Sensory effects of microvascular decompression in trigeminal neuralgia

1997 ◽  
Vol 86 (2) ◽  
pp. 193-196 ◽  
Author(s):  
John B. Miles ◽  
Paul R. Eldridge ◽  
Carol E. Haggett ◽  
David Bowsher
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Nerve Root ◽  
Content Type ◽  
Idiopathic Trigeminal Neuralgia ◽  
Sensory Effects ◽  
Tomographic Angiography ◽  
Fine Print ◽  
Von Frey Filaments

✓ Nineteen patients with “idiopathic” trigeminal neuralgia, who had not undergone any previous interventional procedures, possessed a vessel or vessels compressing the preganglionic nerve root that was demonstrated by magnetic resonance tomographic angiography. Pain was relieved immediately in all of these patients after they underwent microvascular decompression without observed nerve damage. Although preoperative measurement of sensory perception thresholds showed elevations in the thresholds for touch (von Frey filaments) and warmth and coolness sensations, these thresholds normalized during the postoperative period. An apparent deficit in the pinprick (sharpness) sensation appeared postoperatively, but the deficit gradually regressed and completely disappeared by 1 year after surgery; this phenomenon may have been a statistical anomaly. The patients' pain disappeared immediately postoperatively and remained absent throughout the follow-up period. The authors conclude that damage to the nerve or nerve root is not essential for the relief of trigeminal neuralgia.

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.

Microvascular decompression for trigeminal neuralgia in Charcot-Marie-Tooth disease

2000 ◽  
Vol 92 (4) ◽  
pp. 715-717 ◽  
Author(s):  
Marcus de Matas ◽  
Peter Francis ◽  
John B. Miles
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Preoperative Imaging ◽  
Content Type ◽  
Charcot Marie Tooth ◽  
Charcot Marie Tooth Disease ◽  
Second Procedure ◽  
Tomographic Angiography ◽  
Fine Print ◽  
Tooth Disease

✓ The authors report on three patients suffering from coexistent trigeminal neuralgia (TGN) and Charcot-Marie-Tooth disease who, based on preoperative magnetic resonance tomographic angiography findings, underwent microvascular decompression. All patients had demonstrable neural compression and all experienced immediate postoperative pain relief. Symptoms recurred in one patient and required a second procedure in the form of a neurotomy. Two patients suffered from bilateral TGN.When a patient with TGN suffers coexistent neurological disease and experiences bilateral symptoms, preoperative imaging and subsequent decompressive surgery may avoid the unacceptable risk of morbidity associated with bilateral ablative procedures.

Success of microvascular decompression with and without prior surgical therapy for trigeminal neuralgia

1984 ◽  
Vol 60 (1) ◽  
pp. 104-107 ◽  
Author(s):  
David Barba ◽  
John F. Alksne
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Predictors Of Outcome ◽  
Content Type ◽  
Patient Interviews ◽  
Total Pain ◽  
Primary Procedure ◽  
Clinical Records ◽  
Fine Print

✓ Clinical records and patient interviews in 37 cases of trigeminal neuralgia treated by microvascular decompression by a single surgeon were studied retrospectively. Outcomes were determined with an average follow-up period of 43 months. Abnormalities in the region of the trigeminal nerve were identified in each case. Patients undergoing microvascular decompression as a primary procedure were cured (total pain relief without further therapy) at a rate of 91%, versus 43% in patients treated with destructive procedures (rhizotomies) prior to microvascular decompression (p < 0.005). Analysis also suggests that trigeminal neuralgia of greater than 9 years' duration was cured at a rate of only 42%, versus 88% in cases of less lengthy duration (p < 0.005). Sex and age at time of surgery were not significant predictors of outcome. There were no deaths in this group of patients aged from 32 to 90 years. A horizontal surgical approach is described.

