Trigeminal Neuralgia: The New Surgical Treatment Modalities

2015 ◽  
Vol 9 (1) ◽  
pp. 40-43
Author(s):  
A Sharma ◽  
A Kumar ◽  
V Kumar ◽  
M Goel ◽  
A Hooda ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Trigeminal Neuralgia ◽  
Treatment Modalities ◽  
Painful Condition ◽  
Constant Pain ◽  
Trigger Stimulus ◽  
The One ◽  
Patient’S History ◽  
Patients Experience ◽  
Medicinal Therapy

ABSTRACT Trigeminal Neuralgia is a painful condition of the oro-facial structures. The diagnostic criteria are based upon the patient's history, examination and clinical evaluation. In the course of the disease patients experience dull, aching, throbbing or burning, constant pain in the same distribution as the paroxysms. A long interval between the attacks is often described as a period of increasing paresthesias in the nerve distribution. The trigger stimulus, applied to the “trigger zone”, often arouses intense pain in divisions beyond the one stimulated. Treatment involves the medicinal as well as surgical procedures. Medicinal therapy is usually first to start. With time patient became refractive to medicinal therapy. Under this condition, surgical treatment is recommended. This paper focus particularly on the surgical aspect of this painful condition.

Trigeminal Neuralgia: The New Medicinal Treatment Modalities

2015 ◽  
Vol 9 (3) ◽  
pp. 149-152
Author(s):  
A Kumar ◽  
V Kumar ◽  
M Goel ◽  
A Hooda ◽  
A Dahiya
Keyword(s):  
Drug Therapy ◽  
Trigeminal Neuralgia ◽  
Electric Shock ◽  
Treatment Modalities ◽  
Light Touch ◽  
Painful Condition ◽  
Trigger Effect ◽  
Medicinal Treatment ◽  
Long Time ◽  
Medicinal Therapy

ABSTRACT Trigeminal neuralgia has been considered as a painful condition since long time. Pain is perceived in one or more divisions of the trigeminal nerve, mostly unilaterally. Pain is shooting, lancinating, sharp, agonizing and described as an electric shock. Usually lasts seconds to minutes with repetitive bursts every few seconds. The patient is symptom-free between the attacks. Common evidence can be the trigger effect of some routinely actions involving territories innervated by the affected root, such as speaking, swallowing, chewing, brushing the teeth, or sensitive stimuli applied in these regions like simple light touch, cold, or an air blow. Medicinal therapy is the main stay of treatment in trigeminal neuralgia. This review focuses on the drug therapy in neuralgic patients.

scholarly journals Historical perspectives on the diagnosis and treatment of trigeminal neuralgia

2005 ◽  
Vol 18 (5) ◽  
pp. 1-10 ◽  
Author(s):  
Chad D. Cole ◽  
James K. Liu ◽  
Ronald I. Apfelbaum
Keyword(s):  
Surgical Treatment ◽  
Trigeminal Neuralgia ◽  
Historical Review ◽  
Therapeutic Interventions ◽  
Treatment Modalities ◽  
Painful Condition ◽  
Historical Perspectives ◽  
Treatment Techniques ◽  
History Of ◽  
Great Pain

Since the earliest recorded history of medicine, physicians have been challenged by the difficulty in relieving the great pain experienced by individuals suffering from trigeminal neuralgia (TN). The nature of the pain and the events that incite it have been well described, but effective treatments with acceptable levels of side effects remained elusive until the latter part of the 20th century. As a result, many theories about the origins of TN have been proposed, along with numerous treatment modalities. The pathophysiological causes of TN remain incompletely understood, but the medical and surgical treatment techniques currently used offer effective ways to relieve this extremely painful condition. In this historical review the authors discuss the initial descriptions of tic douloureux, Fothergill disease, and TN, along with various therapeutic interventions and their refinements.

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.

scholarly journals Current Surgical Treatment of Knee Osteoarthritis

Arthritis ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
Karolin Rönn ◽  
Nikolaus Reischl ◽  
Emanuel Gautier ◽  
Matthias Jacobi
Keyword(s):  
Surgical Treatment ◽  
Knee Arthroplasty ◽  
Treatment Strategies ◽  
The Elderly ◽  
Treatment Modalities ◽  
Level Of Evidence ◽  
Knee Oa ◽  
Total Arthroplasty ◽  
Arthroscopic Lavage ◽  
The One

