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De Nigris Vasconcellos F, Alzate JD, Mashiach E, Meng Y, Santhumayor B, Bernstein K, Pichardo-Rojas P, Dono A, Damron EP, Blanco AI, Esquenazi Y, Urgosik D, May J, Lee CC, Yang HC, Kawalec P, Kaufmann AM, Mathieu D, Iorio-Morin C, Picozzi P, Franzini A, Tripathi M, Peker S, Samanci Y, Almeida T, Benjamin C, Kondziolka D, Sheehan J. Efficacy and safety of a third stereotactic radiosurgery for recurrent trigeminal neuralgia: an international, multicenter study. Acta Neurochir (Wien) 2024; 166:422. [PMID: 39441236 DOI: 10.1007/s00701-024-06317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 10/15/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND AND OBJECTIVES Trigeminal Neuralgia (TN) is a debilitating facial pain disorder, often necessitating surgical interventions when medication proves insufficient. Stereotactic Radiosurgery (SRS) is an established therapeutic option. Limited studies explored the feasibility of a third SRS procedure. Our study investigates the safety and efficacy of a third SRS procedure for recurrent TN. METHODS We performed a retrospective analysis across multiple centers using databases collected prospectively. Pain status was evaluated utilizing the BNI Pain Intensity Scales. The Kaplan-Meier method was employed to estimate the time to recurrence, with group comparisons conducted using log-rank tests. Associations were explored using Chi-square and logistic regression models. RESULTS Ten institutions contributed with a total of 35 patients. A third SRS revealed sustained effectiveness with a pain control rate of 82.7%. The median time to recurrence was 35.5 months. New sensory dysfunction following the third procedure occurred in 22% of patients who had preserved sensory function after the second procedure. When considering those who developed sensory dysfunction after the second procedure, 40% of the entire cohort was affected. There were no significant differences in pain recurrence intervals among the three procedures. A meta-analysis, combining data from previous studies, showed that 89.6% of patients achieved some degree of pain control after a third SRS, with 27.4% experiencing new sensory dysfunction and a median time to recurrence of 31.6 months. CONCLUSION Our study, the largest on the topic, affirms the sustained effectiveness of a third SRS for TN, providing comparable pain relief to initial procedures. Notably, an extended pain-free interval after the third SRS session was observed. Facial sensory dysfunction emerged as the primary side effect. Larger studies are warranted to explore correlations with demographics and treatment parameters for a comprehensive understanding of repeat SRS in managing recurrent TN.
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Affiliation(s)
- Fernando De Nigris Vasconcellos
- Vivian L. Smith Department of Neurosurgery at McGovern Medical School, Texas Institute for Restorative Neurotechnologies, UTHealth Houston, 6431 Fannin St, Houston, TX, 77030, USA.
| | - Juan Diego Alzate
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Elad Mashiach
- Department of Neurological Surgery, NYU Langone Health, New York, NY, USA
| | - Ying Meng
- Department of Neurological Surgery, NYU Langone Health, New York, NY, USA
| | | | - Kenneth Bernstein
- Department of Neurological Surgery, NYU Langone Health, New York, NY, USA
| | - Pavel Pichardo-Rojas
- Vivian L. Smith Department of Neurosurgery at McGovern Medical School, Texas Institute for Restorative Neurotechnologies, UTHealth Houston, 6431 Fannin St, Houston, TX, 77030, USA
| | - Antonio Dono
- Vivian L. Smith Department of Neurosurgery at McGovern Medical School, Texas Institute for Restorative Neurotechnologies, UTHealth Houston, 6431 Fannin St, Houston, TX, 77030, USA
| | - Ethan P Damron
- Vivian L. Smith Department of Neurosurgery at McGovern Medical School, Texas Institute for Restorative Neurotechnologies, UTHealth Houston, 6431 Fannin St, Houston, TX, 77030, USA
| | - Angel I Blanco
- Vivian L. Smith Department of Neurosurgery at McGovern Medical School, Texas Institute for Restorative Neurotechnologies, UTHealth Houston, 6431 Fannin St, Houston, TX, 77030, USA
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery at McGovern Medical School, Texas Institute for Restorative Neurotechnologies, UTHealth Houston, 6431 Fannin St, Houston, TX, 77030, USA
| | - Dusan Urgosik
- Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaromir May
- Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Cheng-Chia Lee
- Department of Neurological Surgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Huai-Che Yang
- Department of Neurological Surgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Philip Kawalec
- Department of Neurological Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Anthony M Kaufmann
- Department of Neurological Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - David Mathieu
- Department of Neurological Surgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | - Christian Iorio-Morin
- Department of Neurological Surgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | - Piero Picozzi
- Department of Neurological Surgery, IRCCS Humanitas Research Hospital - IRCCS, Rozzano, Italy
| | - Andrea Franzini
- Department of Neurological Surgery, IRCCS Humanitas Research Hospital - IRCCS, Rozzano, Italy
| | - Manjul Tripathi
- Department of Neurological Surgery, PGIMER, Chandigarh, India
| | - Selcuk Peker
- Department of Neurological Surgery, Koc University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- Department of Neurological Surgery, Koc University School of Medicine, Istanbul, Turkey
| | - Timoteo Almeida
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Carolina Benjamin
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Douglas Kondziolka
- Department of Neurological Surgery, NYU Langone Health, New York, NY, USA
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
