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Stergioula A, Moutsatsos A, Pantelis E. Exploring long-term outcomes following CyberKnife robotic radiosurgery for trigeminal neuralgia. Clin Transl Radiat Oncol 2024; 48:100821. [PMID: 39161734 PMCID: PMC11331925 DOI: 10.1016/j.ctro.2024.100821] [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] [Received: 06/01/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 08/21/2024] Open
Abstract
Background and purpose Radiosurgery has been extensively studied for its efficacy and safety in the management of trigeminal neuralgia (TN). However, among the plethora of relevant studies in the literature, only a restricted number have been conducted targeting an elongated trigeminal nerve segment with the CyberKnife radiosurgery (CKRS) system. Herein, we report long-term clinical outcomes of TN patients treated with CKRS. Materials and methods Fifty patients treated with CKRS for medically refractory TN were analyzed. Pain response and sensory dysfunction post CKRS were assessed using the Barrow Neurological Institute (BNI) scale. Kaplan-Meier analysis was used to assess the maintenance of pain control and the risk of onset of facial numbness. The Cox proportional hazards regression model was employed for both univariate and multivariate analyses to identify predictive factors among the collected variables. Results The median follow-up period was 63 months (range: 12-174 months). The median values of treated nerve volume, prescription dose, and integral dose were 59 mm3, 60 Gy and 3.9 mJ, respectively. Pain control (BNI I-III) was achieved in 37 patients (74%). Among them, the actuarial freedom from pain (FFP) rate was 82%, 78% and 74% at 24, 36 and beyond 48 months post-CKRS, respectively. A correlation of FFP rate with patient gender, treated nerve volume, and mean dose was revealed in multivariate analysis. Twenty-three patients (62%) reported onset of new or aggravation of pre-existing, facial numbness with twenty-one of them (57%) characterizing it as "mild facial numbness, not bothersome" (BNI-II) and two (5%) as "somewhat bothersome" (BNI-III). We did not encounter any case with very bothersome facial numbness (BNI-IV). Conclusions Long-term results of this work contribute to the body of evidence supporting the safety and efficacy of CKRS in the treatment of TN patients, in view of excellent pain control for an acceptable toxicity profile.
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Affiliation(s)
| | | | - Evaggelos Pantelis
- Radiotherapy Department, Iatropolis Clinic, Athens, Greece
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Wei L, Han H, Meng J, Li X, Yao QP. Meta-analysis and sequential analysis of acupuncture compared to carbamazepine in the treatment of trigeminal neuralgia. World J Clin Cases 2024; 12:5083-5093. [DOI: 10.12998/wjcc.v12.i22.5083] [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: 04/10/2024] [Revised: 05/24/2024] [Accepted: 06/11/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND In this randomized controlled trial (RCT) comparing current acupuncture with carbamazepine for trigeminal neuralgia, meta- and sequential analyses were utilized.
AIM To guide clinical decision making regarding the treatment of trigeminal neuralgia with carbamazepine.
METHODS The RCT literature on needle comparison was searched in various Chinese biomedical databases including Chinese Biomedical Literature Database, Wanfang Data, VIP Database, as well as international databases such as Excerpt Medica Database, Cochrane Library, PubMed, and Web of Science, along with related clinical registration platforms such as World Health Organization International Clinical Trial Registry Platform, ChiCTR, and Clinical Trials up to 1 April 2020. Risk of bias was evaluated using the Cochrane Collaborative Risk Bias tool, primary outcome measures (pain reduction) were analyzed using STATA meta-analysis, outcome measures were analyzed using trial sequential analysis 0.9.5.10 Beta sequential analysis, GRADE was used to assess the evidence, and adverse reactions were documented.
RESULTS This study analyzed 16 RCTs with a total of 1231 participants. The meta-analysis revealed a statistically significant difference in pain reduction between acupuncture and carbamazepine [standardized mean difference (SMD) = 1.47; 95% confidence interval (CI): 0.99-1.95], although the quality of evidence was deemed to be of extremely low quality. Cumulative meta-analysis based on the year of publication indicated that carbamazepine treatment first demonstrated a statistically significant difference in pain reduction in 2014 and remained relatively stable over time [SMD = 1.84; 95%CI: 0.22-3.47]. Additionally, the number of adverse events associated with acupuncture was significantly lower compared to carbamazepine.
CONCLUSION Acupuncture for trigeminal neuralgia is better than analgesia and safer than carbamazepine; however, firm conclusions still require a high-quality, multicenter, large-sample RCT to confirm these findings.
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Affiliation(s)
- Li Wei
- Department of Encephalopathy, Tianjin Beichen Traditional Chinese Medicine Hospital, Tianjin 300400, China
| | - Hui Han
- Department of Encephalopathy, Tianjin Beichen Traditional Chinese Medicine Hospital, Tianjin 300400, China
| | - Jie Meng
- Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China
| | - Xin Li
- Bio-engineering Institute, Tianjin Modern Vocational Technology College, Tianjin 300350, China
| | - Qing-Ping Yao
- Department of Encephalopathy, Tianjin Beichen Traditional Chinese Medicine Hospital, Tianjin 300400, China
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Costa CMM, Santos DS, Opretzka LCF, de Assis Silva GS, Santos GC, Evangelista AF, Soares MBP, Villarreal CF. Different mechanisms guide the antinociceptive effect of bone marrow-mononuclear cells and bone marrow-mesenchymal stem/stromal cells in trigeminal neuralgia. Life Sci 2024; 354:122944. [PMID: 39111567 DOI: 10.1016/j.lfs.2024.122944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/21/2024] [Accepted: 08/04/2024] [Indexed: 08/10/2024]
Abstract
AIMS Trigeminal neuralgia (TN) is a type of chronic orofacial pain evoked by trivial stimuli that manifests as episodes of excruciating and sudden, recurrent paroxysmal pain. Most patients are refractory to pharmacological therapy used for the treatment of TN. Mononuclear cells (MNC) and mesenchymal stem/stromal cells (MSC) have shown therapeutic potential in painful neuropathies, but their mechanism of action is not fully understood. The present work aimed to investigate the antinociceptive effect and mechanism of action of MNC and MSC in experimental TN. MATERIALS AND METHODS Mice submitted to the chronic constriction injury of the infraorbital nerve (CCI-ION) mouse model of TN received a single intravenous injection of saline, MNC, or MSC (1 × 106 cells/mouse). The effect of the treatments on the behavioral signs of painful neuropathy, morphological aspects of the infraorbital nerve, and inflammatory and oxidative stress markers in the infraorbital nerve were assessed. KEY FINDINGS MNC and MSC improved behavioral painful neuropathy, activated key cell signaling antioxidant pathways by increasing Nrf2 expression, and reduced the proinflammatory cytokines IL-1β and TNF-α. However, treatment with MSC, but not MNC, was associated with a sustained increase of IL-10 and with the re-establishment of the morphometric pattern of the infraorbital nerve, indicating a difference in the mechanism of action between MNC and MSC. In line with this result, in IL-10 knockout mice, MSC transplantation did not induce an antinociceptive effect. SIGNIFICANCE Importantly, these data suggest an IL-10-induced disease-modifying profile related to MSC treatment and reinforce cell therapy's potential in treating trigeminal neuralgia.
