Microvascular Decompression for Patient With Coexistent of Trigeminal Neuralgia, Hemifacial Spasm and Glossopharyngeal Neuralgia- a Case Report

Background: Primary trigeminal neuralgia (TN), hemifacial spasm (HFS) and glossopharyngeal neuralgia (GN) are common diseases of nervous system, with similar pathogenesis and treatment strategies. Coexistent of such disease, especially coexistent of TN-HFS-GN simultaneously, is very rare. To date, only nine cases have been reported.Case Presentation: A 70-year-old male with a history of hypertension and diabetes complained of severe involuntary contraction for about 10 years, knife-like and lighting-like pain, which was restricted to the distribution of the second and third branches of trigeminal nerve and pharynx and root of tongue, for about 2 years. Coexistent of TN HFS and GN was diagnosed and MVD was carried out. After MVD, the patient completely free from symptoms and no recurrence and hypoesthesia were recorded in 18 months follow up.Conclusion: Here we report the tenth and oldest male patient with coexistent of TN-HFS-GN. Despite limited reports, MVD is the preferred choice for such diseases which can free patients from spasm and neuralgia.

Recurrence Rates After Microvascular Decompression in Patients With Primary Trigeminal Neuralgia and Its Influencing Factors: A Systematic Review and Meta-Analysis Based on 8,172 Surgery Patients

Background: Primary trigeminal neuralgia (PTN) is known to reoccur following microvascular decompression (MVD) surgery. However, the rates and contributing factors related to PTN recurrence remain controversial. The purpose of this study was to explore the postoperative recurrence rates and related influencing factors of patients with PTN after MVD. Additionally, recurrence rates after different treatments were compared to provide guidelines for clinicians.Methods: We conducted systematic reviews and meta-analyses in accordance with the preferred reporting items of the PRISMA guidelines. We searched nine databases, namely, the PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, CBM, CNKI, VIP, and Wanfang databases, from establishment to July 13, 2020, selecting for studies about the long-term postoperative efficacy of MVD in the treatment of PTN. Factors associated with higher recurrence rates after MVD and long-term postoperative results of other treatments underwent formal meta-analysis, where odds ratios (ORs) with the corresponding 95% confidence intervals (CIs) were calculated. The dose-response model was used to inspect the associations between several factors and higher recurrence rates.Results: Seventy-four studies (8,172 patients, 32 case series studies, and 42 non-randomized controlled trials) were analyzed in our research. Overall, 956 out of 8,172 patients relapsed, and the pooled recurrence rate was 0.096 (0.080–0.113). Influencing factors of relatively higher recurrence rates included atypical trigeminal neuralgia symptoms, lack of nerve groove, non-arterial compression, patients who were 50–60 years old, and longer disease duration. Dose–response analysis showed that the recurrence rate had a significant trend with the published year and the follow-up time. Simultaneously, the recurrence rate of MVD treatment was much lower than that of conventional drug treatment, gamma knife surgery, percutaneous balloon compression, and radiofrequency thermocoagulation. When the surgical technique was improved or combined with partial sensory rhizotomy (PSR), the postoperative recurrence rates were significantly reduced.Conclusions: Even for PTN patients who have a successful operation, ~10% of them will still relapse. This research identifies several factors that can affect the recurrence rate. Compared with other operations, MVD has a relatively lower recurrence rate. Our analysis suggests that improved surgical techniques and combining PSR and MVD will yield better results.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42020159276.