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Gordon J, Piper K, George Z, Vakharia K, Bezchlibnyk YB, Van Loveren H. Anatomic Variations of Foramen Ovale as a Predictor of Successful Cannulation in Percutaneous Trigeminal Rhizotomies. Oper Neurosurg (Hagerstown) 2024; 26:279-285. [PMID: 38358285 DOI: 10.1227/ons.0000000000000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/15/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Percutaneous trigeminal rhizotomies are common treatment modalities for medically refractory trigeminal neuralgia (TN). Failure of these procedures is frequently due to surgical inability to cannulate the foramen ovale (FO) and is thought to be due to variations in anatomy. The purpose of this study is to characterize the relationships between anatomic features surrounding FO and investigate the association between anatomic morphology and successful cannulation of FO in patients undergoing percutaneous trigeminal rhizotomy. METHODS A retrospective analysis was conducted of all patients undergoing percutaneous trigeminal rhizotomy for TN at our academic center between January 1, 2010, and July 31, 2022. Preoperative 1-mm thin-cut computed tomography head imaging was accessed to perform measurements surrounding the FO, including inlet width, outlet width, interforaminal distance (a representation of the lateral extent of FO along the middle fossa), and sella-sphenoid angle (a representation of the coronal slope of FO). Mann-Whitney U tests assessed the difference in measurements for patients who succeeded and failed cannulation. RESULTS Among 37 patients who met inclusion criteria, 34 (91.9%) successfully underwent cannulation. Successful cannulation was associated with larger inlet widths (median = 5.87 vs 3.67 mm, U = 6.0, P = .006), larger outlet widths (median = 7.13 vs 5.10 mm, U = 14.0, P = .040), and smaller sella-sphenoid angles (median = 52.00° vs 111.00°, U = 0.0, P < .001). Interforaminal distances were not associated with the ability to cannulate FO surgically. CONCLUSION We have identified morphological characteristics associated with successful cannulation in percutaneous rhizotomies for TN. Preoperative imaging may optimize surgical technique and predict cannulation failure.
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Affiliation(s)
- Jonah Gordon
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Keaton Piper
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA
| | - Zeegan George
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Kunal Vakharia
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA
| | - Yarema B Bezchlibnyk
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA
| | - Harry Van Loveren
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA
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Islam J, KC E, So KH, Kim S, Kim HK, Park YY, Park YS. Modulation of trigeminal neuropathic pain by optogenetic inhibition of posterior hypothalamus in CCI-ION rat. Sci Rep 2023; 13:489. [PMID: 36627362 PMCID: PMC9831989 DOI: 10.1038/s41598-023-27610-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Posterior hypothalamus (PH), an important part of the descending pain processing pathway, has been found to be activated in trigeminal autonomic cephalalgias. However, there are very few studies conducted and information regarding its implications in trigeminal neuropathic pain (TNP). Therefore, we aimed to ascertain whether optogenetic inhibition of PH could affect the outcomes of a chronic constriction injury in the infraorbital nerve (CCI-ION) rat model. Animals were divided into the TNP animal, sham, and naive-control groups. CCI-ION surgery was performed to mimic TNP symptoms, and the optogenetic or null virus was injected into the ipsilateral PH. In vivo single-unit extracellular recordings were obtained from both the ipsilateral ventrolateral periaqueductal gray (vlPAG) and contralateral ventral posteromedial (VPM) thalamus in stimulation "OFF" and "ON" conditions. Alterations in behavioral responses during the stimulation-OFF and stimulation-ON states were examined. We observed that optogenetic inhibition of the PH considerably improved behavioral responses in TNP animals. We found increased and decreased firing activity in the vlPAG and VPM thalamus, respectively, during optogenetic inhibition of the PH. Inhibiting PH attenuates trigeminal pain signal transmission by modulating the vlPAG and trigeminal nucleus caudalis, thereby providing evidence of the therapeutic potential of PH in TNP management.
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Affiliation(s)
- Jaisan Islam
- grid.254229.a0000 0000 9611 0917Department of Medical Neuroscience, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Elina KC
- grid.254229.a0000 0000 9611 0917Department of Medical Neuroscience, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Kyoung Ha So
- grid.254229.a0000 0000 9611 0917Institute for Stem Cell and Regenerative Medicine (ISCRM), College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea ,grid.31501.360000 0004 0470 5905Bio-Max/N-Bio Institute, Institute of Bio-Engineering, Seoul National University, Seoul, Republic of Korea
| | - Soochong Kim
- grid.254229.a0000 0000 9611 0917Department of Veterinary Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Hyong Kyu Kim
- grid.254229.a0000 0000 9611 0917Department of Medicine and Microbiology, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Yoon Young Park
- grid.411725.40000 0004 1794 4809Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Young Seok Park
- Department of Medical Neuroscience, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea. .,Institute for Stem Cell and Regenerative Medicine (ISCRM), College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea. .,Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea. .,Department of Neurosurgery, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, 776, 1 Sunhwanro, Seowon-gu, Cheongju-Si, Chungbuk, 28644, Republic of Korea.
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Fayed ZY, Afify H. Long-term follow-up of microvascular decompression for management of trigeminal neuralgia. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-022-00171-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Trigeminal neuralgia (TN) is mostly caused by neurovascular compression of the trigeminal nerve and the root entry zone at the brain stem. Microvascular decompression (MVD) has been established as a standard treatment for trigeminal neuralgia in patients not adequately controlled by medications.
Objectives
Reporting the long-term outcome of MVD in our group of patients with follow-up period equal to or more than five years.
Patients and methods
Twenty-one patients operated by MVD for TN were followed up for at least five years, they were evaluated describing the patient criteria and operative findings, complications, and the long-term clinical outcome.
