Novel Techniques for Trigeminal Neuralgia Including Trigeminal Neurostimulators

2018 ◽  
pp. 118-138
Author(s):  
Arvin R. Wali ◽  
Christian Lopez ◽  
Peter Abraham ◽  
Michael G. Brandel ◽  
David R. Santiago-Dieppa ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Nerve ◽  
Patient Selection ◽  
Microvascular Decompression ◽  
Published Data ◽  
Gasserian Ganglion ◽  
Therapeutic Modalities ◽  
Trigeminal Nerve Stimulation ◽  
Surgical Options ◽  
Novel Therapeutic

Several innovative surgical options for the management of trigeminal neuralgia have emerged over the past 40 years. In addition to microvascular decompression, other techniques have been introduced for the treatment of trigeminal neuralgia and facial nerve pain. This chapter describes the following novel therapeutic modalities: endoscopic microvascular decompression, radiosurgery, radiofrequency, thermocoagulation, glycerol rhizotomoy, balloon compression, Gasserian ganglion stimulation, and subcutaneous trigeminal nerve stimulation. For each of these techniques, this chapter provides a description of the procedure, criteria for patient selection, and discusses published data regarding patient outcomes.

scholarly journals Estimation of Intraoperative Stimulation Threshold of the Facial Nerve in Patients Undergoing Microvascular Decompression

2019 ◽  
Vol 80 (06) ◽  
pp. 599-603
Author(s):  
Rafey A. Feroze ◽  
Michael M. McDowell ◽  
Jeffrey Balzer ◽  
Donald J. Crammond ◽  
Partha Thirumala ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Nerve ◽  
Microvascular Decompression ◽  
Nerve Conduction ◽  
Tumor Burden ◽  
Constant Current ◽  
Facial Weakness ◽  
Stimulation Threshold ◽  
Compound Muscle Action Potentials ◽  
Facial Nerves

Introduction Facial weakness can result from surgical manipulation of the facial nerve. Intraoperative neuromonitoring reduces functional impairment but no clear guidelines exist regarding interpretation of intraoperative electrophysiological results. Most studies describe subjects with facial nerves encumbered by tumors or those with various grades of facial nerve weakness. We sought to obtain the neurophysiological parameters and stimulation threshold following intraoperative facial nerve triggered electromyography (t-EMG) stimulation during microvascular decompression for trigeminal neuralgia to characterize the response of normal facial nerves via t-EMG. Methods Facial nerve t-EMG stimulation was performed in seven patients undergoing microvascular decompression for trigeminal neuralgia. Using constant current stimulation, single stimulation pulses of 0.025 to 0.2 mA intensity were applied to the proximal facial nerve. Compound muscle action potentials, duration to onset, and termination of t-EMG responses were recorded for the orbicularis oculi and mentalis muscles. Patients were evaluated for facial weakness following the surgical procedure. Results Quantifiable t-EMG responses were generated in response to all tested stimulation currents of 0.025, 0.05, 0.1, and 0.2 mA in both muscles, indicating effective nerve conduction. No patients developed facial weakness postoperatively. Conclusions The presence of t-EMG amplitudes in response to 0.025 mA suggests that facial nerve conduction can take place at lower stimulation intensities than previously reported in patients with tumor burden. Proximal facial nerve stimulation that yields responses with thresholds less than 0.05 mA may be a preferred reference baseline for surgical procedures within the cerebellopontine angle to prevent iatrogenic injury.

Microvascular Decompression for Treatment of Trigeminal Neuralgia in Patient with Facial Nerve Schwannoma

2018 ◽  
Vol 113 ◽  
pp. 142-145 ◽  
Author(s):  
John P. Marinelli ◽  
Jamie J. Van Gompel ◽  
Michael J. Link ◽  
Matthew L. Carlson
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Nerve ◽  
Microvascular Decompression ◽  
Facial Nerve Schwannoma

scholarly journals Neuralgies of the lower cranial nerves: Microsurgical posterior fossa exploration

2004 ◽  
Vol 51 (4) ◽  
pp. 39-43 ◽  
Author(s):  
Branislav Antic ◽  
Predrag Peric ◽  
S. Ivanovic ◽  
M. Spaic
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Facial Nerve ◽  
Posterior Fossa ◽  
Trigeminal Nerve ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Cranial Nerves ◽  
Relief Rate ◽  
Lower Cranial Nerves

Neuralgias of the lower cranial nerves are trigeminal neuralgia (TN), glossopharingeal neuralgia (GphN), and geniculate neuralgia (GN). Microsurgical posterior fossa exploration with its variations microvascular decompression (MVD), partial sensory rhisotomy (PSR), and total sensory rhisotomy (TSR) is one of the most efficient ways of treating these neuralgias. It was performed 130 operations in 125 patients with TN, 3 in GphN patients, 1 in GN patient, 1 in GN/TN patients, 1 in GphN/GN patient, and 2 in GN/hemifacial spasm patients. Of total of 125 patients with TN, MVD was performed in 63, PSR in 18, and MVD+PSR in 44 cases. In 5 patients with recidivate TN PSR was performed. Of total 3 patients with GphN MVD was performed in 2 cases, and extirpation of a small meningeoma in 1 case (it was not seen on CT). In the patients with GN TSR of intermediate nerve was performed, in GN/TN patients TSR of intermediate nerve and PSR of trigeminal nerve was performed, in the GN/GphN patients MVD of glossopharingeal and TSR of intermediate nerve were performed, and in the GN/hemifacial spasm patients TSR of intermediate and MVD of facial nerve were performed. The results of TN patients are: excellent in 82,4%, good in 12%, and poor in 5,6% of patients. There is no difference in complete pain relief, rate of recurrence, and complications between MVD, MVD+PSR and PSR operative groups (p>0,05). Among patients with other neuralgias the following results are noted: excellent in 4, good in 3, and poor in 1 patient. Microsurgical posterior fossa exploration is the method of choice in the treatment of the neuralgias of the lower cranial nerves.

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