Flatness of the Meckel cave may cause primary trigeminal neuralgia: a radiomics-based study

Background Neurovascular contact (NVC) is the main cause of primary trigeminal neuralgia (PTN); however, cases of PTN without NVC are still observed. In this study, the Meckel cave (MC) morphology in PTN were analyzed by radiomics and compared to healthy controls (HCs) to explore the cause of PTN. Methods We studied the 3.0T MRI data of 115 patients with PTN and 46 HCs. Bilateral MC was modeled using the 3D Slicer software, and the morphological characteristics of MC were analyzed using the radiomics method. Results The right side incidence rate in the PTN group was higher than the left side incidence. By analyzing the flatness feature of MC, we observed that the affected side of the PTN was lower than that of the unaffected side, the right MC of the PTN and HC was lower than that of the left MC, the MC of the affected side of the left and right PTN without bilateral NVC was lower than that of the unaffected side. Conclusions By providing a method to analyze the morphology of the MC, we found that there is an asymmetry in the morphology of bilateral MC in the PTN and HC groups. It can be inferred that the flatness of the MC may be a cause of PTN.

Flatness of the Meckel Cave May Cause Primary Trigeminal Neuralgia: a Radiomics-based Study

Background: Neurovascular contact (NVC) is the main cause of primary trigeminal neuralgia (PTN); however, cases of PTN without NVC are still observed. In this study, the Meckel cave (MC) morphology in PTN were analyzed by radiomics and compared to healthy controls (HCs) to explore the cause of PTN.Methods: We studied the 3.0T MRI data of 115 patients with PTN and 46 HCs. Bilateral MC was modeled using the 3Dslicer software, and the morphological characteristics of MC were analyzed using the radiomics method.Results: The right side incidence rate in the PTN group was higher than the left side incidence. By analyzing the flatness feature of MC, we observed that the affected side of the PTN was lower than that of the unaffected side, the right MC of the PTN and HC was lower than that of the left MC, the MC of the affected side of the left and right PTN without bilateral NVC was lower than that of the unaffected side.Conclusions: By providing a method to analyze the morphology of MC, we found that there is asymmetry in the morphology of bilateral MC in the PTN and HC groups. It can be inferred that the flatness of MC may be a cause of PTN.

ANALYSIS OF THE RESULTS OF SURGICAL TREATMENT OF PRIMARY TRIGEMINAL NEURALGIA USING LASER DESTRUCTION OF THE SENSITIVE ROOT IN ELDERLY AND SENILE PATIENTS

Цель исследования - анализ результатов хирургического лечения первичной невралгии тройничного нерва при использовании лазерной деструкции чувствительного корешка у пациентов пожилого и старческого возраста. Проспективно изучены результаты лечения 25 пациентов старше 65 лет с устойчивой к консервативному лечению тригеминальной болью, которым была проведена лазерная деструкция чувствительного корешка тройничного нерва (970 нм, частота 9 Гц и мощность 3 Вт в суммарной дозе 100 Дж) в период 2018-2019 гг. Средний катамнез наблюдения составил 12 мес. В результате установлено значительное снижение интенсивности болевых ощущений по шкале лицевой боли с 87 (83,5; 91,5) до 15,5 (12,5; 18,5) мм ( р =0,002) в отдаленном периоде. В среднем через 12 мес после операции выявлено значимое увеличение показателей физического и психологического компонентов здоровья по опроснику SF-36 ( p =0,02 и p =0,01 соответственно). В катамнезе по шкале Macnab отмечены преимущественно отличные ( n =23; 92 %) и хорошие ( n =2; 8 %) результаты лечения. Зарегистрировано одно (4 %) периоперационное осложнение и два (8 %) неблагоприятных последствия анестезиологического пособия. Таким образом, применение лазерной денервации чувствительного корешка при первичной невралгии тройничного нерва у пациентов пожилого и старческого возраста позволяет значительно снизить уровень дооперационного болевого синдрома и улучшить качество жизни при низком риске формирования неблагоприятных последствий. The aim of the study was to analyze the results of surgical treatment of primary trigeminal neuralgia using laser destruction of the sensitive root in elderly and senile patients. The results of treatment of 25 patients older than 65 years with conservative treatment-resistant trigeminal pain who underwent laser destruction of the sensitive trigeminal root (970 nm, 9 Hz and 3 W power in a total dose of 100 J) in the period from 2018-2019 were prospectively studied. The average follow-up was 12 months. As a result, a significant decrease in the intensity of pain on the scale of facial pain was found from 87 (83,5; 91,5) mm to 15,5 (12,5; 18,5) mm ( p =0,002) in the long-term period. On average, 12 months after the operation, a significant improvement in the indicators of the physical and psychological components of health was revealed on the SF-36 questionnaire ( p =0,02 and p =0,01, respectively). In the follow-up on the Macnab scale, predominantly excellent ( n =23; 92 %) and good ( n =2; 8 %) treatment results were noted. Registered 1 (4 %) perioperative complication and 2 (8 %) adverse effects of anesthesiology benefits. Thus, the use of laser denervation of the sensitive root in primary trigeminal neuralgia in elderly and senile patients can significantly reduce the level of preoperative pain and improve the quality of life, with low risks of adverse effects.

