Trigeminal Neuralgy

The objective of this review was to present information on the main causes, possible treatments and morpho-quantitative aspects of trigeminal neuralgia. Trigeminal neuralgia is a condition characterized by intense facial pain, severe throbbing or stabbing; it is usually unilateral and recurrent and is located in the facial area innervated by the trigeminal nerve. The causes of this disease are varied and include neurovascular compression stresses. Medical treatment of choice is carbamazepine, reserving surgical treatment for cases resistant to medical therapy or cases when side effects of drugs used, outweigh the risks and disadvantages of surgery. In this context a detailed knowledge of the structure of the trigeminal nerve and its morphoquantitative characteristics could provide relevant information to make type of treatment more effective.

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MRI-derived neurovascular compression score provides the indication of surgical treatment of patients with primary trigeminal neuralgia: A validated multi-center study

10.21203/rs.3.rs-40269/v1 ◽

2020 ◽

Author(s):

Jian Shen ◽

Wenli Zhou ◽

Weiqiang Shen ◽

Huimei Zhang ◽

Xianfang Hu ◽

...

Keyword(s):

Surgical Treatment ◽

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Scoring System ◽

Diagnostic Performance ◽

False Positive Rate ◽

Radiological Finding ◽

Neurovascular Compression ◽

Mri Findings ◽

Tof Mra

Abstract Background The radiological assessment of neurovascular compression (NVC) is various regarding MRI techniques and assessing methods in patients with trigeminal neuralgia (TN), and the false-positive rate of MRI findings is not low. Better MRI techniques with the NVC assessing method are warranted to be determined. This study aims to investigate the diagnostic performance of 3D TOF MRA and 3D Fast Imaging Employing Steady-state Acquisition (FIESTA) with a novel NVC scoring system in TN patients. Methods Patients with confirmed TN who underwent MRI studies before microvascular decompression (MVD) were retrospectively included into the study. A new NVC scoring system based on the contact relationship of the trigeminal nerve and the vessel was performed to assess the NVC in the symptomatic and contralateral asymptomatic side. The radiological finding was correlated with the intraoperative result to figure out the diagnostic accuracy of MRI techniques. Besides, the comparison of both sides was performed to determine the radiological indicator of MVD. Results Seventy-three TN patients were recruited, and 146 trigeminal nerve sides were analyzed. For the symptomatic sides, 69 patients had surgically confirmed offending vessels, most of which was SCA, and the positive NVC rate was 95.5%. For the contralateral side, 33 patients have been found with NVC on MRI. The NVC score of the symptomatic side was significantly higher than that of asymptomatic sides (6.7 vs. 1.6; p < 0.001). The optimal cut-off value in predicting trigeminal neuralgia was found as NVC > 4 with sensitivity and specificity of 82.2% and 98.6%, respectively. Conclusion 3D-TOF MRA and FIESTA enable a good diagnostic performance of NVC, and NVC score > 4 was identified to predict trigeminal neuralgia, suggestive of subsequent surgical treatment. Trial registration: The study has been retrospectively registered at the local ethical Institution Review Board (IRB) of Huzhou Central Hospital and Sir Run Run Shaw Hospital with the IRB number (20181108-01; Huzhou) and (20200423-43; SRRSH).

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MRI features of responsible contacts in vascular compressive trigeminal neuralgia and prediction modeling

Acta Radiologica ◽

10.1177/0284185120983971 ◽

2021 ◽

pp. 028418512098397

Author(s):

Yufei Zhao ◽

Jianhua Chen ◽

Rifeng Jiang ◽

Xue Xu ◽

Lin Lin ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Predictive Model ◽

Trigeminal Nerve ◽

Roc Curve ◽

Neurovascular Compression ◽

Diagnostic Efficiency ◽

Mri Features ◽

Vascular Origin ◽

Magnetic Resonance Imaging Mri ◽

Mri Characteristics

Background Multiple neurovascular contacts in patients with vascular compressive trigeminal neuralgia often challenge the diagnosis of responsible contacts. Purpose To analyze the magnetic resonance imaging (MRI) features of responsible contacts and establish a predictive model to accurately pinpoint the responsible contacts. Material and Methods Sixty-seven patients with unilateral trigeminal neuralgia were enrolled. A total of 153 definite contacts (45 responsible, 108 non-responsible) were analyzed for their MRI characteristics, including neurovascular compression (NVC) grading, distance from pons to contact (Dpons-contact), vascular origin of compressing vessels, diameter of vessel (Dvessel) and trigeminal nerve (Dtrigeminal nerve) at contact. The MRI characteristics of the responsible and non-responsible contacts were compared, and their diagnostic efficiencies were further evaluated using a receiver operating characteristic (ROC) curve. The significant MRI features were incorporated into the logistics regression analysis to build a predictive model for responsible contacts. Results Compared with non-responsible contacts, NVC grading and arterial compression ratio (84.44%) were significantly higher, Dpons-contact was significantly lower at responsible contacts ( P < 0.001, 0.002, and 0.033, respectively). NVC grading had a highest diagnostic area under the ROC curve (AUC) of 0.742, with a sensitivity of 64.44% and specificity of 75.00%. The logistic regression model showed a higher diagnostic efficiency, with an AUC of 0.808, sensitivity of 88.89%, and specificity of 62.04%. Conclusion Contact degree and position are important MRI features in identifying the responsible contacts of the trigeminal neuralgia. The logistic predictive model based on Dpons-contact, NVC grading, and vascular origin can qualitatively improve the prediction of responsible contacts for radiologists.