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Affiliation(s)
| | | | | | | | - Girlaine Café Santos
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador 40296-710, BA, Brazil.
| | | | - Milena Botelho Pereira Soares
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador 40296-710, BA, Brazil; Institute of Advanced Systems in Health, SENAI CIMATEC, Salvador 41650-010, BA, Brazil.
| | - Cristiane Flora Villarreal
- Faculty of Pharmacy, Federal University of Bahia, Salvador 40170-115, BA, Brazil; Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador 40296-710, BA, Brazil.
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Kaye J, Ramanathan V, Sheehy JP, Andaluz N, Tew J, Forbes JA. Neuronavigation-Specific Parameters for Selective Access of Trigeminal Rootlets in Radiofrequency Lesioning: A Cadaveric Morphometric Study. Oper Neurosurg (Hagerstown) 2024; 27:220-227. [PMID: 38315010 DOI: 10.1227/ons.0000000000001068] [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: 09/18/2023] [Accepted: 12/01/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Radiofrequency lesioning (RFL) is a safe and effective treatment for medically refractory trigeminal neuralgia. Despite gaining mainstream neurosurgical acceptance in the 1970s, the technique has remained relatively unchanged, with the majority of series using lateral fluoroscopy over neuronavigation for cannula guidance. To date, there are no studies describing neuronavigation-specific parameters to help neurosurgeons selectively target individual trigeminal rootlets. In this cadaveric study, we sought to provide a neuronavigation-specific morphometric roadmap for selective targeting of individual trigeminal rootlets. METHODS Embalmed cadaveric specimens were registered to cranial neuronavigation. Frontotemporal craniotomies were then performed to facilitate direct visualization of the Gasserian ganglion. A 19-gauge cannula was retrofit to a navigation probe, permitting real-time tracking. Using preplanned trajectories, the cannula was advanced through foramen ovale (FO) to the navigated posterior clival line (nPCL). A curved electrode was inserted to the nPCL and oriented inferolaterally for V3 and superomedially for V2. For V1, the cannula was advanced 5 mm distal to the nPCL and the curved electrode was reoriented inferomedially. A surgical microscope was used to determine successful contact. Morphometric data from the neuronavigation unit were recorded. RESULTS Twenty RFL procedures were performed (10R, 10L). Successful contact with V3, V2, and V1 was made in 95%, 90%, and 85% of attempts, respectively. Mean distances from the entry point to FO and from FO to the clival line were 7.61 cm and 1.26 cm, respectively. CONCLUSION In this proof-of-concept study, we found that reliable access to V1-3 could be obtained with the neuronavigation-specific algorithm described above. Neuronavigation for RFL warrants further investigation as a potential tool to improve anatomic selectivity, operative efficiency, and ultimately patient outcomes.
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Affiliation(s)
- Joel Kaye
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati , Ohio , USA
| | - Vishan Ramanathan
- University of Cincinnati College of Medicine, Cincinnati , Ohio , USA
| | - John P Sheehy
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati , Ohio , USA
| | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati , Ohio , USA
| | - John Tew
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati , Ohio , USA
| | - Jonathan A Forbes
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati , Ohio , USA
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Pergolizzi JV, LeQuang JA, El-Tallawy SN, Wagner M, Ahmed RS, Varrassi G. An update on pharmacotherapy for trigeminal neuralgia. Expert Rev Neurother 2024; 24:773-786. [PMID: 38870050 DOI: 10.1080/14737175.2024.2365946] [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: 03/28/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Trigeminal neuralgia is a rare condition that can be effectively treated by carbamazepine or oxcarbazepine but these older drugs are associated with dose-dependent and potentially treatment-limiting adverse effects. Third-generation anticonvulsants, new calcitonin gene-related peptide blockers for migraine, and older drugs such as ketamine and cannabinoids may be promising adjuvants or monotherapeutic options. AREAS COVERED The new drugs, their presumed mechanisms of action, safety and efficacy are discussed herein. There is a paucity of robust clinical evidence in support of these drugs for trigeminal neuralgia. New migraine agents are considered as well although migraines and trigeminal neuralgia are distinct, albeit similar, conditions. No new drugs have been released to market in recent years with the specific indication of trigeminal neuralgia. EXPERT OPINION In real-world clinical practice, about half of trigeminal neuralgia patients take more than one agent for prevention and combination therapy may be the optimal approach. Combination therapy might allow for lower doses of carbamazepine or oxcarbazepine, thus reducing the number and severity of potential adverse events but the potential for pharmacokinetic drug-drug interactions must be considered. Drug therapy for trigeminal neuralgia involves acute or abortive treatments, often administered in hospital versus long-term preventive therapy, usually involving oral agents.
