scholarly journals Trigeminal interfascicular neurolysis (nerve combing) for refractory recurrent neuralgia in multiple sclerosis

2020 ◽  
Vol 3 (2) ◽  
pp. V3
Author(s):  
Paolo Ferroli ◽  
Ignazio G. Vetrano ◽  
Francesco Acerbi ◽  
Gabriella Raccuia ◽  
Marco Schiariti ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Medical Therapy ◽  
Myelin Sheath ◽  
Neurovascular Conflict ◽  
Entry Zone ◽  
Link Type ◽  
Root Entry Zone ◽  
Good Pain Relief

In multiple sclerosis (MS) patients, trigeminal neuralgia (TN) represents a challenging syndrome to treat, often refractory to medical therapy and percutaneous techniques. Despite the frequent lack of a neurovascular conflict, the trigeminal nerve’s axons are often damaged, with the myelin sheath permanently degenerated, thus explaining the difficulty in treating TN in MS.The authors illustrate trigeminal interfascicular neurolysis (the combing technique) to control refractory recurrent TN in MS: the nerve is longitudinally divided along its fibers from the root entry zone, determining good pain relief.The video can be found here: https://youtu.be/o1XksPW5fMY

Dorsal root entry zone lesions for the treatment of post-herpetic neuralgia

1984 ◽  
Vol 60 (6) ◽  
pp. 1258-1262 ◽  
Author(s):  
Allan H. Friedman ◽  
Blaine S. Nashold ◽  
Janice Ovelmen-Levitt
Keyword(s):  
Pain Relief ◽  
Dorsal Root ◽  
Post Herpetic Neuralgia ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Adequate Pain Relief ◽  
Good Pain Relief ◽  
Transcutaneous Nerve Stimulation

✓ Post-herpetic pain was treated in 12 patients using dorsal root entry zone (DREZ) lesions. All patients had failed to receive adequate pain relief from conservative therapy consisting of transcutaneous nerve stimulation, carbamazepine, and/or amitriptyline. Dorsal root entry zone lesions were made to include the involved dermatomes plus one-half of the dermatomes above and below the painful areas. Eight patients reported good pain relief with follow-up periods ranging from 6 to 21 months. A ninth patient obtained satisfactory pain relief, but the superior 1 cm of the original painful area was not included in the distribution of the DREZ lesions. Patients whose lesions were performed using a thermally controlled lesion probe suffered no significant postoperative neurological deficit. Dorsal root entry zone lesions appeared to be a satisfactory treatment for post-herpetic neuralgia in patients who have failed to respond to more conservative modes of therapy.

Cluster Headache-Like Pain in Multiple Sclerosis

Cephalalgia ◽  
1999 ◽  
Vol 19 (8) ◽  
pp. 732-734 ◽  
Author(s):  
M Leandri ◽  
G Craccu ◽  
A Gottlieb
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Cluster Headache ◽  
Evoked Potentials ◽  
Simultaneous Occurrence ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Trigeminal Root

We describe a case with simultaneous occurrence of cluster headache-like pain and multiple sclerosis. Both neuroimaging and neurophysiology (trigeminal evoked potentials) revealed a demyelination plaque in the pons, at the trigeminal root entry zone, on the side of pain. Although that type of lesion is usually associated with trigeminal neuralgia pain, we hypothesize that in this case it may be linked with the concomitant cluster headache, possibly by activation of trigemino-vascular mechanisms.

Trigeminal Neuralgia and Multiple Sclerosis

Neurosurgery ◽  
1979 ◽  
Vol 5 (6) ◽  
pp. 711-717 ◽  
Author(s):  
Martin L. Lazar ◽  
Joel B. Kirkpatrick
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Nerve Root ◽  
Superior Cerebellar Artery ◽  
Electron Microscopic ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Cerebellar Artery ◽  
Microsurgical Approach ◽  
Electron Microscopic Demonstration

Abstract Trigeminal neuralgia is unique to humans. The most common cause seems to be an injury to the myelin of the trigeminal nerve root entry zone as it extends for several millimeters lateral to the pons. Jannetta has developed an elegant retromastoid microsurgical approach to this region. He has identified a compression-distortion phenomenon of this nerve root entry zone, usually from an anomalous position of the superior cerebellar artery. Trigeminal neuralgia can also occur in association with multiple sclerosis, when the plaque lies in this same location. The historical evidence for this explanation is reinforced by the electron microscopic demonstration of the plaque in this region in a patient with multiple sclerosis who was suffering from tic douloureux.

