Olfactory threshold increase in trigeminal neuralgia after balloon compression

Trigeminal Sensory Neuropathy Predicts Chemosensory Dysfunction After Skull Base Surgery

BACKGROUND

Trigeminal sensory neuropathy, characterized by diminished or exaggerated/painful sensation along the distribution of trigeminal branches, is one of the complications after skull base surgery. These procedures can also affect chemosensory functions and compromise the patients' quality of life.

OBJECTIVE

To examine those postoperative complications in chemosensory and facial cutaneous sensory functions as well as their interaction.

METHODS

A total of 61 patients being operated for various pathologies in the vicinity of trigeminal pathway (17 with trigeminal neuralgia, 20 with meningiomas, and 24 with vestibular schwannomas) and 50 healthy controls were enrolled in this case-control study. Postoperative trigeminal neuropathic symptoms were evaluated. The olfactory, gustatory, and intranasal trigeminal functions were assessed using the Sniffin' Stick olfactory test, lateralized taste strip test, and the lateralized intranasal trigeminal CO 2 detection thresholds, respectively.

RESULTS

Patients with trigeminal neuralgia and meningioma had relatively decreased olfactory function, whereas those with vestibular schwannoma had a relative decrease in taste function. As for the relationship between the distribution of trigeminal neuropathy and chemosensory dysfunction, we found that V3 involvement predicted lower side-specific taste function. In addition, V2/V3 involvement predicted relatively lower side-specific intranasal trigeminal function.

CONCLUSION

The present results suggest a differential involvement of the chemical senses in relation to the site and pathology of the lesions after surgery. The presence of trigeminal neuropathy is associated with taste and intranasal trigeminal dysfunction. The results serve as a basis for consultation regarding outcome prediction and patient education.

Quantitative sensory testing in elderly: longitudinal study

ABSTRACT Objective: To evaluate elderly patients in a geriatric service, along with their sensory characteristics and their association with clinical aspects. Methods: This was a descriptive longitudinal study. We enrolled 36 healthy participants of both sexes in this study. The following instruments were used and evaluations performed: clinical evaluation, Mini-Mental State Exam, and quantitative sensory testing. Results: During the follow-up, there was reduction of mean corpuscular volume at each evaluation (p < 0.001) and significant increase in mean corpuscular hemoglobin concentration (p < 0.001). There was an increase of the olfactory (p < 0.001), salty (p = 0.024), sour (p = 0.020), bitter (p = 0.001), facial cold (p = 0.019), hand cold (p = 0.004), facial tactile (p < 0.001), hand tactile (p = 0.012) and facial vibration (p = 0.018) thresholds. Previous existing morbidities were associated with sensitivity changes in the individuals in this sample. Conclusion: This longitudinal study suggests that the loss of sensitivity with aging may be associated with the presence of morbidities in elders.

Long-term outcome of percutaneous balloon compression for trigeminal neuralgia patients elder than 80 years: A STROBE-compliant article

This article evaluates the long-term outcome of percutaneous balloon compression (PBC) for trigeminal neuralgia (TN) patients elder than 80 years. A total of 138 elderly patients aged above 80 years with primary TN, who were admitted to Neurosurgery Department, Hangzhou First People's Hospital from January 2007 to December 2011 for PBC treatment, were retrospectively analyzed in this study. The postoperative cure rate of immediate pain was 98.6% (Barrow Neurological Institute [BNI] classes I, II); according to the follow-up, the pain cure rates at 1, 2, 3, 4, and 5 years after surgery were 93.5%, 90.4%, 84.7%, 80.4%, and 72.9%, respectively. In our group, postoperative diplopia was reported in 1 case, masticatory muscle weakness in 3 cases, and herpes labialis in 19 cases. A total of 100% of pain-cured patients exhibited facial numbness and facial hypoesthesia. No serious complications occurred in this group of patients. PBC is an effective and safe procedure for TN treatment and can be employed as the preferred regimen for elderly TN patients aged above 80 years in poorer physical condition.

