scholarly journals Neuronavigated percutaneous approach to the sphenopalatine ganglion

2017 ◽  
Vol 126 (2) ◽  
pp. 375-378 ◽  
Author(s):  
Nicola Benedetto ◽  
Paolo Perrini
Keyword(s):  
Trigeminal Neuralgia ◽  
Cluster Headache ◽  
Gold Standard ◽  
Facial Pain ◽  
Technical Note ◽  
Sphenopalatine Ganglion ◽  
Atypical Facial Pain ◽  
Percutaneous Approach ◽  
Percutaneous Procedures ◽  
First Time

The sphenopalatine ganglion (SPG) has been assumed to be involved in the genesis of several types of facial pain, including Sluder's neuralgia, trigeminal neuralgia, persistent idiopathic facial pain, cluster headache, and atypical facial pain. The gold standard treatments for SPG-related pain are percutaneous procedures performed with the aid of fluoroscopy or CT. In this technical note the authors present, for the first time, an SPG approach using the aid of a neuronavigator.

Facial pain

2018 ◽  
Author(s):  
Paul Davies
Keyword(s):  
Differential Diagnosis ◽  
Trigeminal Neuralgia ◽  
Parotid Gland ◽  
Cluster Headache ◽  
Effective Treatment ◽  
Facial Pain ◽  
Cervical Spondylosis ◽  
Atypical Facial Pain ◽  
Neurological Syndrome ◽  
Persistent Idiopathic Facial Pain

Facial pain occupies the area below the orbitomeatal line, above the neck and anterior to the pinnae. It comes in many forms and may or may not be accompanied by other symptoms. It may be acute, subacute, or chronic, arise from local pathology (e.g. dentition, parotid gland, sinus), be referred from other structures (e.g. pain behind the eye may be due to cervical spondylosis or sphenoidal sinusitis) or be part of a neurological syndrome such as trigeminal neuralgia or persistent idiopathic facial pain (previously termed atypical facial pain). There is a wide differential diagnosis. As with headache, serious causes are rare. Some benign conditions are particularly painful (trigeminal neuralgia, cluster headache) but have effective treatment.

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 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.

Treatment of trigeminal neuralgia with linear accelerator radiosurgery: initial results

2004 ◽  
pp. 346-350 ◽  
Author(s):  
Joseph C. T. Chen ◽  
Michael Girvigian ◽  
Hugh Greathouse ◽  
Michael Miller ◽  
Javad Rahimian
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Linear Accelerator ◽  
Facial Pain ◽  
Recurrent Pain ◽  
Content Type ◽  
Percutaneous Procedures ◽  
Single Isocenter ◽  
Initial Results ◽  
Fine Print

Object. Radiosurgery has emerged as an important treatment of trigeminal neuralgia. Substantial advantages have been demonstrated in safety and comfort over other modalities. Radiosurgical treatment of trigeminal neuralgia has been well investigated with gamma knife devices involving fixed cobalt sources. Few reports exist concerning trigeminal neuralgia treated using linear accelerator (LINAC)—based devices. In recent years these devices have reached the level of mechanical precision that is required for such functional treatments. The authors describe their initial experience with radiosurgical treatment of trigeminal neuralgia when using a BrainLAB Novalis LINAC device equipped with the commercially available 4-mm collimator. Methods. A total of 32 patients were treated in a 12-month period between November 2002 and November 2003. The median patient age was 67 years (range 38–84 years). Facial pain was graded using the Barrow Neurological Institute (BNI) scoring system. All patients' pain was BNI Grade IV or V prior to treatment. Of these patients, 22 were undergoing initial treatment, and 10 were undergoing retreatment for recurrent pain following various treatments including percutaneous procedures, gamma knife surgery (GKS), or microvascular decompression. Two patients had multiple sclerosis. In patients undergoing initial radiosurgery, the most proximal segment of the cisternal portion of the trigeminal nerve received 85 to 90 Gy administered in a 5— or 7—noncoplanar arc single-isocenter plan with a 4-mm circular collimator. In patients undergoing repeated radiosurgery, the target received 60 Gy. Overall good and excellent results (BNI Grade I, II, or III) were achieved in 25 (78%) of 32 patients. The median time to pain relief was 6 weeks. Fair results (improvement in pain with BNI Grade IV) were achieved in three patients (9%), and poor results (no improvement in pain and BNI Grade IV or V) were seen in four (13%). Two patients demonstrated new trigeminal dysfunction following treatment. No other complications occurred. Conclusions. High-precision imaging and LINAC instrumentation have allowed for treatment of trigeminal neuralgia with results and safety comparable to those achieved using GKS. Linear accelerator—based radiosurgery with the Novalis device is a safe and effective method of managing trigeminal neuralgia and may become the preferred means at centers where the technology is available.

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.

Trigeminal Neuralgia and Atypical Facial Pain

2012 ◽  
pp. 398-413
Author(s):  
Trang Nguyen ◽  
Pablo F. Recinos ◽  
Michael Lim
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Atypical Facial Pain

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...

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