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Affiliation(s)
| | | | - Salah N El-Tallawy
- Anesthesia and Pain Department, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Anesthesia Department, Medicine, Minia University & NCI, Minia, Egypt
| | | | - Rania S Ahmed
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Gomes-da Silva de Rosenzweig P, Pastrana-Brandes S, Merikansky-Gerson S, Victoria-Garcia LO, Curtius-Caruso MS, Carrillo-Ruiz JD. Factors associated with outcomes following microvascular decompression for the treatment of primary trigeminal neuralgia in adults: a systematic review and meta-analysis. J Dent Anesth Pain Med 2024; 24:227-243. [PMID: 39118815 PMCID: PMC11304043 DOI: 10.17245/jdapm.2024.24.4.227] [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] [Received: 06/04/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
This study aimed to evaluate pain assessment strategies and factors associated with outcomes after microvascular decompression for the treatment of primary trigeminal neuralgia in adults. We conducted a systematic review and meta-analysis of English, Spanish, and French literature. We searched three databases, PubMed, Ovid, and EBSCO, from 2010 to 2022 and selected studies including patients with primary trigeminal neuralgia, clear pain assessment, and pain outcomes. Population means and standard deviations were calculated. Studies that included factors associated with postoperative outcomes were included in the meta-analysis. A total of 995 studies involving 5673 patients with primary trigeminal neuralgia following microvascular decompression were included. Patients with arteries compressing the trigeminal nerve demonstrated optimal outcomes following microvascular decompression (odds ratio [OR]= 0.39; 95% confidence interval [CI] = 0.19-0.80; X2 = 46.31; Dof = 15; I2 = 68%; P = < 0.0001). Conversely, when comparing arterial vs venous compression of the trigeminal nerve (OR = 2.72; 95% CI = 1.16-6.38; X2 = 23.23; Dof = 10; I2 = 57%; P = 0.01), venous compression demonstrated poor outcomes after microvascular decompression. Additionally, when comparing single-vessel vs multiple-vessel compression (OR = 2.72; 95% CI = 1.18-6.25; X2 = 21.17; Dof = 9; I2 = 57%; P = 0.01), patients demonstrated unfavorable outcomes after microvascular decompression. This systematic review and meta-analysis evaluated factors associated with outcomes following microvascular decompression (MVD) for primary trigeminal neuralgia (PTN). Although MVD is an optimal treatment strategy for PTN, a gap exists in interpreting the results when considering the lack of evidence for most pain assessment strategies.
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Affiliation(s)
- Pablo Gomes-da Silva de Rosenzweig
- Facultad de Ciencias de la Salud, Centro de Investigación en Ciencias de la Salud (CICSA), Universidad Anáhuac México Norte Huixquilucan, Estado de México, Mexico
| | | | - Salomon Merikansky-Gerson
- Facultad de Ciencias de la Salud, Centro de Investigación en Ciencias de la Salud (CICSA), Universidad Anáhuac México Norte Huixquilucan, Estado de México, Mexico
| | - Luis Octavio Victoria-Garcia
- Facultad de Ciencias de la Salud, Centro de Investigación en Ciencias de la Salud (CICSA), Universidad Anáhuac México Norte Huixquilucan, Estado de México, Mexico
| | - Magdalena Sophia Curtius-Caruso
- Facultad de Ciencias de la Salud, Centro de Investigación en Ciencias de la Salud (CICSA), Universidad Anáhuac México Norte Huixquilucan, Estado de México, Mexico
| | - José Damián Carrillo-Ruiz
- Coordinación de Neurociencias, Facultad de Psicología, Universidad Anáhuac México, Mexico
- Servicio de Neurocirugía Funcional y Estereotaxia, Hospital General de México Dr Eduardo Liceaga, Mexico City, Mexico
- Dirección de Investigación, Hospital General de México Dr Eduardo Liceaga, Mexico City, Mexico
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He HX, Li YX, Xiao YS, Fan WH, Xue H. The efficacy of acupuncture for trigeminal neuralgia: an overview of systematic reviews. Front Neurol 2024; 15:1375587. [PMID: 39036634 PMCID: PMC11258042 DOI: 10.3389/fneur.2024.1375587] [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: 01/24/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024] Open
Abstract
Background Many systematic reviews (SRs) and meta-analysis (MAs) have reported the efficacy of acupuncture treatment for primary trigeminal neuralgia (PTN), but the quality of evidence is unknown and therefore needs to be evaluated comprehensively. Methods Eight electronic databases were searched from their inception until January 5, 2024. The methodological quality, reporting quality, and risk of bias of the included SRs were assessed by the assessment of multiple systematic reviews 2 (AMSTAR-2), the Risk of Bias in Systematic Reviews (ROBIS) tool, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The quality of evidence for outcome measures was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results We identified 13 SRs/MAs met inclusion criteria. According to the results of the AMSTAR-2, six were rated as critically low quality and seven as low quality. According to ROBIS assessment, 8 SRs/MAs were classified as low risk, and 5 SRs/MAs were found to be high risk. The PRISMA report still has some reporting deficiencies in aspects such as protocol and registration, search strategy, risk of bias, additional analyzes and funding. According to the GRADE system, no high-quality evidence was found, 1 was of moderate quality, 4 were of low quality, and 8 were of critical low quality. Conclusion Based on the evidence collected, acupuncture shows promise as a treatment for PTN patients. However, it is important to note that the included SRs/MAs generally have low methodological quality and evidence quality. Therefore, caution must be exercised when interpreting this conclusion. To enhance future research in this area, it is recommended to adequately report methodological details and adhere to guidelines for conducting SRs/MAs.Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024499280.