Osteoathritis (OA) of the knee is common, and the chances of suffering from OA increase with age. Its treatment should be initially nonoperative—and requires both pharmacological and nonpharmacological treatment modalities. If conservative therapy fails, surgery should be considered. Surgical treatments for knee OA include arthroscopy, cartilage repair, osteotomy, and knee arthroplasty. Determining which of these procedures is most appropriate depends on several factors, including the location, stage of OA, comorbidities on the one side and patients suffering on the other side. Arthroscopic lavage and débridement is often carried out, but does not alter disease progression. If OA is limited to one compartment, unicompartmental knee arthroplasty or unloading osteotomy can be considered. They are recommended in young and active patients in regard to the risks and limited durability of total knee replacement. Total arthroplasty of the knee is a common and safe method in the elderly patients with advanced knee OA. This paper summarizes current surgical treatment strategies for knee OA, with a focus on the latest developments, indications and level of evidence.

scholarly journals Is it possible to estimate the need for surgical management in patients with a tubo-ovarian abscess at admission? A retrospective long-term analysis

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Murat Gözüküçük ◽  
Esra Gülen Yıldız
Keyword(s):  
Surgical Treatment ◽  
Antibiotic Therapy ◽  
Treatment Failure ◽  
Medical Treatment ◽  
Length Of Hospital Stay ◽  
Treatment Modalities ◽  
Laboratory Findings ◽  
Factors Affecting ◽  
Laboratory Infection ◽  
Major Factors

Abstract Background This study aimed to determine the possible prognostic factors correlated with the treatment modalities of tubo-ovarian abscesses (TOAs) and thus to assess whether the need for surgery was predictable at the time of initial admission. Materials and methods Between January 2012 and December 2019, patients who were hospitalized with a TOA in our clinic were retrospectively recruited. The age of the patients, clinical and sonographic presentation, pelvic inflammatory risk factors, antibiotic therapy, applied surgical treatment, laboratory infection parameters, and length of hospital stay were recorded. Results The records of 115 patients hospitalized with a prediagnosis of TOA were reviewed for the current study. After hospitalization, TOA was ruled out in 19 patients, and data regarding 96 patients was included for analysis. Twenty-eight (29.2%) patients underwent surgical treatment due to failed antibiotic therapy. Sixty-eight (70.8%) were successfully treated with parenteral antibiotics. Medical treatment failure and need for surgery were more common in patients with a large abscess (volume, > 40 cm3, or diameter, > 5 cm). The group treated by surgical intervention was statistically older than the patients receiving medical treatment (p < 0.05). Conclusions Although the treatment in TOA may vary according to clinical, sonographic, and laboratory findings; age of patients, the abscess size, and volume were seen as the major factors affecting medical treatment failure. Moreover, TOA treatment should be planned on a more individual basis.

scholarly journals Lymphoscintigraphy in breast cancer: a short review about the impact on upper limb after surgical treatment

2008 ◽  
Vol 51 (spe) ◽  
pp. 83-89
Author(s):  
Anke Bergmann ◽  
Juliana Miranda Dutra de Resende ◽  
Sebastião David Santos-Filho ◽  
Marcelo Adeodato Bello ◽  
Juliana Flavia de Oliveira ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Surgical Treatment ◽  
Current Trend ◽  
Surgical Techniques ◽  
Short Review ◽  
Lymphatic Drainage ◽  
Key Words Breast ◽  
Axillary Lymphadenectomy ◽  
The One ◽  
The Impact

Breast cancer is still associated with high mortality rates and one of the most important factors governing long survival is accurate and early diagnosis. In underdeveloped countries, this disease frequently is only detected in advanced stages; however, through mammography, many women have been diagnosed at early stages. In this context, the sentinel lymph node (SLN) technique is associated with less postoperative morbidity compared to axillary lymphadenectomy. Lymphoscintigraphy has emerged as a method for the evaluation of lymphatic drainage chains in various tumours, being both accurate and non invasive. The aim of this work is to present the main aspects which cause controversy about SLN and lymphoscintigraphy and the impact that these procedures have had on lymphedema after surgical treatment for breast cancer. A short review including papers in English, Spanish and Portuguese, available on Lilacs and Medline database, published between January, 2000 and July, 2008 was performed. The key words breast cancer, lymphoscintigraphy, SLN biopsy, lymphedema were used. Various studies have aimed to compare the incidence and prevalence of lymphedema according to the technique used; however, the population subjected to SLN is different from the one with indication for axillary lymphadenectomy regarding staging. Moreover, little is known about long term morbidity since it is a relatively new technique. In conclusion, the development of surgical techniques has permitted to minimize deformities and the current trend is that these techniques be as conservative as possible. Thus, lymphoscintigraphy plays an important role in the identification of SLN, contributing to the prevention and minimization of postoperative complications.