Abducent nerve palsy after microballoon compression of the trigeminal ganglion: Case report

Background:

Trigeminal neuralgia (TN) is the most common type of facial neuralgia with incidence of 26.8/100,000 person year. In general, this scenario is characterized by a lancinating, unilateral, paroxysmal pain in the area of the fifth cranial nerve. Several treatment methods, including the injection of ethyl alcohol or butyl alcohol into the ganglion, the glycerol injection into the trigeminal cistern, peripheral nerve divisions, the radiofrequency thermocoagulation of the preganglionic fibers, and radiosurgery has been used for TN.

Case Description:

A case of a 74-year-old woman patient who undergone a treatment of TN through a compression of Meckel cave and developed a transient abducent palsy is presented. Complication regarding to a palsy of abducent nerve is discussed as well as the analysis of presumable evolving physiopathology. A critical review of literature was performed.

Conclusions:

Among the procedures, we mean that percutaneous microballoon compression (PMC) is the best choice for elderly frail patients, because it had a very low associated mortality-morbidity rate and does not damage permanent the Gasserian ganglion.

Sensory abnormalities and masticatory function after microvascular decompression or balloon compression for trigeminal neuralgia compared with carbamazepine and healthy controls

OBJECT

Idiopathic trigeminal neuralgia (iTN) is a neurological condition treated with pharmacotherapy or neurosurgery. There is a lack of comparative papers regarding the outcomes of neurosurgery in patients with iTN. The objective of this study was to investigate sensory thresholds and masticatory function in 78 patients with iTN who underwent microvascular decompression (MVD) or balloon compression (BC), and compare these treatments with carbamazepine and 30 untreated healthy controls.

METHODS

The authors conducted a case-controlled longitudinal study. Patients were referred to 1 of 3 groups: MVD, BC, or carbamazepine. All patients were evaluated before and after treatment with a systematic protocol composed of a clinical orofacial questionnaire, Research Diagnostic Criteria for temporomandibular disorders, Helkimo indices, and a quantitative sensory-testing protocol (gustative, olfactory, cold, warm, touch, vibration, superficial, and deep pain thresholds).

RESULTS

Both MVD and BC were effective at reducing pain intensity (p = 0.012) and carbamazepine doses (p < 0.001). Myofascial and articular complaints decreased in both groups (p < 0.001), but only the patients in the MVD group showed improvement in Helkimo indices (p < 0.003). Patients who underwent MVD also showed an increase in sweet (p = 0.014) and salty (p = 0.003) thresholds. The sour threshold decreased (p = 0.003) and cold and warm thresholds increased (p < 0.001) in patients after MVD and BC, but only the patients who underwent BC had an increase in touch threshold (p < 0.001).

CONCLUSIONS

Microvascular decompression and BC resulted in a reduction in myofascial and jaw articular complaints, and the impact on masticatory function according to Helkimo indices was greater after BC than MVD. MVD resulted in more gustative alterations, and both procedures caused impairment in thermal thresholds (warm and cold). However, only BC also affected touch perception. The sensorial and motor deficits after BC need to be included as targets directly associated with the success of the surgery and need to be assessed and relieved as goals in the treatment of iTN.

The role of xerostomia in burning mouth syndrome: a case-control study

Objective : To assess the efficacy of anti-xerostomic topical medication (urea 10%) in patients with burning mouth syndrome (BMS). Method : Thirty-eight subjects diagnosed with BMS according to the International Association for the Study of Pain guidelines were randomized to either placebo (5% sodium carboxymethylcellulose, 0.15% methyl paraben, and 10% glycerol in distilled water qsp 100 g) or treatment (urea 10%) to be applied to the oral cavity 3-4 times per day for 3 months. The patients were evaluated before and after treatment with the following instruments: the EDOF-HC protocol (Orofacial Pain Clinic – Hospital das Clínicas), a xerostomia questionnaire, and quantitative sensory testing. Results : There were no differences in salivary flow or gustative, olfactory, or sensory thresholds (P>0.05). Fifteen (60%) patients reported improvement with the treatments (P=0.336). Conclusion : In conclusion, there were no differences between groups, and both exhibited an association between reported improvement and salivation.