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Affiliation(s)
- Hong-xian He
- Department of Rehabilitation, Sichuan Taikang Hospital, Chengdu, Sichuan, China
| | - Ya-xin Li
- Department of Neurology, Sichuan Taikang Hospital, Chengdu, Sichuan, China
| | - Ya-song Xiao
- Department of Geriatrics, Sichuan Taikang Hospital, Chengdu, Sichuan, China
| | - Wen-hui Fan
- Department of Neurology, Sichuan Taikang Hospital, Chengdu, Sichuan, China
| | - Hua Xue
- Department of Neurology, Sichuan Taikang Hospital, Chengdu, Sichuan, China
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Lafta MS, Sokolov AV, Landtblom AM, Ericson H, Schiöth HB, Abu Hamdeh S. Exploring biomarkers in trigeminal neuralgia patients operated with microvascular decompression: A comparison with multiple sclerosis patients and non-neurological controls. Eur J Pain 2024; 28:929-942. [PMID: 38158702 DOI: 10.1002/ejp.2231] [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: 09/17/2023] [Revised: 12/07/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a severe facial pain condition often associated with a neurovascular conflict. However, neuroinflammation has also been implicated in TN, as it frequently co-occurs with multiple sclerosis (MS). METHODS We analysed protein expression levels of TN patients compared to MS patients and controls. Proximity Extension Assay technology was used to analyse the levels of 92 proteins with the Multiplex Neuro-Exploratory panel provided by SciLifeLab, Uppsala, Sweden. Serum and CSF samples were collected from TN patients before (n = 33 and n = 27, respectively) and after (n = 28 and n = 8, respectively) microvascular decompression surgery. Additionally, we included samples from MS patients (n = 20) and controls (n = 20) for comparison. RESULTS In both serum and CSF, several proteins were found increased in TN patients compared to either MS patients, controls, or both, including EIF4B, PTPN1, EREG, TBCB, PMVK, FKBP5, CD63, CRADD, BST2, CD302, CRIP2, CCL27, PPP3R1, WWP2, KLB, PLA2G10, TDGF1, SMOC1, RBKS, LTBP3, CLSTN1, NXPH1, SFRP1, HMOX2, and GGT5. The overall expression of the 92 proteins in postoperative TN samples seems to shift towards the levels of MS patients and controls in both serum and CSF, as compared to preoperative samples. Interestingly, there was no difference in protein levels between MS patients and controls. CONCLUSIONS We conclude that TN patients showed increased serum and CSF levels of specific proteins and that successful surgery normalizes these protein levels, highlighting its potential as an effective treatment. However, the similarity between MS and controls challenges the idea of shared pathophysiology with TN, suggesting distinct underlying mechanisms in these conditions. SIGNIFICANCE This study advances our understanding of trigeminal neuralgia (TN) and its association with multiple sclerosis (MS). By analysing 92 protein biomarkers, we identified distinctive molecular profiles in TN patients, shedding light on potential pathophysiological mechanisms. The observation that successful surgery normalizes many protein levels suggests a promising avenue for TN treatment. Furthermore, the contrasting protein patterns between TN and MS challenge prevailing assumptions of similarity between the two conditions and point to distinct pathophysiological mechanisms.
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Affiliation(s)
- Muataz S Lafta
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
| | - Aleksandr V Sokolov
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
| | - Anne-Marie Landtblom
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Hans Ericson
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Helgi B Schiöth
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
| | - Sami Abu Hamdeh
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
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Escobar-Espinal DM, Vivanco-Estela AN, Barros N, Dos Santos Pereira M, Guimaraes FS, Del Bel E, Nascimento GC. Cannabidiol and it fluorinate analog PECS-101 reduces hyperalgesia and allodynia in trigeminal neuralgia via TRPV1 receptors. Prog Neuropsychopharmacol Biol Psychiatry 2024; 132:110996. [PMID: 38508408 DOI: 10.1016/j.pnpbp.2024.110996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/04/2024] [Accepted: 03/17/2024] [Indexed: 03/22/2024]
Abstract
Trigeminal neuralgia (TN) is an intense and debilitating orofacial pain. The gold standard treatment for TN is carbamazepine. This antiepileptic drug provides pain relief with limited efficacy and side effects. To study the antinociceptive potential of cannabidiol (CBD) and its fluorinated analog PECS-101 (former HUF-101), we induced unilateral chronic constriction injury of the infraorbital nerve (IoN-CCI) in male Wistar rats. Seven days of treatment with CBD (30 mg/kg), PECS-101 (3, 10, and 30 mg/kg), or carbamazepine (10 and 30 mg/kg) reduced allodynia and hyperalgesia responses. Unlike carbamazepine, CBD and PECS-101 did not impair motor activity. The relief of the hypersensitive reactions has been associated with transient receptor potential vanilloid type 1 (TRPV1) modulation in the trigeminal spinal nucleus. CBD (30 mg/kg) and PECS-101 (10 and 30 mg/kg) reversed the increased expression of TRPV1 induced by IoN-CCI in this nucleus. Using a pharmacological strategy, the combination of the selective TRPV1 antagonist (capsazepine-CPZ - 5 mg/kg) with sub-effective doses of CBD (3 and 10 mg/kg) is also able to reverse the IoN-CCI-induced allodynia and hyperalgesia responses. This effect was accompanied by reduced TRPV1 protein expression in the trigeminal spinal nucleus. Our results suggest that CBD and PECS-101 may benefit trigeminal neuralgia without motor coordination impairments. PECS-101 is more potent against the hypernociceptive and motor impairment induced by TN compared to CBD and carbamazepine. The antinociceptive effect of these cannabinoids is partially mediated by TRPV1 receptors in the caudal part of the trigeminal spinal nucleus, the first central station of orofacial pain processing.
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Affiliation(s)
- Daniela Maria Escobar-Espinal
- Department of Basic and Oral Biology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP 14040-904, Brazil
| | - Airam Nicole Vivanco-Estela
- Department of Basic and Oral Biology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP 14040-904, Brazil
| | - Núbia Barros
- Department of Neuroscience, School of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP 14049-900, Brazil
| | - Maurício Dos Santos Pereira
- Department of Basic and Oral Biology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP 14040-904, Brazil
| | - Francisco Silveira Guimaraes
- Department of Neuroscience, School of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP 14049-900, Brazil
| | - Elaine Del Bel
- Department of Basic and Oral Biology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP 14040-904, Brazil; Department of Pharmacology, School of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP 14049-900, Brazil; Department of Physiology, School of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP 14049-900, Brazil.
| | - Glauce C Nascimento
- Department of Basic and Oral Biology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP 14040-904, Brazil.