Results
Sixteen of the twenty-one patients had complete pain relief maintained for up to five years and three of them up to eight years. Two patients had significant improvement but with mild occasional pain not requiring medications only one of them had his occasional pain maintained till five years, three patients experienced persistent pain which was still there after five years one of them showed mild improvement in his pain after one year of follow-up. Complications were mild and/or transient most frequent were headache nausea and dizziness.
Conclusion
In the long-term follow-up, microvascular decompression still maintains its clinical benefit with most patients still pain free after at least five years and up to eight years. It is safe procedures and should be considered in every patient with failed medical treatment.
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Skinner C, Kumar S. Ultrasound-Guided Occipital Nerve Block for Treatment of Atypical Occipital Neuralgia. Cureus 2021; 13:e18584. [PMID: 34765351 PMCID: PMC8575339 DOI: 10.7759/cureus.18584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Occipital neuralgia can occur secondary to injury to the occipital nerves or the C2 or C3 nerve roots. Symptoms of occipital neuralgia can include sudden and debilitating craniofacial pain, otalgia, neck pain, shoulder pain, vision changes, and tinnitus. We describe how an ultrasound-guided greater occipital nerve block substantially reduced symptoms associated with a middle-aged woman’s atypical presentation of occipital neuralgia, which was refractory to oral medications and other procedural interventions.
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Affiliation(s)
- Colby Skinner
- Anesthesiology, University of Florida College of Medicine, Gainesville, USA
| | - Sanjeev Kumar
- Anesthesiology, University of Florida College of Medicine, Gainesville, USA
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Yang S, Kwon S, Chang MC. The Usefulness of Diffusion Tensor Tractography in Diagnosing Neuropathic Pain: A Narrative Review. Front Neurosci 2021; 15:591018. [PMID: 33841069 PMCID: PMC8032899 DOI: 10.3389/fnins.2021.591018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/25/2021] [Indexed: 11/13/2022] Open
Abstract
Diffusion tensor tractography (DTT) is derived from diffusion tensor imaging. It has allowed visualization and estimation of neural tract injury, which may be associated with the pathogenesis of neuropathic pain (NP). The aim of the present study was to review DTT studies that demonstrated the relationship between neural injuries and NP and to describe the potential use of DTT in the evaluation of neural injuries that are involved in the pathophysiological process of NP. A PubMed search was conducted for articles published until July 3, 2020, which used DTT to investigate the association between neural injuries and NP. The key search phrase for identifying potentially relevant articles was (diffusion tensor tractography AND pain). The following inclusion criteria were applied for article selection: (1) studies involving patients with NP and (2) studies in which DTT was applied for the evaluation of NP. Review articles were excluded. Altogether, 108 potentially relevant articles were identified. After reading the titles and abstracts and assessment of eligibility based on the full-text articles, 46 publications were finally included in our review. The results of the included studies suggested that DTT may be beneficial in identifying the pathophysiological mechanism of NP of various origins including central pain caused by brain injuries, trigeminal neuralgia, sciatica, and some types of headache. Further studies are needed to validate the efficacy of DTT in investigating the pathophysiology of other types of NP.
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Affiliation(s)
- Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Women's University Seoul Hospital, Ewha Women's University School of Medicine, Seoul, South Korea
| | - SuYeon Kwon
- Department of Rehabilitation Medicine, Ewha Women's University Seoul Hospital, Ewha Women's University School of Medicine, Seoul, South Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, South Korea
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Texakalidis P, Tora MS, McMahon JT, Greven A, Anthony CL, Nagarajan P, Campbell M, Boulis NM. Percutaneous Trigeminal Stimulation for Intractable Facial Pain: A Case Series. Neurosurgery 2021; 87:547-554. [PMID: 32243534 DOI: 10.1093/neuros/nyaa065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/30/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Facial pain syndromes can be refractory to medical management and often need neurosurgical interventions. Neuromodulation techniques, including percutaneous trigeminal ganglion (TG) stimulation, are reversible and have emerged as alternative treatment options for intractable facial pain. OBJECTIVE To report the complication rates and analgesic effects associated with TG stimulation and identify potential predictors for these outcomes. METHODS A retrospective chart review of 59 patients with refractory facial pain who underwent TG stimulation was conducted. Outcomes following trial period and permanent stimulation were analyzed. Patients with >50% pain relief during trial stimulation received permanent implantation of the stimulation system. RESULTS Successful trial stimulation was endorsed by 71.2% of patients. During the trial period, 1 TG lead erosion was identified. History of trauma (facial/head trauma and oral surgery) was the only predictor of a failed trial compared to pain of idiopathic etiology (odds ratio: 0.15; 95% CI: 0.03-0.66). Following permanent implantation, approximately 29.6% and 26.5% of patients were diagnosed with lead erosion and infection of the hardware, respectively. TG lead migrations occurred in 11.7% of the patients. The numeric rating scale score showed a statistically significant reduction of 2.49 (95% CI: 1.37-3.61; P = .0001) at an average of 10.8 mo following permanent implantation. CONCLUSION TG stimulation is a feasible neuromodulatory approach for the treatment of intractable facial pain. Facial/head trauma and oral surgery may predict a nonsuccessful trial stimulation. Future development of specifically designed electrodes for stimulation of the TG, and solutions to reduce lead contamination are needed to mitigate the relatively high complication rate.