Post-Reduction Stability of the Proximal Interphalangeal Joint after Dorsal Fracture Dislocation—A Cadaveric Study

2016 ◽  
Vol 21 (03) ◽  
pp. 382-387 ◽  
Author(s):  
Andre Eu-Jin Cheah ◽  
Tun-Lin Foo ◽  
Janice Chin-Yi Liao ◽  
Min He ◽  
Alphonsus Khin-Sze Chong
Keyword(s):  
Traction Force ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Fracture Dislocation ◽  
Treatment Modalities ◽  
Full Extension ◽  
Early Motion ◽  
Fracture Dislocations ◽  
Reduction Stability ◽  
The One

Background: Proximal interphalangeal joint (PIPJ) dorsal fracture dislocations (DFD) are challenging injuries. Treatment aims to achieve stability of the PIPJ after reduction so that early motion can be initiated. We studied how increasing articular destruction would affect post reduction stability and investigate the amount of traction and PIPJ flexion needed to maintain the reduction. Methods: Increasing amounts (20%, 40% and 60%) of damage to the volar lip of the middle phalanx in cadaveric specimens were created to represent PIPJ DFD that were stable, of tenuous stability and frankly unstable. Traction forces and PIPJ flexion needed to maintain the reduction were then measured. Results: The PIPJ DFD with 20% damage were stable and did not subluxe while the one with 40% articular involvement was stable after reduction. For unstable the PIPJ with 60% involvement, the more the PIPJ was flexed, the less traction force was needed to hold the joint in reduction. For PIPJ flexion of 20 degrees, a minimum 4.4N of force is needed to maintain reduction while PIPJ flexion of 10 degrees required a minimum 5.0N of force. No amount of force could maintain PIPJ reduction if traction was performed in full extension. Conclusions: In our model, PIPJ DFD with less than 30% articular damage are stable while those with 30% to 50% of involvement have tenuous stability. For the unstable PIPJ DFD, traction obviates the need for excessive flexion of the PIPJ to maintain joint reduction. This information should be considered in treatment modalities for PIPJ DFD, as well in the design of external traction devices for the treatment of PIPJ DFD.

TRIGEMINAL NERVE RADIOSURGICAL TREATMENT IN INTRACTABLE CHRONIC CLUSTER HEADACHE

Neurosurgery ◽  
2006 ◽  
Vol 59 (6) ◽  
pp. 1252-1257 ◽  
Author(s):  
Anne Donnet ◽  
Manabu Tamura ◽  
Dominique Valade ◽  
Jean Régis
Keyword(s):  
Trigeminal Neuralgia ◽  
Cluster Headache ◽  
Trigeminal Nerve ◽  
Chronic Cluster Headache ◽  
High Rate ◽  
Long Term Results ◽  
Complete Relief ◽  
Term Evaluation ◽  
The One

Abstract OBJECTIVE We have previously reported short-term results of a prospective open trial designed to evaluate trigeminal nerve radiosurgical treatment in intractable chronic cluster headache (CCH). Medium- and long-term results have not yet been reported. METHODS Ten patients presenting with a severe and drug-resistant CCH were enrolled (nine men, one woman). The radiosurgical treatment was performed according to the technique usually used for trigeminal neuralgia in our department. A single 4-mm shot was positioned at the level of the cisternal portion of the trigeminal nerve. The median distance between the center of the shot and the emergence of the nerve was 9.35 mm (range, 7.5–13.3 mm). The median of this maximum dose to the brainstem was 8.0 Gy (range, 4.0–11.1 Gy). Mean age was 49.8 years (range, 32–77 yr). Mean duration of the CCH was 9 years (range, 2–33 yr). The mean follow-up period was 36.3 months (range, 24–48 mo). RESULTS Two patients had complete relief of CCH. One patient had a good result with evolution in an episodic form. Seven patients had no improvement. Nine patients developed a new trigeminal nerve disturbance: three developed paresthesia with no hypoesthesia and six developed hypoesthesia, including two patients with deafferentation pain. Only one patient had neither paresthesia nor hypoesthesia. CONCLUSION We confirmed, with medium- and long-term evaluation, the high rate of toxicity and failure of the technique. The high toxicity, despite a methodology identical to the one used in trigeminal neuralgia, leads us to suspect an underlying specificity of the nerve in CCH. We do not recommend radiosurgery for treatment of intractable CCH.

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