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Türk Börü Ü, Kadir Sarıtaş Z, Görücü Özbek F, Bölük C, Acar H, Koç Y, Zeytin Demiral G. Alterations in the spinal cord, trigeminal nerve ganglion, and infraorbital nerve through inducing compression of the dorsal horn region at the upper cervical cord in trigeminal neuralgia. Brain Res 2024; 1832:148842. [PMID: 38447599 DOI: 10.1016/j.brainres.2024.148842] [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: 01/08/2024] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Idiopathic trigeminal neuralgia (TN) cases encountered frequently in daily practice indicate significant gaps that still need to be illuminated in the etiopathogenesis. In this study, a novel TN animal model was developed by compressing the dorsal horn (DH) of the upper cervical spinal cord. METHODS Eighteen rabbits were equally divided into three groups, namely control (CG), sham (SG), and spinal cord compression (SCC) groups. External pressure was applied to the left side at the C3 level in the SCC group. Dorsal hemilaminectomy was performed in the SG, and the operative side was closed without compression. No procedure was implemented in the control group. Samples from the SC, TG, and ION were taken after seven days. For the histochemical staining, damage and axons with myelin were scored using Hematoxylin and Eosin and Toluidine Blue, respectively. Immunohistochemistry, nuclei, apoptotic index, astrocyte activity, microglial labeling, and CD11b were evaluated. RESULTS Mechanical allodynia was observed on the ipsilateral side in the SCC group. In addition, both the TG and ION were partially damaged from SC compression, which resulted in significant histopathological changes and increased the expression of all markers in both the SG and SCC groups compared to that in the CG. There was a notable increase in tissue damage, an increase in the number of apoptotic nuclei, an increase in the apoptotic index, an indication of astrocytic gliosis, and an upsurge in microglial cells. Significant increases were noted in the SG group, whereas more pronounced significant increases were observed in the SCC group. Transmission electron microscopy revealed myelin damage, mitochondrial disruption, and increased anchoring particles. Similar changes were observed to a lesser extent in the contralateral spinal cord. CONCLUSION Ipsilateral trigeminal neuropathic pain was developed due to upper cervical SCC. The clinical finding is supported by immunohistochemical and ultrastructural changes. Thus, alterations in the DH due to compression of the upper cervical region should be considered as a potential cause of idiopathic TN.
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Affiliation(s)
- Ülkü Türk Börü
- Department of Neurology University of Afyonkarahisar Health Sciences, Afyonkarahisar, Turkey
| | - Zülfükar Kadir Sarıtaş
- Department of Surgery, Faculty of Veterinary Medicine, University of Afyon Kocatepe, Afyonkarahisar, Turkey
| | - Fatma Görücü Özbek
- Department of Surgery, Faculty of Veterinary Medicine, University of Afyon Kocatepe, Afyonkarahisar, Turkey
| | - Cem Bölük
- Department of Neurology and Clinical Neurophysiology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey.
| | - Hakan Acar
- Department of Neurology University of Afyonkarahisar Health Sciences, Afyonkarahisar, Turkey
| | - Yusuf Koç
- Department of Surgery, Faculty of Veterinary Medicine, University of Afyon Kocatepe, Afyonkarahisar, Turkey
| | - Gökçe Zeytin Demiral
- Department of Neurology University of Afyonkarahisar Health Sciences, Afyonkarahisar, Turkey
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11
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Geng Y, Yu M, Wu H, Zhang D, Wang X. Three-dimensional printed personalised digital guide plate for greater palatine block in trigeminal neuralgia. Br J Oral Maxillofac Surg 2024; 62:453-458. [PMID: 38763853 DOI: 10.1016/j.bjoms.2024.01.010] [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: 06/22/2023] [Revised: 12/23/2023] [Accepted: 01/29/2024] [Indexed: 05/21/2024]
Abstract
The nerve block is a safe and effective method to theat trigeminal neuralgia (TN). In terms of the V2 trigeminal neuralgia, the most difficult procedure in nerve block is accurate and fast greater palatine foramen (GPF) insertion. In this study, we developed a new technique using a personalised digital tooth-supported guide plate to increase insertion accuracy and success rates and reduce the pain of patients during injection. A total of 18 patients with TN (11 female and 7 male) were enrolled and treated between September 2020 and June 2022. Before injection, the guide plate was designed via Mimics three-dimensional (3D) reconstruction technology and printed via 3D printer. Then, all patients underwent maxillary nerve block with a guide plate for each injection. In this study, placement of all guide plates was completed within one minute and all punctures were successful the first time. The depth of the injection needle was over 2.5 cm in all cases and the guide plate was stability-supported by the maxillary teeth. The various pain scores had an obvious improvement. No patients presented symptoms of local anaesthetic toxicity or onset of new neurological sequelae. Using this new technology, we can significantly reduce the difficulty of GPF insertion and decrease patient pain during injection. The enhanced success rate of nerve block can achieve better therapeutic effect. For surgeons, personalised digital tooth-supported guide plates make the operation easier, especially for novice surgeons.
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Affiliation(s)
- Yiming Geng
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Miao Yu
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Haiwei Wu
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Dongsheng Zhang
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Xuan Wang
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.