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Affiliation(s)
- Pavlos Texakalidis
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia
| | - Muhibullah S Tora
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia
| | - J Tanner McMahon
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia
| | - Alexander Greven
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia
| | - Casey L Anthony
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia
| | - Purva Nagarajan
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia
| | - Melissa Campbell
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia
| | - Nicholas M Boulis
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia
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Hu A, Morrison M, Honey CR. Hemi-laryngopharyngeal Spasm (HeLPS): Defining a New Clinical Entity. Ann Otol Rhinol Laryngol 2020; 129:849-855. [PMID: 32312092 DOI: 10.1177/0003489420916207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Hemi-laryngopharyngeal spasm (HeLPS) has recently been described in the neurosurgical literature as a cause of intermittent laryngopharyngeal spasm and cough due to vascular compression of the vagus nerve at the cerebellopontine angle. We present the diagnostic criteria for this syndrome. METHODS A retrospective chart review of six patients with HeLPS and three patients misdiagnosed with this condition are presented. All patients were diagnosed and treated at a tertiary care academic centre from July 2013 to July 2017. RESULTS Patients with HeLPS had five defining characteristics: 1) All patients had symptoms of episodic laryngopharyngeal spasm and coughing. Patients were asymptomatic between episodes and were refractory to speech therapy and reflux management. 2) Laryngoscopy showed hyperactive twitching of the ipsilateral vocal fold in two of the six patients. No other inter-episodic abnormalities were seen. 3) Botulinum toxin A injections into the thyroarytenoid muscle on the affected ipsilateral side reduced laryngopharyngeal spasms. Botulinum toxin injection in the contralateral thyroarytenoid muscle did not improve laryngopharyngeal spasm. 4) Magnetic resonance imaging revealed ipsilateral neurovascular compression of the vagus nerve rootlets by the posterior inferior cerebellar artery. 5) Microvascular decompression (MVD) surgery of the ipsilateral vagus nerve resolved all symptoms (follow-up 2-4 years). CONCLUSION The diagnostic criteria for hemi-laryngopharyngeal spasm (HeLPS) are proposed. Otolaryngology recognition of this new clinical entity may lead to a surgical cure and avoid the unnecessary therapies associated with misdiagnosis. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Amanda Hu
- Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Murray Morrison
- Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Christopher R Honey
- Department of Surgery, Division of Neurosurgery, University of British Columbia, Vancouver, BC, Canada
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Texakalidis P, Tora MS, Anthony CL, Greven A, McMahon JT, Nagarajan P, Kasoff WS, AuYong N, Boulis NM. Peripheral trigeminal branch stimulation for refractory facial pain: A single-center experience. Clin Neurol Neurosurg 2020; 194:105819. [PMID: 32259672 DOI: 10.1016/j.clineuro.2020.105819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Facial pain refractory to medical treatments may benefit from neurosurgical interventions. Only a few studies have reported on the efficacy of peripheral trigeminal stimulation and more specifically supraorbital nerve (SON) and infraorbital nerve (ION) stimulation for the treatment of facial pain. PATIENTS AND METHODS In the present study, we identified all patients at our institution who underwent SON and/or ION stimulation for treatment of facial pain due to post-herpetic, traumatic or idiopathic etiology. Relevant pre and post-operative outcomes were analyzed. RESULTS We identified 15 patients who underwent SON and/or ION stimulation. Among them, 12 (80 %) endorsed >50 % pain relief during the trial stimulation period. After a median follow-up of 5.8 months with permanent implantation, 1 patient (8.3 %) was diagnosed with lead erosion and IPG migration, two patients had lead infections (16.7 %) and one (8.3 %) had wound dehiscence. No lead migrations were identified during the long-term follow-up. The VAS score showed a statistically significant reduction from a median pre-operative score of 7 to a post-operative score of 1.8 (p = 0.011), which corresponded to a 74.3 % average pain reduction. CONCLUSION SON and/or ION stimulation can be an effective treatment for intractable facial pain due to post-herpetic, traumatic or idiopathic etiology; however the complication rate is relatively high. Future prospective studies with longer follow-up periods are warranted.
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Affiliation(s)
- Pavlos Texakalidis
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, United States.
| | - Muhibullah S Tora
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, United States
| | - Casey L Anthony
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, United States
| | - Alexander Greven
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, United States
| | - J Tanner McMahon
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, United States
| | - Purva Nagarajan
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, United States
| | - Willard S Kasoff
- Department of Neurosurgery, School of Medicine, University of Arizona, Tucson, AZ, United States
| | - Nicholas AuYong
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, United States
| | - Nicholas M Boulis
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, United States
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Tang Y, Wang M, Zheng T, Yuan F, Yang H, Han F, Chen G. Grey matter volume alterations in trigeminal neuralgia: A systematic review and meta-analysis of voxel-based morphometry studies. Prog Neuropsychopharmacol Biol Psychiatry 2020; 98:109821. [PMID: 31756417 DOI: 10.1016/j.pnpbp.2019.109821] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/29/2019] [Accepted: 11/12/2019] [Indexed: 02/08/2023]
Abstract
In recent decades, a growing number of structural neuroimaging studies of grey matter (GM) in trigeminal neuralgia (TN) have reported inconsistent alterations. We carried out a systematic review and meta-analysis to identify consistent and replicable GM volume abnormalities using effect-size signed differential mapping (ES-SDM). Furthermore, we conducted a meta-regression to explore the potential effects of clinical characteristics on GM volume alterations in patients with TN. A total of 13 studies with 15 datasets, representing 407 TN patients and 376 healthy individuals, were included in the present study. The results revealed that TN patients had GM volume abnormalities mainly in the basal ganglia, including the putamen, nucleus accumbens (NAc), caudate nucleus and amygdala, as well as the cingulate cortex (CC), thalamus, insula and superior temporal gyrus (STG). The meta-regression analysis showed that verbal rating scale (VRS) scores were negatively correlated with decreased GM volume in the left striatum and that illness duration was negatively correlated with decreased GM volume in the left STG and left insula. These results provide a thorough profile of GM volume alterations in TN patients and constitute robust evidence that aberrant GM volumes in the brain regions regulating and moderating sensory-motor and affective processing may play an important role in the pathophysiology of TN.