Diffusivity signatures characterize trigeminal neuralgia associated with multiple sclerosis

2015 ◽  
Vol 22 (1) ◽  
pp. 51-63 ◽  
Author(s):  
David Q Chen ◽  
Danielle D DeSouza ◽  
David J Hayes ◽  
Karen D Davis ◽  
Paul O’Connor ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Pain Syndrome ◽  
Neurovascular Compression ◽  
Neuropathic Pain Syndrome ◽  
Entry Zone ◽  
Non Invasive ◽  
Root Entry Zone ◽  
Mr Diffusion ◽  
3T Mr

Background: Trigeminal neuralgia secondary to multiple sclerosis (MS-TN) is a facial neuropathic pain syndrome similar to classic trigeminal neuralgia (TN). While TN is caused by neurovascular compression of the fifth cranial nerve (CN V), how MS-related demyelination correlates with pain in MS-TN is not understood. Objectives: We aim to examine diffusivities along CN V in MS-TN, TN, and controls in order to reveal differential neuroimaging correlates across groups. Methods: 3T MR diffusion weighted, T1, T2 and FLAIR sequences were acquired for MS-TN, TN, and controls. Multi-tensor tractography was used to delineate CN V across cisternal, root entry zone (REZ), pontine and peri-lesional segments. Diffusion metrics including fractional anisotropy (FA), and radial (RD), axial (AD), and mean diffusivities (MD) were measured from each segment. Results: CN V segments showed distinctive diffusivity patterns. The TN group showed higher FA in the cisternal segment ipsilateral to the side of pain, and lower FA in the ipsilateral REZ segment. The MS-TN group showed lower FA in the ipsilateral peri-lesional segments, suggesting differential microstructural changes along CN V in these conditions. Conclusions: The study demonstrates objective differences in CN V microstrucuture in TN and MS-TN using non-invasive neuroimaging. This represents a significant improvement in the methods currently available to study pain in MS.

Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit

1996 ◽  
Vol 84 (6) ◽  
pp. 940-945 ◽  
Author(s):  
Douglas Kondziolka ◽  
L. Dade Lunsford ◽  
John C. Flickinger ◽  
Ronald F. Young ◽  
Sandra Vermeulen ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Stereotactic Radiosurgery ◽  
Good Control ◽  
Dose Selection ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Fine Print

✓ A multiinstitutional study was conducted to evaluate the technique, dose-selection parameters, and results of gamma knife stereotactic radiosurgery in the management of trigeminal neuralgia. Fifty patients at five centers underwent radiosurgery performed with a single 4-mm isocenter targeted at the nerve root entry zone. Thirty-two patients had undergone prior surgery, and the mean number of procedures that had been performed was 2.8 (range 1–7). The target dose of the radiosurgery used in the current study varied from 60 to 90 Gy. The median follow-up period after radiosurgery was 18 months (range 11–36 months). Twenty-nine patients (58%) responded with excellent control (pain free), 18 (36%) obtained good control (50%–90% relief), and three (6%) experienced treatment failure. The median time to pain relief was 1 month (range 1 day–6.7 months). Responses remained consistent for up to 3 years postradiosurgery in all cases except three (6%) in which the patients had pain recurrence at 5, 7, and 10 months. At 2 years, 54% of patients were pain free and 88% had 50% to 100% relief. A maximum radiosurgical dose of 70 Gy or greater was associated with a significantly greater chance of complete pain relief (72% vs. 9%, p = 0.0003). Three patients (6%) developed increased facial paresthesia after radiosurgery, which resolved totally in one case and improved in another. No patient developed other deficits or deafferentation pain. The proximal trigeminal nerve and root entry zone, which is well defined on magnetic resonance imaging, is an appropriate anatomical target for radiosurgery. Radiosurgery using the gamma unit is an additional effective surgical approach for the management of medically or surgically refractory trigeminal neuralgia. A longer-term follow-up review is warranted.

Radiosurgical Treatmement of Trigeminal Neuralgia: Pain Relief Correlates with Root Entry Zone Dose

Neurosurgery ◽  
1999 ◽  
Vol 45 (3) ◽  
pp. 737-737 ◽  
Author(s):  
Nicholas Barbaro ◽  
Patricia Sneed ◽  
Mariann Ward ◽  
Michael McDermott
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Entry Zone ◽  
Root Entry Zone

Dorsal Root Entry Zone Lesions for the Treatment of Brachial Plexus Avulsion Injuries: A Follow-up Study

Neurosurgery ◽  
1988 ◽  
Vol 22 (2) ◽  
pp. 369-373 ◽  
Author(s):  
Allan H. Friedman ◽  
Blaine S. Nashold ◽  
Peter R. Bronec
Keyword(s):  
Pain Relief ◽  
Brachial Plexus ◽  
Dorsal Root ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Avulsion Injury ◽  
Brachial Plexus Avulsion ◽  
Root Entry Zone ◽  
Good Pain Relief