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12
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Prathapan V, Eipert P, Wigger N, Kipp M, Appali R, Schmitt O. Modeling and simulation for prediction of multiple sclerosis progression. Comput Biol Med 2024; 175:108416. [PMID: 38657465 DOI: 10.1016/j.compbiomed.2024.108416] [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: 12/07/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
In light of extensive work that has created a wide range of techniques for predicting the course of multiple sclerosis (MS) disease, this paper attempts to provide an overview of these approaches and put forth an alternative way to predict the disease progression. For this purpose, the existing methods for estimating and predicting the course of the disease have been categorized into clinical, radiological, biological, and computational or artificial intelligence-based markers. Weighing the weaknesses and strengths of these prognostic groups is a profound method that is yet in need and works directly at the level of diseased connectivity. Therefore, we propose using the computational models in combination with established connectomes as a predictive tool for MS disease trajectories. The fundamental conduction-based Hodgkin-Huxley model emerged as promising from examining these studies. The advantage of the Hodgkin-Huxley model is that certain properties of connectomes, such as neuronal connection weights, spatial distances, and adjustments of signal transmission rates, can be taken into account. It is precisely these properties that are particularly altered in MS and that have strong implications for processing, transmission, and interactions of neuronal signaling patterns. The Hodgkin-Huxley (HH) equations as a point-neuron model are used for signal propagation inside a small network. The objective is to change the conduction parameter of the neuron model, replicate the changes in myelin properties in MS and observe the dynamics of the signal propagation across the network. The model is initially validated for different lengths, conduction values, and connection weights through three nodal connections. Later, these individual factors are incorporated into a small network and simulated to mimic the condition of MS. The signal propagation pattern is observed after inducing changes in conduction parameters at certain nodes in the network and compared against a control model pattern obtained before the changes are applied to the network. The signal propagation pattern varies as expected by adapting to the input conditions. Similarly, when the model is applied to a connectome, the pattern changes could give an insight into disease progression. This approach has opened up a new path to explore the progression of the disease in MS. The work is in its preliminary state, but with a future vision to apply this method in a connectome, providing a better clinical tool.
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Affiliation(s)
- Vishnu Prathapan
- Medical School Hamburg University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany.
| | - Peter Eipert
- Medical School Hamburg University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany.
| | - Nicole Wigger
- Department of Anatomy, University of Rostock Gertrudenstr 9, 18057, Rostock, Germany.
| | - Markus Kipp
- Department of Anatomy, University of Rostock Gertrudenstr 9, 18057, Rostock, Germany.
| | - Revathi Appali
- Institute of General Electrical Engineering, University of Rostock, Albert-Einstein-Straße 2, 18059, Rostock, Germany; Department of Aging of Individuals and Society, Interdisciplinary Faculty, University of Rostock, Universitätsplatz 1, 18055, Rostock, Germany.
| | - Oliver Schmitt
- Medical School Hamburg University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany; Department of Anatomy, University of Rostock Gertrudenstr 9, 18057, Rostock, Germany.
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13
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Zhang Z, Zhao H, Tang Y, Wang B, Yuan Q, Zhang Y, Li Y, Zhong J, Li S. Revisiting the Efficacy of Redo Microvascular Decompression for Trigeminal Neuralgia. World Neurosurg 2024; 186:e335-e341. [PMID: 38552788 DOI: 10.1016/j.wneu.2024.03.131] [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: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/30/2024]
Abstract
BACKGROUND Microvascular decompression (MVD) is an effective nondestructive neurosurgical procedure for trigeminal neuralgia (TN). However, some patients may undergo surgery failure or experience pain recurrence, sparking debates on the need for reoperation. METHODS We conducted a retrospective analysis of 103 cases of patients with primary TN who underwent redo MVD at our center between January 2020 and December 2022. Comparative prognostic assessments were performed by comparing these cases against a cohort of 348 patients who underwent primary MVD during the same study period. RESULTS During the redo MVD cases, arachnoid membranes adhesions (80.6%) and Teflon adhesions with/without granuloma (86.4%) as well as remaining vascular compression (36.9%) were observed. After the reoperation, an immediate relief rate of 94.2% was observed. During a mean follow-up period of 17.4 ± 4.4 months, a long-term relief rate of 89.3% was achieved. Postoperative complications included 3 cases of persistent paresthesia, 1 case each of hearing loss, cerebrospinal fluid leak, and facial palsy. Ten cases without evident compression received nerve combing and all experienced immediate complete relief, with only 1 patient experiencing recurrence 9 months after surgery. Compared to the primary MVD group, the reoperation group had a higher average age, longer disease duration, and operating time (P < 0.05). However, there were no significant differences in immediate relief rate, long-term relief rate, or complications between the 2 groups. The main cause of persistent symptom was inadequate decompression, such as missing the offending vessel; while the recurrent was primarily due to Teflon adhesion or granuloma formation. CONCLUSIONS The redo MVD for TN is equally efficacious and safe compared to the primary procedure, with an emphasis on meticulous dissection and thorough decompression. Additionally, nerve combing proves to be an effective supplementary option for patients without obvious compression.
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Affiliation(s)
- Zhongding Zhang
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China
| | - Hua Zhao
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China
| | - Yinda Tang
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China
| | - Baimiao Wang
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China
| | - Qing Yuan
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China
| | - Ying Zhang
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China
| | - Yihua Li
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China
| | - Jun Zhong
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China
| | - Shiting Li
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China.
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14
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Pergolizzi JV, LeQuang JAK, El-Tallawy SN, Ahmed RS, Wagner M, Varrassi G. The Challenges in Clinical Diagnosis of Trigeminal Neuralgia: A Review. Cureus 2024; 16:e61898. [PMID: 38978896 PMCID: PMC11228405 DOI: 10.7759/cureus.61898] [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: 04/26/2024] [Accepted: 06/07/2024] [Indexed: 07/10/2024] Open
Abstract
The lack of established laboratory tests or biomarkers for trigeminal neuralgia (TN) makes diagnosing this relatively rare condition extremely challenging. Trigeminal nerve compression observable on magnetic resonance imaging may indicate TN, but many patients do not have visible lesions or compression. In particular, TN may be confused with migraine, cluster headache, temporomandibular disorder, and other types of headache. An accurate diagnosis is imperative for proper treatment since these conditions do not respond to the same treatment. Many symptoms of these headaches can be vague or overlap, and clinicians depend in large measure on the subjective reports of their patients. Nevertheless, it is imperative to diagnose TN better, which can cause excruciating pain, reduce the quality of life, and even result in disability. It is possible that TN is underestimated.