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Affiliation(s)
- Yu Tang
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Maohua Wang
- Department of Anesthesiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Ting Zheng
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Fengying Yuan
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Han Yang
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Fugang Han
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Guangxiang Chen
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China.
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Moayedi M, Hodaie M. Trigeminal nerve and white matter brain abnormalities in chronic orofacial pain disorders. Pain Rep 2019; 4:e755. [PMID: 31579849 PMCID: PMC6728001 DOI: 10.1097/pr9.0000000000000755] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/27/2019] [Accepted: 04/12/2019] [Indexed: 02/02/2023] Open
Abstract
Medial temporal lobe activity is investigated in meta-analyses of experimental and chronic pain. Abnormal hippocampal connectivity is found in patients with chronic low back pain. The orofacial region is psychologically important, given that it serves fundamental and important biological purposes. Chronic orofacial pain disorders affect the head and neck region. Although some have clear peripheral etiologies, eg, classic trigeminal neuralgia, others do not have a clear etiology (eg, muscular temporomandibular disorders). However, these disorders provide a unique opportunity in terms of elucidating the neural mechanisms of these chronic pain conditions: both the peripheral and central nervous systems can be simultaneously imaged. Diffusion-weighted imaging and diffusion tensor imaging have provided a method to essentially perform in vivo white matter dissections in humans, and to elucidate abnormal structure related to clinical correlates in disorders, such as chronic orofacial pains. Notably, the trigeminal nerve anatomy and architecture can be captured using diffusion imaging. Here, we review the trigeminal somatosensory pathways, diffusion-weighted imaging methods, and how these have contributed to our understanding of the neural mechanisms of chronic pain disorders affecting the trigeminal system. We also discuss novel findings indicating the potential for trigeminal nerve diffusion imaging to develop diagnostic and precision medicine biomarkers for trigeminal neuralgia. In sum, diffusion imaging serves both an important basic science purpose in identifying pain mechanisms, but is also a clinically powerful tool that can be used to improve treatment outcomes.
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Affiliation(s)
- Massieh Moayedi
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.,University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada.,Department of Dentistry, Mount Sinai Hospital, Toronto, ON, Canada
| | - Mojgan Hodaie
- University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada.,Division of Neurosurgery and Krembil Research Institute, Toronto Western Hospital, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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12
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Occipital Nerves. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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Hayes DJ, Chen DQ, Zhong J, Lin A, Behan B, Walker M, Hodaie M. Affective Circuitry Alterations in Patients with Trigeminal Neuralgia. Front Neuroanat 2017; 11:73. [PMID: 28928638 PMCID: PMC5591854 DOI: 10.3389/fnana.2017.00073] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 08/11/2017] [Indexed: 11/24/2022] Open
Abstract
Trigeminal neuralgia (TN) is a severe chronic neuropathic facial pain disorder. Affect-related behavioral and structural brain changes have been noted across chronic pain disorders, but have not been well-studied in TN. We examined the potential impact of TN (37 patients: 23 with right-sided TN, 14 with left-sided TN), compared to age- and sex-matched healthy controls, on three major white matter tracts responsible for carrying affect-related signals—i.e., cingulum, fornix, and medial forebrain bundle. Diffusion magnetic resonance imaging (dMRI), deterministic multi-tensor tractography for tract modeling, and a model-driven region-of-interest approach was used. We also used volumetric gray matter analysis on key targets of these pathways (i.e., hippocampus, cingulate cortex subregions, nucleus accumbens, and ventral diencephalon). Hypotheses included: (1) successful modeling of tracts; (2) altered white matter microstructure of the cingulum and medial forebrain bundle (via changes in dMRI metrics such as fractional anisotropy, and mean, axial, and radial diffusivities) compared to controls; (3) no alterations in the control region of the fornix; (4) corresponding decreases in gray matter volumes. Results showed (1) all 325 tracts were successfully modeled, although 11 were partially complete; (2) The cingulum and medial forebrain bundle (MFB) were altered in those with TN, with dMRI metric changes in the middle (p = 0.001) and posterior cingulum (p < 0.0001), and the MFB near the ventral tegmental area (MFB-VTA) (p = 0.001). The posterior cingulum and MFB-VTA also showed unilateral differences between right- and left-sided TN patients; (3) No differences were noted at any fornix subdivision; (4) decreased volumes were noted for the hippocampus, posterior cingulate, nucleus accumbens, and ventral diencephalon. Together, these results support the notion of selectively altered affective circuits in patients with TN, which may be related to the experience of negative affect and the increased comorbidity of mood and anxiety disorders in this population.
