The blink reflex before and after percutaneous glycerol rhizotomy in patients with trigeminal neuralgia--a prospective study of 28 patients

A Nod for Meckel: A Novel Surgical Position Utilizing Meckel's Cave Anatomy for Percutaneous Glycerol Rhizotomy in Trigeminal Neuralgia

Objective  We aim to describe a novel positioning technique using a specific surgical table to achieve the optimal angle during percutaneous glycerol rhizotomy (PGR) for trigeminal neuralgia (TN). Design  This is a descriptive and photographic analysis of successful cases for future implementation. Setting  This study was conducted at a single-institution, academic center. Participants  The participants were adult patients with TN who underwent PGR and provided consent for publication. Main Outcome Measures  Primary outcomes of this study were TN symptomatic relief and surgical complications. Results  The use of a beach chair sliding headboard surgical table for PGR is plausible and ensures precise and immobile head flexion for 1 hour postglycerol injection. There were no intraoperative or postoperative complications. All patients achieved successful reduction of TN symptoms. Conclusions  Utilizing this new method of intraoperative navigation with a unique surgical table in the upright position, surgeons may achieve precise head adjustments post-PGR. Head flexion has been postulated as a means of ensuring glycerol containment in Meckel's cave. This method can help standardize this procedure for future systematic studies on the importance of head positioning post-PGR.

Laboratory tests of headache disorders – dawn of a new era?

Context

The classification of headache disorders has improved over the years, but further work is needed to develop and improve headache diagnosis within headache subtypes. The present review is a call for action to implement laboratory tests in the classification and management of primary and some secondary headaches.

Background

In this narrative review we present and discuss published tests that might be useful in phenotyping and/or diagnosis of long-lasting headache disorders such as migraine, tension-type headache, trigeminal autonomic cephalalgias, trigeminal neuralgia and persisting secondary headaches.

Aim

The palpometer test, quantitative sensory testing, nociceptive blink reflex and autonomic tests may be valuable to phenotype and/or diagnose subforms of migraine, tension-type headache, cluster headache, trigeminal neuralgia and medication-overuse headache. Provocation tests with glyceryl trinitrate (GTN) and calcitonin gene-related peptide (CGRP) may be valuable in subclassification of migraine and cluster headache. Lumbar pressure monitoring and optical coherence tomography may valuable tools to diagnose and follow patients with chronic headache and raised intracranial pressure.

Finding

A number of laboratory tests in headache research are presently available, but have primarily been performed in single research studies or a few studies that differ in methods and patient groups. At present, there is no evidence-based strategy for implementing diagnostic tests, but this could be achieved if well-reputed tertiary headache centers commence developing and implementing laboratory tests in order to improve the classification and treatment of headache patients.

Neuro-ophthalmic considerations in trigeminal neuralgia and its surgical treatment

PURPOSE OF REVIEW

In this review, we will briefly discuss the clinical manifestations and etiology of trigeminal neuralgia, outline the neuro-ophthalmic features of trigeminal neuralgia, and detail the neuro-ophthalmic side effects and complications of the surgical treatment of trigeminal neuralgia.

RECENT FINDINGS

There is a variety of surgical treatment modalities available for patients with trigeminal neuralgia intolerable or resistant to medical therapy. Significant ocular and visual morbidity can result from the surgical treatment of trigeminal neuralgia.

SUMMARY

Percutaneous or open surgical procedures for trigeminal neuralgia can result in corneal anesthesia, neurotrophic keratitis, exposure keratitis, herpetic keratitis, ocular motor cranial neuropathies, and optic neuropathy. Ophthalmologists should be aware of these potential problems because they may need to evaluate and provide care to patients with ocular or visual complaints following surgery for trigeminal neuralgia.