedures was 35.7% and for MVDs was 24.9% (P =.04), including minor and transient complications. Kaplan-Meier analysis demonstrated that MVD provided longer pain relief than percutaneous procedures (P <.001); 25% of patients had recurrence at 96 months following MVD compared with 12 months after percutaneous surgery. Subgroup analysis showed that balloon compression provided more durable relief amongst percutaneous procedures. Multivariate analysis revealed that post-operative numbness and age were prognostic factors for percutaneous procedures (P =.03 and .01, respectively). Conclusions MVD provides better initial pain relief and longer durability of relief than percutaneous surgery, although carrying a small risk of major complications. Amongst percutaneous procedures, balloon compression gave the most durable relief from pain. Older age and post-operative numbness were predictors of good outcome from percutaneous surgery. These results can help clinicians to counsel patients with primary TN on neurosurgical treatment selection for pain relief.

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10 State dissociation and interoception in functional neurological disorder

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2020-bnpa.10 ◽

2020 ◽

Vol 91 (8) ◽

pp. e4.2-e5

Author(s):

Susannah Pick ◽

Morgan Butler ◽

Maya Rojas-Aguiluz ◽

Timothy Nicholson ◽

H Laura

Keyword(s):

Neurological Disorder ◽

Medical Documentation ◽

Aetiological Factor ◽

Healthy Controls ◽

Induction Procedure ◽

Before And After ◽

Interoceptive Accuracy ◽

Mirror Gazing ◽

The Impact ◽

Functional Neurological Disorder

Objective/aimsInteroceptive differences have been proposed as an aetiological factor in functional neurological disorder (FND) but there is limited supportive evidence. Previous studies are few, have mixed findings and assessed only (objective) interoceptive accuracy, but not (metacognitive) interoceptive awareness. The aim of this study was to explore interoception in FND in greater detail, by assessing interoceptive accuracy and awareness in individuals with a range of FND presentations. As dissociative symptoms (e.g., depersonalisation, derealisation) are common in FND and could influence interoception, we sought to examine the effects of induced acute dissociation on interoception. We hypothesised that interoceptive accuracy/awareness would be impaired at baseline in FND relative to healthy controls, but that the differences would be exacerbated following dissociation induction.MethodsTwenty adults with FND were recruited from online FND support groups. Diagnosis was confirmed by medical documentation from a relevant healthcare professional. The FND group was compared to a group of 20 healthy controls recruited from online community groups. A modified heart-beat tracking task measured interoceptive accuracy (correct detection of heart beats) and awareness (confidence judgements). A control task involved counting visually presented geometric shapes. Both tasks were completed before and after a validated dissociation induction procedure (mirror-gazing).ResultsThe FND group reported elevated dissociation at baseline relative to controls (p<0.01) but this difference was larger following mirror-gazing (p<0.001). Interoceptive accuracy did not differ significantly between groups at baseline; however, the FND group had significantly lower accuracy scores following mirror-gazing (p<0.05). There was no effect of group on shape counting accuracy at either timepoint. Confidence ratings on the interoception and shape counting tasks were significantly lower at both timepoints in the FND group relative to controls (all p-values <0.05 or <0.01).ConclusionsIndividuals with FND reported elevated dissociation both before and after a dissociation induction procedure, although this was exacerbated post-dissociation induction. In contrast, interoceptive accuracy was unimpaired at baseline, but impaired following dissociation induction, relative to controls. The FND group showed reduced metacognitive awareness for detection of bodily states and external (visual) stimuli. Future research should better determine the nature of interoceptive deficits in FND and assess the impact of dissociation on a range of cognitive and affective processes relevant to the disorder.

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