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Affiliation(s)
| | | | - Salah N El-Tallawy
- Anesthesia and Pain Management, Faculty of Medicine, Minia University and NCI, Cairo University, Cairo, EGY
- Anesthesia and Pain Management, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, SAU
| | - Rania S Ahmed
- College of Medicine, Alfaisal University, Riyadh, SAU
| | - Morgan Wagner
- Entrepreneur Program, NEMA Research, Inc., Naples, USA
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15
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Shields LBE, Malkawi A, Daniels MW, Rao AJ, Plato BM, Yao TL, Howe JN, Spalding AC. Frameless image-guided linear accelerator (LINAC) stereotactic radiosurgery for medically refractory trigeminal neuralgia: Clinical outcomes in 116 patients. Surg Neurol Int 2024; 15:181. [PMID: 38840612 PMCID: PMC11152532 DOI: 10.25259/sni_101_2024] [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] [Received: 02/11/2024] [Accepted: 05/04/2024] [Indexed: 06/07/2024] Open
Abstract
Background Frameless image-guided radiosurgery (IGRS) is an effective and non-invasive method of treating patients who are unresponsive to medical management for trigeminal neuralgia (TN). This study evaluated the use of frameless IGRS to treat patients with medically refractory TN. Methods We performed a retrospective review of records of 116 patients diagnosed with TN who underwent frameless IGRS using a linear accelerator (LINAC) over 10 years (March 2012-February 2023). All patients had failed medical management for TN. Facial pain was graded using the Barrow Neurological Institute (BNI) scoring system. Each patient received a BNI score before frameless IGRS and following treatment. Failure was defined as a BNI score IV-V at the last follow-up and/or undergoing a salvage procedure following IGRS. Results All patients had a BNI score of either IV or V before the frameless IGRS. The mean follow-up duration for all 116 patients following IGRS was 44.1 months. Most patients (81 [69.8%]) had not undergone surgery (microvascular decompression [MVD] or rhizotomy) or stereotactic radiosurgery (SRS) for TN before frameless IGRS. A total of 41 (35.3%) patients underwent a salvage procedure (MVD, rhizotomy, or an additional IGRS) following frameless IGRS. The mean duration between the initial frameless IGRS and salvage procedure was 20.1 months. At the last follow-up, a total of 110 (94.8%) patients had a BNI score of I-III. No complications were reported after the frameless IGRS. The BNI score at the last follow-up was lower compared to the initial BNI for patients regardless of prior intervention (P < 0.001). Patients who failed IGRS had a higher BNI score at the last follow-up compared to those who did not fail IGRS (2.8 vs. 2.5, P = 0.05). Patients with pain relief had a shorter follow-up compared to those with pain refractory to SRS (38.0 vs. 55.1, P = 0.005). Conclusion In this large cohort of patients with medically refractory TN, frameless IGRS resulted in durable pain control in the majority of patients without any toxicity.
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Affiliation(s)
- Lisa B. E. Shields
- Norton Healthcare, Norton Neuroscience Institute, Louisville, Kentucky, United States
| | - Azzam Malkawi
- Norton Neuroscience Institute, Norton Healthcare, Norton Cancer Institute, Louisville, Kentucky, United States
| | - Michael W. Daniels
- Department of Bioinformatics and Biostatistics, University of Louisville, School of Public Health and Information Sciences, Louisville, Kentucky, United States
| | - Abigail J. Rao
- Norton Healthcare, Norton Neuroscience Institute, Louisville, Kentucky, United States
| | - Brian M. Plato
- Norton Healthcare, Norton Neuroscience Institute, Louisville, Kentucky, United States
| | - Tom L. Yao
- Norton Healthcare, Norton Neuroscience Institute, Louisville, Kentucky, United States
| | - Jonathan N. Howe
- Norton Neuroscience Institute, Norton Healthcare, Norton Cancer Institute, Louisville, Kentucky, United States
| | - Aaron C. Spalding
- Norton Neuroscience Institute, Norton Healthcare, Norton Cancer Institute, Louisville, Kentucky, United States
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16
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Kloock T, Pickles KJ, Roberts V, Uhlendorf F, Twele L, Wilkens HL, Stehle E, Feige K, Niebuhr T. History, Rest and Exercise Score (HRE-S) for assessment of disease severity in horses with trigeminal-mediated headshaking. Equine Vet J 2024; 56:464-474. [PMID: 37608443 DOI: 10.1111/evj.13986] [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: 09/28/2022] [Accepted: 07/20/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND In horses with trigeminal-mediated headshaking (TMHS), clinical signs are likely to be expression of neuropathic facial pain. Currently, subjective assessment of disease severity is used as measure of compromise of animal's welfare. OBJECTIVES To develop and validate a precise scoring system for TMHS: History, Rest and Exercise Score (HRE-S). The HRE-S consists of three subscores: history score (H-S), resting score (R-S) and exercise score (E-S). STUDY DESIGN Retrospective observational study. METHODS Seven masked observers with different experience used HRE-S to score 40 video recordings taken during rest and lungeing including five duplicates. Video recordings were taken from nine horses with TMHS and three controls. Inter- and intraobserver reliability and practicability of HRE-S were assessed. For every video recording severity of clinical signs was graded by every observer using an intuitive global-type-scale and interobserver reliability was calculated. Convergent validity was evaluated comparing HRE-S to groups created by an existing score (grade 0-3). Discriminant validity was analysed comparing HRE-S to groups created by intuitive global-type-scale. RESULTS Reliability for HRE-S was excellent, irrespective of observers experience: Spearman's Rho = 0.946, p < 0.001 (intraobserver reliability) and intraclass correlation coefficient = 0.98, p < 0.001 (interobserver reliability). Interobserver reliability for intuitive global-type-scale was fair to substantial: Fleiss' κappa = 0.48 (R-S) -0.63 (E-S). Groups created by intuitive global-type-scale had significantly different R-S and E-S (p < 0.05), demonstrating discriminant validity. Convergent validity was proven as horses with grade 3/3 had significantly higher average E-S and total scores compared with an existing score than those with grade 0/3 or 1/3 (p < 0.001). MAIN LIMITATIONS Retrospective nature, video recordings, sample size. CONCLUSIONS HRE-S is a valid and reliable score evaluating disease severity in TMHS, independent of observers' experience.