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Affiliation(s)
- Dave J Hayes
- Psychology Department and Neuroscience Program, Union CollegeSchenectady, NY, United States.,Division of Brain, Imaging and Behaviour Systems Neuroscience and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Krembil Research Institute, University Health Network, University of TorontoToronto, ON, Canada
| | - David Q Chen
- Division of Brain, Imaging and Behaviour Systems Neuroscience and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Krembil Research Institute, University Health Network, University of TorontoToronto, ON, Canada
| | - Jidan Zhong
- Division of Brain, Imaging and Behaviour Systems Neuroscience and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Krembil Research Institute, University Health Network, University of TorontoToronto, ON, Canada
| | - Ariel Lin
- Psychology Department and Neuroscience Program, Union CollegeSchenectady, NY, United States
| | - Brendan Behan
- Division of Brain, Imaging and Behaviour Systems Neuroscience and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Krembil Research Institute, University Health Network, University of TorontoToronto, ON, Canada
| | - Matthew Walker
- Division of Brain, Imaging and Behaviour Systems Neuroscience and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Krembil Research Institute, University Health Network, University of TorontoToronto, ON, Canada
| | - Mojgan Hodaie
- Division of Brain, Imaging and Behaviour Systems Neuroscience and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Krembil Research Institute, University Health Network, University of TorontoToronto, ON, Canada
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14
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Kang DH, Kim SY, Kim HG, Park JH, Kim TK, Kim KH. Earlier treatment improves the chances of complete relief from postherpetic neuralgia. Korean J Pain 2017; 30:214-219. [PMID: 28757922 PMCID: PMC5532529 DOI: 10.3344/kjp.2017.30.3.214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 02/07/2023] Open
Abstract
Background As herpes zoster progresses via postherpetic neuralgia (PHN) to well-established PHN, it presents its recalcitrant nature to the treatment. At this point, the well-established PHN is fixed as a non-treatable, but manageable chronic painful neuropathic disorder. This study evaluated the incidence of complete relief from PHN according to PHN duration at their first visit, and the other factors influencing it. Methods A retrospective chart review was performed on patients with PHN at a university-based pain clinic over 7 years. The responders were defined as patients who had complete relief from pain after 1 year of active treatment. Age, sex, PHN duration at their first visit, dermatomal distribution, and underlying disorders were compared in the responder and non-responder groups. Responders were also compared according to these factors. Results Among 117 PHN patients (M/F = 48/69), 35 patients (29.9%) had complete relief from PHN. Mean ages were 64.3 ± 10.6 and 66.9 ± 10.7 years, numbers of male to female patients were 11/24 and 37/45, and mean durations of PHN at their first visit were 8.5 ± 6.3 and 15.3 ± 10.7 months in the responder and non- responder groups, respectively. In addition, PHN patients who visited the clinic before 9 months showed a better result. Dermatomal distribution and underlying disorders did not show significant differences. Conclusions Almost 30% of PHN patients received complete relief. Those who sought treatment in a pain clinic before 9 months received a better result.
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Affiliation(s)
- Dong Hee Kang
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Su Young Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Hyuck Goo Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Jung Hyun Park
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Tae Kyun Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Kyung Hoon Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
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Abstract
The pain experienced by patients with trigeminal, occipital, or postherpetic neuralgia is often severe, chronic, and difficult to treat. In this article, Drs Ashkenazi and Levin outline the pathologic mechanisms of pain in these common neuralgias and discuss individually tailored pharmacologic and surgical approaches to their treatment.
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Affiliation(s)
- Avi Ashkenazi
- Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
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16
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Gladstone JP, Dodick DW. Revised 2004 International Classification of Headache Disorders: New Headache Types. Can J Neurol Sci 2014; 31:304-14. [PMID: 15376472 DOI: 10.1017/s031716710000336x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 1988, the International Headache Society created a classification system that has become the standard for headache diagnosis and research. The International Classification of Headache Disorders galvanized the headache community and stimulated nosologic, epidemiologic, pathophysiologic, and genetic research. It also facilitated multinational clinical drug trials that have led to the basis of current treatment guidelines. While there have been criticisms, the classification received widespread support by headache societies around the globe. Fifteen years later, the International Headache Society released the revised and expanded International Classification of Headache Disorders second edition. The unprecedented and rapid advances in the field of headache led to the inclusion of many new primary and secondary headache disorders in the revised classification. Using illustrative cases, this review highlights 10 important new headache types that have been added to the second edition. It is important for neurologists to familiarize themselves with the diagnostic criteria for the frequently encountered primary headache disorders and to be able to access the classification (www.i-h-s.org) for the less commonly encountered or diagnostically challenging presentations of headache and facial pain.
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17
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Hebb ALO, Sawynok J, Bance M, Walling S, Chisholm K, Morris DP. Pharmacological management of neuropathic pain in patients with vestibular schwannomas: Experience of the Atlantic Lateral Skull Base Clinic. World J Pharmacol 2014; 3:24-32. [DOI: 10.5497/wjp.v3.i2.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 05/31/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
Neuropathic pain is chronic pain generated by disorders of the peripheral and central nervous system, including skull base tumours. A skull base tumour can be any type of tumour that forms in the skull base, and this includes vestibular schwannomas which arise from the sheath of the inner ear vestibulocochlear nerve (eighth cranial nerve). Growth of the tumour, surgical resection, and/or stereotactic radiotherapy may result in compression and/or irritation of the fifth cranial nerve (trigeminal nerve) resulting in facial pain and/or numbness. Non-trigeminal afferent input may contribute to the wide constellation of symptoms seen in orofacial pain patients. The purpose of this report was to develop a decision tool to guide the recognition and treatment of neuropathic pain in this specialized population. Recommendations for treatment are based on evidence presented in Canadian and international neuropathic treatment guidelines. Algorithms are included for assessment and treatment of adult patients with agents that are recognized to have analgesic efficacy within the broad context of neuropathic pain.