Abstract Dorsal root entry zone (DREZ) lesions have been shown to yield short term relief from the pain associated with a brachial plexus avulsion injury. Because of the propensity of pain to recur after neuroablative procedures, 39 patients with pain after a brachial plexus avulsion injury were observed for 14 months to 10 years after DREZ lesions were made. Fifty-four per cent of these patients were afforded good pain relief. Of 21 patients who had multiple small lesions made within the DREZ, 15 (72%) were afforded good pain relief. (Neurosurgery 22:369-373, 1988)

scholarly journals Trigeminal Neuralgia and Multiple Sclerosis: A Historical Perspective

2017 ◽  
Vol 44 (5) ◽  
pp. 589-593 ◽  
Author(s):  
David B. Burkholder ◽  
Peter J. Koehler ◽  
Christopher J. Boes
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
English Language ◽  
Language Translation ◽  
Original Text ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Trigeminal Root ◽  
Early English ◽  
Hermann Oppenheim

AbstractTrigeminal neuralgia (TN) associated with multiple sclerosis (MS) was first described in Lehrbuch der Nervenkrankheiten für Ärzte und Studirende in 1894 by Hermann Oppenheim, including a pathologic description of trigeminal root entry zone demyelination. Early English-language translations in 1900 and 1904 did not so explicitly state this association compared with the German editions. The 1911 English-language translation described a more direct association. Other later descriptions were clinical with few pathologic reports, often referencing Oppenheim but citing the 1905 German or 1911 English editions of Lehrbuch. This discrepancy in part may be due to the translation differences of the original text.

scholarly journals Teflon bridge technique for endoscopic-assisted microvascular decompression of ectatic basilar artery and anterior inferior cerebellar artery for trigeminal neuralgia: operative video and technical nuances

2020 ◽  
Vol 3 (2) ◽  
pp. V5
Author(s):  
James K. Liu ◽  
Asif Shafiq
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Basilar Artery ◽  
Microvascular Decompression ◽  
Facial Pain ◽  
Anterior Inferior Cerebellar Artery ◽  
Safe Alternative ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Cerebellar Artery

In this illustrative operative video, the authors demonstrate a Teflon bridge technique to achieve safe transposition of a large, tortuous ectatic basilar artery (BA) and anterior inferior cerebellar artery (AICA) complex to decompress the root entry zone (REZ) of the trigeminal nerve in a 61-year-old woman with refractory trigeminal neuralgia via an endoscopic-assisted retractorless microvascular decompression. Postoperatively, the patient experienced immediate facial pain relief without requiring further medications. The Teflon bridge technique can be a safe alternative to sling techniques when working in narrow surgical corridors between delicate nerves and vessels. The operative technique and surgical nuances are demonstrated.The video can be found here: https://youtu.be/hIHX7EvZc1c

Linear Accelerator Radiosurgery Using 90 Gray for Essential Trigeminal Neuralgia: Results and Dose Volume Histogram Analysis

Neurosurgery ◽  
2003 ◽  
Vol 53 (4) ◽  
pp. 823-830 ◽  
Author(s):  
Bryan W. Goss ◽  
Leonardo Frighetto ◽  
Antonio A.F. DeSalles ◽  
Zachary Smith ◽  
Timothy Solberg ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Nerve Root ◽  
Linear Accelerator ◽  
Treatment Plan ◽  
Case Series ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Dose Volume ◽  
Facial Numbness

Abstract OBJECTIVE To evaluate treatment of essential trigeminal neuralgia with 90 Gy delivered by a linear accelerator dedicated to radiosurgery. METHODS This is a retrospective case series of 25 patients with essential trigeminal neuralgia treated from March 1999 to March 2001. All were treated with 90 Gy by means of a 5-mm collimator directed to the nerve root entry zone. Patient follow-up (range, 8–52 mo; median, 18 mo) was completed by an uninvolved party. Dose volume histograms of the brainstem were developed for the 20, 30, and 50% isodose lines by means of radiosurgery planning software. RESULTS All patients obtained good to excellent pain relief with treatment. Nineteen (76%) of 25 patients achieved excellent pain relief (pain-free without medication). Six patients (24%) achieved good pain relief (50–90% reduction of pain with or without medication). Median time to pain relief was 2 months. Eight patients (32%) experienced relapse 4 to 13 months after treatment. Eight patients (32%) developed facial numbness, but none developed painful numbness. Mean brainstem volume within the 50% isodose line and occurrence of numbness was statistically significant (P = 0.03). There was no correlation between brainstem volume treated and outcome. CONCLUSION Dedicated linear accelerator-based stereotactic radiosurgery that uses a 5-mm collimator to deliver 90 Gy to the nerve root entry zone is a safe and effective method for the treatment of essential trigeminal neuralgia. Care should be taken to limit brainstem volume included in the 50% isodose line in the treatment plan to avoid facial numbness.

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