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Neuralgias of the Trigeminal Nerve

Pain Research and Management ◽

10.1155/2000/517683 ◽

2000 ◽

Vol 5 (1) ◽

pp. 107-113 ◽

Cited By ~ 2

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.

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TRIGEMINAL NEURALGIA AND VASCULAR COMPRESSION IN PATIENTS WITH TRIGEMINAL SCHWANNOMAS

Neurosurgery ◽

10.1227/01.neu.0000318187.10536.bf ◽

2008 ◽

Vol 62 (4) ◽

pp. E974-E975 ◽

Cited By ~ 12

Author(s):

Jonathan P. Miller ◽

Feridun Acar ◽

Kim J. Burchiel

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Gamma Knife Radiosurgery ◽

Vascular Compression ◽

Neurovascular Compression ◽

Intracranial Tumors ◽

Resonance Imaging

Abstract OBJECTIVE Trigeminal neuralgia (TN) is often associated with neurovascular compression. However, intracranial tumors are occasionally observed, particularly when symptoms are atypical. We describe three patients with Type-1 TN and trigeminal schwannoma diagnosed by magnetic resonance imaging, with concomitant arterial compression of the trigeminal nerve. CLINICAL PRESENTATION All three patients had Type-1 TN with spontaneous onset, paroxysm-triggered pain, and response to antiepileptic medication. Contrast-enhanced T1-weighted magnetic resonance imaging scans demonstrated an ipsilateral enhancing perineural mass consistent with a schwannoma. Two of the three patients had previously undergone gamma knife radiosurgery without improvement. Subsequent high-resolution magnetic resonance imaging in all three patients revealed obvious compression of the trigeminal nerve by an arterial structure. INTERVENTION Two patients underwent retrosigmoid craniectomy followed by microvascular decompression and remain pain-free. One patient elected not to pursue surgical intervention. CONCLUSION Although intracranial tumors are occasionally observed in patients with TN, neurovascular compression must still be considered as an etiology, especially if typical TN symptoms are reported.

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Anatomoradiological Landmarks for Accuracy of Radiofrequency Thermorhizotomy in the Treatment of Trigeminal Neuralgia

Operative Neurosurgery ◽

10.1227/01.neu.0000313569.43073.b2 ◽

2008 ◽

Vol 63 (suppl_1) ◽

pp. ONS129-ONS138 ◽

Cited By ~ 10

Author(s):

Mehmet Tatli ◽

Marc Sindou

Keyword(s):

Side Effects ◽

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Study Groups ◽

X Rays ◽

Preoperative Pain ◽

Paired Samples ◽

Percutaneous Procedures ◽

Trigeminal Root ◽

Mean Differences

Abstract Objective: The correct positioning of the electrode is of prime importance for effectiveness and selectivity of percutaneous trigeminal radiofrequency thermorhizotomy (RF-TR) for the treatment of trigeminal neuralgia (TN). The aim of our study was to establish some anatomoradiological landmarks for the purpose of accurate placement of the electrode tip in RF-TR. Methods: Of 1000 patients who underwent RF-TR, 100 were retrospective and randomly selected and divided into study groups according to postoperative hypoesthesia in the trigeminal nerve divisions. The patients’ petroclival angle, petroelectrodal angle, electrode tip, and the petroelectrodal angle/petroclival angle ratio were calculated on lateral cranial x-rays. These measurements were then correlated with the topography of hypoesthesia obtained by the RF-TR to define the anatomoradiological x-ray landmarks corresponding to the divisions of the trigeminal root. The postoperative hypoesthesia groups were correlated with their respective preoperative pain topography to check the accuracy of the thermolesion. In addition, the intraoperatively evoked paresthesia responses and the side effects were evaluated. The results were analyzed using a paired-samples Student's ttest, the χ2 test, and one-way analysis of variance, followed by Bonferroni and Tamhane post hoc tests. Results: All study groups were comparable with respect to age, sex, side effects, electrode tip location, side of TN, and values of petroclival angle. The lowest values of petroelectrodal angle/orbitomeatal electrodal angle and petroelectrodal angle/ petroclival angle were detected in patients with V3 TN, whereas the greatest values were in patients who had TN in all branches of the trigeminal nerve. The greatest height of the electrode was in patients who had TN in all branches, whereas the least height was in patients with V3TN. When the results were compared with each other, the mean differences were found to be statistically significant between V3 TN patients and the other groups with different Pvalues. There was no statistical difference between the postoperative hypoesthesia data and the preoperative pain topography, which demonstrated evidence of the accuracy of the thermolesion in our series. Conclusion: Our data suggest that the determination of the presented landmarks allows customization to individual patient anatomy and may help the surgeon achieve a more selective effect with a variety of percutaneous procedures for each branch of the trigeminal root.