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18
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Broggi M, Acerbi F, Ferroli P, Tringali G, Schiariti M, Broggi G. Microvascular decompression for neurovascular conflicts in the cerebello-pontine angle: which role for endoscopy? Acta Neurochir (Wien) 2013; 155:1709-16. [PMID: 23884611 DOI: 10.1007/s00701-013-1824-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 07/10/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Microvascular decompression (MVD) is the surgical intervention designed to resolve neurovascular conflicts (NCs) in the cerebellopontine angle (CPA). Today, endoscopy is commonly used in many neurosurgical procedures. This study aims to retrospectively assess the usefulness of endoscopy during MVD, focusing on microscopic endoscopic-assisted (MEA) MVD. METHODS Between January 2010 and December 2012, 141 patients underwent MVD procedures: 119 (84.5 %) were affected by idiopathic trigeminal neuralgia (TN), 20 (14 %) by hemifacial spasm (HFS), 1 by glossopharyngeal neuralgia (GN) and 1 by TN and GN simultaneously; 128 (91 %) MVD were first time procedures, while 13 (9 %) were recurrences (10 TN, 3 HFS). Visualization techniques used were: pure microscopic in 89 (63 %) cases, fully endoscopic in 12 (8.5 %) and MEA in 40 (28.5 %). The MEA technique was used when the conflict was not clearly identified under microscopic view or it was not certainly resolved. RESULTS Overall, a NC was found in 130 (92 %) cases, while 11 patients had no intraoperative evidence of NC. Considering specifically the 40 MEA cases, 12 (8.5 % overall) conflicts not clearly visible with the microscope were revealed and solved, a complete conflict resolution was confirmed in 13 (9 % overall) cases, while an incomplete conflict resolution was shown in four cases (3 % overall). CONCLUSION Pure microscopic MVD remains the technique of choice. The endoscope is a useful adjunctive imaging tool in confirming NCs identified by the microscope, revealing conflicts missed by the microscopic survey alone and verifying adequate nerve decompression.
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Affiliation(s)
- Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milano, Italy.
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Broggi G, Broggi M, Ferroli P, Franzini A. Surgical technique for trigeminal microvascular decompression. Acta Neurochir (Wien) 2012; 154:1089-95. [PMID: 22531963 DOI: 10.1007/s00701-012-1324-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 03/07/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Microvascular decompression (MVD) is a non-ablative technique designed to resolve the neurovascular conflict responsible for typical idiopathic trigeminal neuralgia (TN). METHOD With the patient in a supine position, a small elliptical retrosigmoid craniectomy is used to approach the cerebellopontine angle and the trigeminal nerve. After careful exploration of the trigeminal root entry zone, the offending vessel is identified and moved away. Oxidized regenerated cellulose is used to keep the vessel in its new position far from the nerve. CONCLUSION MVD represents the gold standard first line treatment for TN; its aim is to free the nerve from any contact.
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Affiliation(s)
- Giovanni Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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20
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Maggioni F, Bellamio M, Margoni M, Zanchin G, Manara R. Hematoma of Meckel’s cave: a rare possible symptomatic trigeminal neuralgia. J Neurol 2012; 259:1481-2. [DOI: 10.1007/s00415-012-6410-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 12/31/2011] [Accepted: 01/04/2012] [Indexed: 11/28/2022]
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21
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Stiles MA, Evans JJ. Trigeminal Neuralgia. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00050-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Pérez C, Saldaña MT, Navarro A, Martínez S, Rejas J. Trigeminal neuralgia treated with pregabalin in family medicine settings: its effect on pain alleviation and cost reduction. J Clin Pharmacol 2009; 49:582-90. [PMID: 19299534 DOI: 10.1177/0091270009333017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study is to analyze the effect of pregabalin (PGB) on pain alleviation, use of health care and non-health care resources, and associated costs in patients with trigeminal neuralgia under usual clinical practice in primary care settings. Sixty-five PGB-naïve patients receiving PGB as monotherapy (n = 36, 55%) or combined with other drugs (n = 29, 45%) fulfill criteria for inclusion in a secondary analysis from a 12-week, multicenter, observational prospective study aimed to ascertain the cost of illness in subjects with neuropathic pain. Pain is evaluated using the Short Form McGill Pain Questionnaire. Use of health care and non-health care resources and lost workdays equivalents (LWDEs) are also recorded. PGB significantly reduces pain scores, use of health care resources (ancillary tests and unscheduled medical visits), and number of LWDEs. Additional cost of PGB treatment (+euro 174 +/- 106) is broadly compensated for by a reduction in both health care costs (-euro 621 +/-1211, P < .001) and indirect costs (-euro 1210 +/- 1141, P < .001). It is concluded that PGB as monotherapy or combined with other drugs is effective in pain management in patients with trigeminal neuralgia and reduces the cost of illness.
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Affiliation(s)
- Concepción Pérez
- Unidad del Dolor, Hospital de La Princesa, C/Diego de León, Madrid, Spain.
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23
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Kanpolat Y, Kahilogullari G, Ugur HC, Elhan AH. Computed Tomography-guided Percutaneous Trigeminal Tractotomy-nucleotomy. Oper Neurosurg (Hagerstown) 2008. [DOI: 10.1227/01.neu.0000320139.27501.69] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Objective:
The destruction of the descending trigeminal tractus in the medulla is known as trigeminal tractotomy (TR), whereas the lesioning of the nucleus caudalis is known as trigeminal nucleotomy (NC). Trigeminal TR and/or NC procedures can be used in a large group of pain syndromes, such as glossopharyngeal, vagal, and geniculate neuralgias, atypical facial pain, craniofacial cancer pain, postherpetic neuralgias, and atypical forms of trigeminal neuralgia.
Methods:
In this study, anatomic and technical details of the procedure and the experience gained from 65 patients over the course of 20 years are discussed. Patients’ pain scores and Karnofsky Performance Scale scores were evaluated pre- and postoperatively (postoperative Day 1).