Comparative evaluation of surgical procedures for trigeminal neuralgia

Trigeminal neuralgia (TN) is a debilitating ailment. Pharmacotherapy still remains the first line therapy for the management of TN. However, often the patients become refractory to the pharmacotherapy and need surgical interventions. There is a wide array of surgical treatment modalities available for TN and it is important to select the most appropriate surgery for a patient. This review evaluates the various surgical modalities by employing a comparative analysis with respect to patient selection, success rate, complications and cost effectiveness. For the evaluation, a critical review of literature was done with predefined search terms to obtain the details of individual procedures, which were then compared, under similar parameters. The results suggested that microvascular decompression seem to be the most effective treatment in terms of patient satisfaction and long term cost effectiveness. However, if patient factors do not permit, then the peripheral procedures may be employed as a substitute, though they have higher recurrence rate and complications and have relatively lower long term cost effectiveness. The newer modalities like stereotactic radiosurgery and botulinum injections have promising results and further refinement in these procedures will provide additional options for the patients suffering from TN.

Trigeminal pain and quantitative sensory testing in painful peripheral diabetic neuropathy

OBJECTIVE

To evaluate patients with Diabetes Mellitus type 2 and painful peripheral neuropathy in order to investigate oral complaints and facial somatosensory findings.

RESEARCH DESIGN AND METHODS

Case-control study; 29 patients (12 women, mean age 57.86 yo) with Diabetes Mellitus type 2 and 31 age-gender-matched controls were evaluated with a standardized protocol for general characteristics, orofacial pain, research diagnostic criteria for temporomandibular disorders, visual analogue scale and McGill Pain questionnaire, and a systematic protocol of quantitative sensory testing for bilateral facial sensitivity at the areas innervated by the trigeminal branches, which included the thermal detection by ThermoSensi 2, tactile evaluation with vonFrey filaments, and superficial pain thresholds with a superficial algometer (Micromar). Statistical analysis was performed with Wilcoxon, chi-square, confidence intervals and Spearman (p<0.05).

RESULTS

Orofacial pain was reported by 55.2% of patients, and the most common descriptor was fatigue (50%); 17.2% had burning mouth. Myofascial temporomandibular disorders were diagnosed in 9 (31%) patients. The study group showed higher sensory thresholds of pain at the right maxillary branch (p=0.017) but sensorial differences were not associated with pain (p=0.608). Glycemia and HbA(1c) were positively correlated with the quantitative sensory testing results of pain (p<0.05) and cold (p=0.044) perceptions. Higher pain thresholds were correlated with higher glycemia and glycated hemoglobin (p=0.027 and p=0.026).

CONCLUSIONS

There was a high prevalence of orofacial pain and burning mouth was the most common complaint. The association of loss of pain sensation and higher glycemia and glycated hemoglobin can be of clinical use for the follow-up of DM complications.

Factors That Influence Outcome of Percutaneous Balloon Compression in the Treatment of Trigeminal Neuralgia

BACKGROUND:

Percutaneous balloon compression is an effective, low-cost, simple therapeutic modality with the special advantage of being the only percutaneous technique that can be simply performed with the patient under general anesthesia for the treatment of trigeminal neuralgia.

OBJECTIVE:

To identify surgical and individual parameters that could influence outcome in patients with trigeminal neuralgia treated with percutaneous balloon compression.

METHODS:

Within a 5-year period, 66 consecutive percutaneous balloon compressions were performed in 47 patients. The medical and surgical records of all patients were retrospectively reviewed and analyzed for a possible correlation between the following parameters and outcome: balloon shape, balloon volume, compression time, age, sex, type of pain, duration of disease, previous procedures, and trigeminal division affected. Univariate and multivariate analyses were used to test for statistical significance.

RESULTS:

The initial success rate was 85%, and 36% of the responders are still pain free with a mean follow-up of approximately 20 months, whereas in 33 patients, trigeminal pain recurred after a mean of approximately 17 months. Of the investigated parameters, significant correlations were obtained between balloon shape and all aspects of outcome, previous operations and complication rate, pain type and complication rate, and compression time and postoperative numbness.