Microvascular decompression for trigeminal neuralgia

1982 ◽  
Vol 57 (4) ◽  
pp. 487-490 ◽  
Author(s):  
Robert Breeze ◽  
Ronald J. Ignelzi
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Late Recurrence ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Early Success ◽  
Trigeminal Nerve Root ◽  
Fine Print

✓ Fifty-one consecutive patients with trigeminal neuralgia underwent 52 procedures for microvascular decompression of the trigeminal nerve root entry zone. There was an 85% early success rate; however, after a longer follow-up period, a 13% late recurrence rate was found. In all, 60% of the patients experienced some form of complication, but in only 23% was the complication persistent.

Trigeminal neuralgia: a quantitative sensory perception threshold study in patients who had not undergone previous invasive procedures

1997 ◽  
Vol 86 (2) ◽  
pp. 190-192 ◽  
Author(s):  
David Bowsher ◽  
John B. Miles ◽  
Carol E. Haggett ◽  
Paul R. Eldridge
Keyword(s):  
Trigeminal Neuralgia ◽  
Sensory Perception ◽  
Gasserian Ganglion ◽  
Invasive Procedures ◽  
Perception Threshold ◽  
Content Type ◽  
Idiopathic Trigeminal Neuralgia ◽  
Tactile Threshold ◽  
Fine Print ◽  
Von Frey Filaments

✓ The authors investigated 28 patients with “idiopathic” trigeminal neuralgia who had undergone no previous invasive procedures; together these patients had a total of 50 affected trigeminal divisions. Quantitative sensory perception thresholds were measured before operation. Preoperative measurements in the affected divisions indicated raised thresholds for touch (von Frey filaments) and temperature, but not for pinprick or heat pain, in agreement with the findings of Nurmikko. Only the tactile threshold was also significantly affected in the unaffected divisions on the affected side. The authors discuss their findings in relation to the pathophysiology of trigeminal neuralgia, concluding that the origin of the condition is almost certainly central to the gasserian ganglion.

Percutaneous retrogasserian glycerol rhizotomy for patients with idiopathic trigeminal neuralgia: a prospective analysis of factors related to pain relief

2005 ◽  
Vol 102 (2) ◽  
pp. 223-228 ◽  
Author(s):  
Bruce E. Pollock
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Content Type ◽  
Idiopathic Trigeminal Neuralgia ◽  
Glycerol Injection ◽  
Pain Outcomes ◽  
Pain Outcome ◽  
The Mean ◽  
Fine Print

Object. The goal of this study was to analyze prospectively factors associated with facial pain outcomes after percutaneous retrogasserian glycerol rhizotomy (PRGR) for patients with medically unresponsive idiopathic trigeminal neuralgia. Methods. Between July 1999 and December 2003, 98 patients underwent PRGR in the manner described by Håkanson. The mean patient age was 72.1 years and the average pain duration prior to PRGR was 8.6 years. Fifty patients (51%) had previously undergone surgery. In six patients (6%), the trigeminal cistern could not be defined and the procedure was aborted; six patients were lost to follow-up review. An excellent facial pain outcome was defined as the absence of facial pain without medications. Thirty-two (35%) of 92 patients either received no benefit (17 patients) or experienced recurrent pain (15 patients) and required additional surgery at a mean of 7.5 months after PRGR; the mean duration of follow-up review in the other 60 patients was 28.7 months (range 3–52 months). Including patients who did not receive a glycerol injection, the 1- and 3-year chances of an excellent facial pain outcome were 61 and 50%, respectively. A multivariate analysis of clinical and surgical factors showed that the facial pain exhibited on glycerol injection correlated with excellent facial pain outcomes (relative risk [RR] = 1.02; 95% confidence interval [CI] 0.26–1.77; p < 0.01), whereas patients who experienced any constant pain less frequently had excellent outcomes (RR = 1.13; 95% CI 0.06–2.20; p = 0.04). Forty-six patients (53%) experienced either mild numbness/parathesias (39 patients) or dysesthesias (seven patients). New trigeminal deficits after PRGR were associated with excellent facial pain outcomes (RR = 1.25; 95% CI 0.56–1.93; p < 0.001). Conclusions. Percutaneous retrogasserian glycerol rhizotomy remains a good operation for patients with medically unresponsive trigeminal neuralgia who are considered poor candidates for posterior fossa exploration. Predictive factors for success include patients without any constant facial pain, patients with immediate facial pain during glycerol injection, and patients with new trigeminal deficits after PRGR.

Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia

1989 ◽  
Vol 71 (3) ◽  
pp. 359-367 ◽  
Author(s):  
Joshua B. Bederson ◽  
Charles B. Wilson
Keyword(s):  
Trigeminal Neuralgia ◽  
Posterior Fossa ◽  
Microvascular Decompression ◽  
Nerve Root ◽  
Trigeminal System ◽  
Vascular Compression ◽  
Duration Of Symptoms ◽  
Content Type ◽  
The Mean

✓ Outcome after 252 posterior fossa explorations for the treatment of trigeminal neuralgia was determined by a retrospective review. Patients with distortion of the fifth nerve root caused by extrinsic vascular compression underwent microvascular decompression, those with no compression underwent partial sensory rhizotomy, and those with vascular contact but no distortion of the nerve root underwent decompression and rhizotomy. The mean follow-up period was 5.1 years. An excellent (75%) or good (8%) clinical outcome was achieved in 208 patients; 13 patients (5%) experienced little or no pain relief. Thirty-one patients (12%) suffered recurrent trigeminal neuralgia an average of 1.9 pain-free years after operation; recurrence continued at a rate of approximately 2% per year thereafter. Reoperation for recurrent or persistent pain provided excellent or good results in 85% of reoperated patients, but partial sensory rhizotomy was required in most of these patients. Outcome was affected by previous surgical procedures. A previous percutaneous radiofrequency lesion was associated with a significantly greater incidence of fifth nerve complications and a worse outcome after posterior fossa exploration. Because of this finding, the authors recommend that percutaneous radiofrequency rhizolysis be reserved for patients who have failed posterior fossa exploration or who are not candidates for surgery. Patients with compressive nerve root distortion and a short duration of symptoms before surgery had a significantly better outcome than patients with a longer duration of symptoms. In contrast, there was no relationship between the duration of symptoms and outcome of patients without nerve root distortion. Vascular decompression may cause dysfunction of the trigeminal system in tic douloureux, but in patients who remain untreated for long periods an intrinsic abnormality develops that may perpetuate pain even after microvascular decompression. Posterior fossa exploration is recommended as the procedure of choice for patients with trigeminal neuralgia who are surgical candidates.

Evaluation of endorphin content in the CSF of patients with trigeminal neuralgia before and after Gasserian ganglion thermocoagulation

1981 ◽  
Vol 55 (6) ◽  
pp. 935-937 ◽  
Author(s):  
Giuseppe Salar ◽  
Salvatore Mingrino ◽  
Marco Trabucchi ◽  
Angelo Bosio ◽  
Carlo Semenza
Keyword(s):  
Cerebrospinal Fluid ◽  
Trigeminal Neuralgia ◽  
Control Group ◽  
Gasserian Ganglion ◽  
Content Type ◽  
Group Of Seven ◽  
Idiopathic Trigeminal Neuralgia ◽  
Significant Difference ◽  
Before And After ◽  
Fine Print

✓ The β-endorphin content in cerebrospinal fluid (CSF) was evaluated in 10 patients with idiopathic trigeminal neuralgia during medical treatment (with or without carbamazepine) and after selective thermocoagulation of the Gasserian ganglion. These values were compared with those obtained in a control group of seven patients without pain problems. No statistically significant difference was found between patients suffering from trigeminal neuralgia and those without pain. Furthermore, neither pharmacological treatment nor surgery changed CSF endorphin values. It is concluded that there is no pathogenetic relationship between trigeminal neuralgia and endorphins.