Results:
The best results were obtained in the second-largest group (vagoglossopharyngeal neuralgia, n = 17) and in geniculate neuralgia (n = 4). Patients with atypical facial pain (n = 21; 13 women, eight men) accounted for the largest group to undergo computed tomography-guided TR-NC surgery; pain relief was achieved in 19 of these patients. In the third-largest group (craniofacial and oral cancer pain, n = 13), 11 of 13 patients were successfully treated with TR-NC. Four of five patients with failed trigeminal neuralgia were also effectively treated with TR-NC.
Conclusion:
We propose that computed tomography-guided TR-NC provides direct visualization of the target-electrode relation and can be considered a first-step procedure in patient management. In view of its high efficacy, low complication rate, and minimal invasiveness, computed tomography-guided trigeminal TR-NC is a safe and effective procedure in the treatment of intractable facial pain syndromes.
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Affiliation(s)
- Yucel Kanpolat
- Department of Neurosurgery, School of Medicine, Ankara University, Sihhiye, Turkey
| | - Gokmen Kahilogullari
- Department of Neurosurgery, School of Medicine, Ankara University, Sihhiye, Turkey
| | - Hasan C. Ugur
- Department of Neurosurgery, School of Medicine, Ankara University, Sihhiye, Turkey
| | - Atilla H. Elhan
- Department of Biostatistics, School of Medicine, Ankara University, Sihhiye, Turkey
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25
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Stiles MA, Evans J. Trigeminal Neuralgia. Pain Manag 2007. [DOI: 10.1016/b978-0-7216-0334-6.50050-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Volcy M, Tepper SJ, Rapoport AM, Sheftell FD, Bigal ME. Botulinum toxin A for the treatment of greater occipital neuralgia and trigeminal neuralgia: a case report with pathophysiological considerations. Cephalalgia 2006; 26:336-40. [PMID: 16472343 DOI: 10.1111/j.1468-2982.2005.00959.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Volcy
- The New England Centre for Headache, Stamford, CT 06902-1251, USA
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Bhatti MT, Patel R. Neuro-ophthalmic considerations in trigeminal neuralgia and its surgical treatment. Curr Opin Ophthalmol 2005; 16:334-40. [PMID: 16264342 DOI: 10.1097/01.icu.0000183859.67294.c6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- M Tariq Bhatti
- Department of Ophthalmology, University of Florida College of Medicine, JHMHSC, Gainesville, Florida 32610-0284, USA.
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Kanpolat Y, Savas A, Ugur HC, Bozkurt M. The trigeminal tract and nucleus procedures in treatment of atypical facial pain. ACTA ACUST UNITED AC 2005; 64 Suppl 2:S96-100; discussion S100-1. [PMID: 16256853 DOI: 10.1016/j.surneu.2005.07.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2005] [Indexed: 11/23/2022]
Abstract
BACKGROUND Atypical facial pain (AFP) is a throbbing pain situated deep in the eye and malar region, often radiating to the ear, neck, and shoulders. The pain generally is not within any dermatomal or anatomical boundaries. Atypical facial pain is distinct from trigeminal neuralgia and its variants. Therefore, the treatment of AFP should be specified. There is also no consensus in the treatment of AFP. Two different treatment procedures on the trigeminal tract and nucleus in a series of cases with AFP are presented. METHODS Between 1989 and 2005, 17 patients with AFP, in whom previous therapies had failed, underwent computed tomography (CT)-guided percutaneous trigeminal tractotomy-nucleotomy (TR-NC). One patient with unfavorable response to TR-NC underwent trigeminal dorsal root entry zone (DREZ) operation. RESULTS In the series with AFP, pain relief was achieved in all of the 17 cases. TR-NC provided maximum to inadequate degrees of pain relief in 16 of 17 patients. Dorsal root entry zone operation provided partial relief in 1 case. Neither mortality nor serious permanent complication was observed in the series. CONCLUSION Neurosurgical procedures such as TR-NC or trigeminal DREZ operation may be effective in the treatment of intractable AFP. The primary choice of operation should be TR-NC because this procedure is minimally invasive. Trigeminal DREZ operation, which affects a larger spread area, may follow if TR-NC fails. The indications and procedure of choice should be individually tailored, depending on the type of pain, underlying pathology, and experience of the surgeon.
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Affiliation(s)
- Yücel Kanpolat
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara 06100, Turkey.
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Burchiel KJ, Baumann TK. Pathophysiology of trigeminal neuralgia: new evidence from a trigeminal ganglion intraoperative microneurographic recording. Case report. J Neurosurg 2004; 101:872-3. [PMID: 15540931 DOI: 10.3171/jns.2004.101.5.0872] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The origin of trigeminal neuralgia (TN) appears to be vascular compression of the trigeminal nerve at the root entry zone; however, the physiological mechanism of this disorder remains uncertain. The authors obtained intraoperative microneurographic recordings from trigeminal ganglion neurons in a patient with TN immediately before percutaneous radiofrequency-induced gangliolysis. Their findings are consistent with the idea that the pain of TN is generated, at least in part, by an abnormal discharge within the peripheral nervous system.
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Affiliation(s)
- Kim J Burchiel
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon 97239-3098, USA
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31
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Kilpatrick SR. Craniofacial Neural Disorders: A Guide for Diagnosis and Management. Cranio 2004; 22:304-13. [PMID: 15532315 DOI: 10.1179/crn.2004.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The purpose of this article is to provide a succinct diagnosis and management regimen for neural disorders of the craniofacial region. This guide is an attempt to organize available data in a format for use by the craniofacial pain practitioner. The management regimens are brief because the management of many of these disorders may be outside the scope of dentistry. Also, the purpose of this guide is to be user-friendly and complete. Terminology is based on a literature review so individual disorders may be researched more completely.
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