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To be or not to be a neurovascular conflict: importance of the preoperative identification of the neurovascular conflict in the trigeminal neuralgia

Romanian Neurosurgery ◽

10.1515/romneu-2016-0053 ◽

2016 ◽

Vol 30 (3) ◽

pp. 336-344

Author(s):

Dana Mihaela Turliuc ◽

B. Dobrovăţ ◽

A. I. Cucu ◽

Ş. Turliuc ◽

Daniela Trandafir ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Surgical Approach ◽

Neurovascular Compression ◽

Neurovascular Conflict

Abstract The trigeminal neuralgia caused by neurovascular compression is a neurosurgical pathology requiring the preoperative identification as exact as possible of the neurovascular conflict. In this case, neuroimaging is very useful, as it allows not only the determination of the neurovascular conflict of the trigeminal nerve, but also the correct indication of an adequate surgical approach.

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Microvascular relations of the trigeminal nerve

Journal of Neurosurgery ◽

10.3171/jns.1980.52.3.0381 ◽

1980 ◽

Vol 52 (3) ◽

pp. 381-386 ◽

Cited By ~ 123

Author(s):

Stephen J. Haines ◽

Peter J. Jannetta ◽

David S. Zorub

Keyword(s):

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Facial Pain ◽

Entry Zone ◽

Content Type ◽

Root Entry Zone ◽

Venous Compression ◽

Trigeminal Nerve Root ◽

Trigeminal Nerves ◽

Fine Print

✓ The vascular relationships of the trigeminal nerve root entry zone were examined bilaterally in 20 cadavers of individuals known to be free of facial pain. Fourteen of 40 nerves made contact with an artery, but only four of these showed evidence of compression or distortion of the nerve. In addition, the vascular relationships of 40 trigeminal nerves exposed surgically for treatment of trigeminal neuralgia were studied, and 31 nerves showed compression by adjacent arteries. Venous compression was seen in four of the cadaver nerves and in eight nerves from patients with trigeminal neuralgia. These data support the hypothesis that arterial compression of the trigeminal nerve is associated with trigeminal neuralgia.

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Trigeminal neuralgia resulting from auditory brainstem implant cable compression

Journal of Neurosurgery ◽

10.3171/2010.5.jns091709 ◽

2011 ◽

Vol 114 (1) ◽

pp. 186-188 ◽

Cited By ~ 3

Author(s):

Marc S. Schwartz ◽

Derald E. Brackmann ◽

Eric P. Wilkinson ◽

John L. Go ◽

Felipe Santos

Keyword(s):

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Imaging Study ◽

Neurofibromatosis Type ◽

Auditory Brainstem ◽

Fast Imaging ◽

Neurovascular Compression ◽

Auditory Brainstem Implant ◽

Maximal Medical Therapy

The authors report a case of neurofibromatosis Type 2 presenting with symptoms of trigeminal neuralgia refractory to medical management following placement of an auditory brainstem implant (ABI). Physical examination and history revealed trigeminal neuralgia. A 3D FIESTA (fast imaging employing steady-state acquisition) MR imaging study demonstrated compression of the trigeminal nerve by an ABI cable. After maximal medical therapy, a retrosigmoid microscopic decompression of the trigeminal nerve achieved complete symptom resolution. This is the first report of an ABI cable becoming displaced, resulting in neurovascular compression. This case demonstrates that trigeminal neuralgia can result from nonvascular compression of the trigeminal nerve.

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Radiofrequency Thermoablation of the Gasserian Ganglion Versus the Peripheral Branches of the Trigeminal Nerve for Treatment of Trigeminal Neuralgia: A Randomized, Control Trial

January 2018 - Pain Physician ◽

10.36076/ppj/2019.22.147 ◽

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

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Ultrasound-Guided Trigeminal Nerve Block via the Pterygopalatine Fossa: An Effective Treatment for Trigeminal Neuralgia and Atypical Facial Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2013/16/e537 ◽

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.

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