The Efficacy and Safety of the Application of Pulsed Radiofrequency, Combined With Low-Temperature Continuous Radiofrequency, to the Gasserian Ganglion for the Treatment of Primary Trigeminal Neuralgia: Study Protocol for a Prospective, Open-Label, Parallel, Randomized Controlled Trial

BACKGROUND: Trigeminal neuralgia is a very painful condition, and radiofrequency therapy is reserved for patients who are resistant or intolerant to pharmacologic therapy. Continuous radiofrequency (CRF) and pulsed radiofrequency (PRF) both have advantages and disadvantages. Recently, studies have found that PRF combined with low-temperature (< 65°C) CRF increases the efficacy of treatment, without leading to a significant increase in complications caused by nerve lesions. However, these reports have some limitations. OBJECTIVES: We plan to conduct a randomized, controlled study to compare the efficacy of applying high-voltage PRF, with and without low-temperature CRF, to the Gasserian ganglion for the treatment of trigeminal neuralgia. STUDY DESIGN: A study protocol for a prospective, open-label, parallel, randomized controlled trial (clinicaltrials.gov; NCT04174443). SETTING: The Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University in Beijing, China. METHODS: One hundred forty-six patients with primary trigeminal neuralgia will be randomly assigned to 1 of 2 groups using an allocation ratio of 1:1. In the high-voltage PRF combined with low-temperature CRF group, 2 Hz of PRF will be applied under the following conditions: a voltage of 70 V, temperature of 42°C, pulse width of 20 ms, and treatment time of 600 s. Low-temperature CRF will then be performed at 60°C, with a treatment time of 270 s. In the high-voltage PRF group, only high-voltage PRF will be performed, using the same treatment parameters. Follow-up process will last for a duration of 1 year. RESULTS: The primary outcome will be the effectiveness of the treatment after 12 months, which is the percentage of patients with a modified Barrow Neurological Institute Pain Intensity Score (BNI) between I and III. The secondary outcome will include the following: BNI score, Numeric Rating Scale, dose of carbamazepine or oxcarbazepine, patient satisfaction score, quality of life, numbness, side effects, and adverse reactions. These will be recorded over a 1-year follow-up period. LIMITATIONS: The open-label study design may influence the measurement of outcomes and introduce bias, for example, performance or ascertainment bias. CONCLUSIONS: To our knowledge, this will be the first prospective, open-label, parallel, randomized controlled trial to compare the efficacy and safety of the application of high-voltage PRF, combined with and without low-temperature (60°C) CRF, for the patients who have failed to respond to pharmacologic treatments for primary trigeminal neuralgia. If proven effective, this will be an important, safe, minimally destructive alternative treatment modality for primary trigeminal neuralgia following an ineffective conservative treatment. KEY WORDS: Trigeminal neuralgia, PRF, continuous radiofrequency, high-voltage PRF combined with low-temperature continuous radiofrequency, study protocol, Barrow Neurological Institute Pain Intensity Score, patient satisfaction score, quality of life, numbness