Bilateral trigeminal neuralgia: a 14-year experience with microvascular decompression

1988 ◽  
Vol 68 (4) ◽  
pp. 559-565 ◽  
Author(s):  
Ian F. Pollack ◽  
Peter J. Jannetta ◽  
David J. Bissonette
Keyword(s):  
Trigeminal Neuralgia ◽  
Posterior Fossa ◽  
Microvascular Decompression ◽  
Pain Control ◽  
Symptom Control ◽  
Sensory Loss ◽  
Content Type ◽  
Cranial Nerve Dysfunction ◽  
Ablative Procedures ◽  
Fine Print

✓ Thirty-five patients with trigeminal neuralgia (TN) bilaterally underwent posterior fossa microvascular decompression (MVD) between 1971 and 1984. They comprised 5.0% of a larger series of 699 patients with TN who underwent MVD during that interval. Compared to the subgroup of 664 patients with only unilateral symptoms, the population with bilateral TN included a greater percentage of females (74% vs. 58%, p < 0.1), a higher rate of “familial” TN (17% vs. 4.1%, p < 0.001), and an increased incidence of additional cranial nerve dysfunction (17% vs. 6.6%, p < 0.05) and hypertension (34% vs. 19%, p < 0.05). Of the 35 patients with bilateral TN, 10 underwent bilateral MVD (22 procedures) and 25 underwent unilateral MVD (30 procedures). In the latter patients, pain on the nonoperative side was well controlled with medication alone or had previously been treated by ablative procedures. Good or excellent pain control was achieved after one MVD was performed in 40 of the 45 sides treated (89%), and was maintained 1, 5, and 10 years after surgery in 82%, 66%, and 60%, respectively, based on life-table analysis. Six of 10 patients with recurrent symptoms underwent repeat unilateral MVD. Good or excellent long-term pain control was maintained in all six. With these repeat procedures included, symptom control at 1, 5, and 10 years after initial surgery was maintained in 87%, 78%, and 78% of the treated sides, respectively. Overall, 26 of 35 patients (74%) maintained good or excellent pain relief throughout the duration of the study (mean follow-up period 75 months) without resumption of regular medication usage. Although preoperative neurological deficits resulting from previous ablative procedures were seen in the majority of patients before MVD, no patient developed new major trigeminal sensory loss or masseter weakness after MVD. Operative mortality was zero. The results indicate that posterior fossa MVD is an effective and relatively safe treatment for the majority of patients with bilateral “idiopathic” TN, avoiding the risks of bilateral trigeminal nerve injury seen with other approaches.

Microvascular decompression of cranial nerves: lessons learned after 4400 operations

1999 ◽  
Vol 90 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Mark R. McLaughlin ◽  
Peter J. Jannetta ◽  
Brent L. Clyde ◽  
Brian R. Subach ◽  
Christopher H. Comey ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Trigeminal Neuralgia ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Cranial Nerve ◽  
Glossopharyngeal Neuralgia ◽  
Complication Rates ◽  
Content Type ◽  
Csf Leakage ◽  
Fine Print

Object. Microvascular decompression has become an accepted surgical technique for the treatment of trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, and other cranial nerve rhizopathies. The senior author (P.J.J.) began performing this procedure in 1969 and has performed more than 4400 operations. The purpose of this article is to review some of the nuances of the technical aspects of this procedure.Methods. A review of 4415 operations shows that numerous modifications to the technique of microvascular decompression have occurred during the last 29 years. Of the 2420 operations performed for trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia before 1990, cerebellar injury occurred in 21 cases (0.87%), hearing loss in 48 (1.98%), and cerebrospinal fluid (CSF) leakage in 59 cases (2.44%). Of the 1995 operations performed since 1990, cerebellar injuries declined to nine cases (0.45%), hearing loss to 16 (0.8%), and CSF leakage to 37 (1.85% p < 0.01, test for equality of distributions). The authors describe slight variations made to maximize surgical exposure and minimize potential complications in each of the six principal steps of this operation. These modifications have led to decreasing complication rates in recent years.Conclusions. Using the techniques described in this report, microvascular decompression is an extremely safe and effective treatment for many cranial nerve rhizopathies.

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