CONCLUSION:

The balloon shape is a parameter with a very strong impact on outcome, and balloon volume should be adjusted to this parameter. Persistent elliptical balloon shapes should raise consideration of aborting the procedure. There were no differences in outcomes between 60 seconds and longer compression times. The number of previous operations did not correlate with pain relief, but seemed to increase the risk of complications. Patients with multiple sclerosis seemed to obtain similar benefit from the procedure as do patients with classic trigeminal neuralgia.

Cardiovascular response during trigeminal ganglion compression for trigeminal neuralgia according to the use of local anesthetics

OBJECTIVES

There are controversies about the use of local anesthetics during balloon compression for trigeminal neuralgia (TN) as a protective factor for cardiovascular events. The objective of this study was to investigate cardiovascular parameters (blood pressure and heart rate [HR]) of patients that underwent trigeminal balloon compression with local anesthetics compared to a control group (placebo).

METHODS

This is a randomized controlled study; 55 patients were randomized into two groups: study (deep sedation and trigeminal block with 0.8-mL lidocaine 2%) and control group (deep sedation and trigeminal injection of 0.8-mL saline). Blood pressure and HR were measured in five distinct moments: preoperative, during puncture for local anesthesia/placebo, during puncture with the catheter, during balloon compression, and final evaluation. Statistical analysis was performed with Pearson's chi (2) and McNemar tests and the analysis of variance for repetitive measures.

RESULTS

The means of systolic and diastolic blood pressures (SBP and DBP, respectively) were higher in the control group when compared to the study group at the evaluation during puncture with the catheter (p < 0.001) and balloon compression (p < 0.001 and p = 0.018 for DBP and SBP, respectively). There was an increase in the HR in the control group during the procedure (p = 0.017).

CONCLUSION

The use of local anesthetics during the trigeminal balloon compression for TN can have a preventive role for the risk of cardiovascular events.

Self-reported severity of taste disturbances correlates with dysfunctional grade of TMD pain

Altered central neural processing of sensory information may be associated with temporomandibular disorders (TMD) pain. The objectives of this study were to compare the prevalence of self-reported taste disturbances in TMD pain patients and in a control population, and to determine whether frequency of taste disturbances was correlated with dysfunctional grade of TMD pain. Subjects were 2026 people within a German population sample and 301 consecutive TMD patients diagnosed using the Research Diagnostic Criteria. Taste disturbances were measured using two questions from the Oral Health Impact Profile. Dysfunctional grade of TMD pain was measured with the Graded Chronic Pain Scale. A two-sample test of proportions revealed that TMD patients reported a greater frequency of taste disturbances, 6%, than did the general population subjects, 2% (P < 0.001). Moreover, the frequency of taste disturbances correlated with the dysfunctional grade of TMD pain. For each 1 unit increase in taste disturbance, the odds of observing a higher grade of TMD pain increased by 29% (95% CI: 3-63%, P = 0.03). Analysis by individual taste question and adjustment for age and gender did not substantially affect the results. These findings are consistent with a central neural dysfunction in TMD pain and suggest that a common neural substrate may underlie sensory disturbances of multiple modalities in chronic pain patients. Further research regarding taste disturbances and trigeminally mediated pains such as in TMD is warranted.

Operative treatment of trigeminal neuralgia: review of current techniques

Surgical approaches to pain management are performed when medication cannot control pain or patients cannot tolerate the adverse effects of the medication. Microvascular decompression (MVD) is generally performed when the patient is healthy and relatively young. Partial sensory rhizotomy is performed in addition to, or instead of MVD, in patients in whom significant compression of the trigeminal sensory root does not exist or in whom MVD is technically not feasible. Three percutaneous ablative procedures and gamma knife radiosurgery (GKS) are also performed when MVD cannot be performed. The result of MVD is superior to that of the 3 ablative procedures. GKS is inferior to the 3 ablative procedures in terms of initial pain relief and recurrence, but superior in terms of complications. Peripheral procedures are usually performed in patients not suitable for or not wishing to have other procedures. However, no strict rules exist and each patient should be evaluated individually.