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Affiliation(s)
- Tanja Kloock
- Clinic for Horses, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Kirstie J Pickles
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, UK
| | | | | | - Lara Twele
- Clinic for Horses, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Henriette L Wilkens
- Clinic for Horses, University of Veterinary Medicine Hannover, Hanover, Germany
| | | | - Karsten Feige
- Clinic for Horses, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Tobias Niebuhr
- Clinic for Horses, University of Veterinary Medicine Hannover, Hanover, Germany
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17
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Mercadante S. Palliative Care Aspects in Multiple Sclerosis. J Pain Symptom Manage 2024; 67:e425-e437. [PMID: 38219965 DOI: 10.1016/j.jpainsymman.2024.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
CONTEXT Multiple sclerosis (MS) is an inflammatory, chronic, demyelinating, and neurodegenerative disorder of central nervous system, determined by an auto-immune dysfunction. Severe disability generally occurs in patients with progressive forms of MS that typically develop either after an earlier relapsing phase or less commonly from disease onset. Despite advances in research to slow the progression of MS, this condition remains a life-limiting disease with symptoms impacting negatively the lives of patients and caregivers. OBJECTIVES To analyze the difefrent aspects of palliative cae in patients with MS. METHODS To analyse selected literature assessing several palliative care aspects in patients with MS. RESULTS People with MS have complex symptoms and different needs. These demands include how to deal with the burden of physical disability, how to organise daily life, restructuring social roles in the family and at work, keeping self-sufficiency in personal care, and preserving personal identity and community roles. CONCLUSION An early palliative care approach aims to improve the palliative care skills and competencies of health professionals caring for the patients since the early stage of disease, including those who are actively undergoing disease-targeted therapies, rather than merely providing end-of-life care.
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Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center of Pain Relief and Supportive/Palliative Care (S.M.), La Maddalena Cancer Center, Regional Home care program, SAMOT, Palermo, Italy.
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18
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Wang H, Hu S, Huang ZN, Ma Y, Yao G, Chen K, Dou N, Xia L, Li S, Zhong J. Riveting technique in percutaneous balloon compression for trigeminal neuralgia remedy. Clin Neurol Neurosurg 2024; 240:108245. [PMID: 38518629 DOI: 10.1016/j.clineuro.2024.108245] [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: 01/18/2024] [Revised: 02/18/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND The percutaneous balloon compression (PBC) is a safe and simple treatment for trigeminal neuralgia. It works by compressing the Gasserian ganglion to block pain signals from the trigeminal nerve. To ensure effectiveness, it is important to focus the compression on the lower part of the balloon. OBJECTIVE To validate the efficacy of a riveting technique, specifically pulling an inflated balloon, in order to apply enhanced compression on the ganglion. METHODS To compare this novel technique with the conventional approach, a retrospective investigation was conducted on consecutive PBCs performed in our department between 2019 and 2022. For postoperative outcome assessment, efficacy was defined as achieving a VAS score of 0 or an improvement exceeding 5 points. Postoperative numbness was graded as none, mild, or severe based on its impact on daily life and tolerance level. RESULTS Excluding cases with missed follow-up, a total of 179 participants were included in the study, and their follow-up period ranged up to 40 months. Postoperatively, symptomatic remission was achieved by 98.1% (52/53) of patients in the riveting technique group compared to 87.3% (110/126) in the conventional group (P<0.05). At the last follow-up period, with recurrence observed over time, the long-term efficacy of riveting and conventional groups were 94.3% and 74.6%, respectively (P<0.05). The majority of cases in both groups experienced ipsilateral facial numbness immediately following PBC, which appeared to diminish after 3 months in both groups without significant difference between them (P>0.05).
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Affiliation(s)
- Haolin Wang
- Dept. Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - ShaoZhen Hu
- Dept. Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zheng Nan Huang
- Dept. Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - YuJie Ma
- Dept. Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ge Yao
- Dept. Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Dept. Neurology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kui Chen
- Dept. Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ningning Dou
- Dept. Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lei Xia
- Dept. Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shiting Li
- Dept. Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jun Zhong
- Dept. Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Allam AK, Larkin MB, Sharma H, Viswanathan A. Trigeminal and Glossopharyngeal Neuralgia. Neurol Clin 2024; 42:585-598. [PMID: 38575268 DOI: 10.1016/j.ncl.2023.12.011] [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] [Indexed: 04/06/2024]
Abstract
Trigeminal neuralgia and glossopharyngeal neuralgia are craniofacial pain syndromes characterized by recurrent brief shock-like pains in the distributions of their respective cranial nerves. In this article, the authors aim to summarize each condition's characteristics, pathophysiology, and current pharmacotherapeutic and surgical interventions available for managing and treating these conditions.
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Affiliation(s)
- Anthony K Allam
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - M Benjamin Larkin
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Himanshu Sharma
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
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20
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Bauer M, Krigers A, Schoen V, Thomé C, Freyschlag CF. Clinical Depression and Anxiety Are Relieved by Microvascular Decompression in Patients with Trigeminal Neuralgia-A Prospective Patient-Reported Outcome Study. J Clin Med 2024; 13:2329. [PMID: 38673601 PMCID: PMC11051355 DOI: 10.3390/jcm13082329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Objective: Patients with idiopathic trigeminal neuralgia (TN) live in constant fear of triggering shock-like pain episodes, which may cause symptoms of depression and a reduction in quality of life. Microvascular decompressive surgery has been demonstrated to achieve satisfactory and stable results. With this study, we wanted to investigate prevalence and risk factors for depression and perceived stress in correlation with symptom relief after surgical treatment. Methods: In this prospective study, patients undergoing microvascular decompression (MVD) for TN were included. The Barrow Neurological Institute Pain Score (BNI), Beck Depression Inventory (BDI), Chronic Pain Acceptance Questionnaire (CPAQ), Perceived Stress Questionnaire (PSQ) and McGill questionnaire were used to evaluate depression, stress and anxiety disorders before and 3 months after MVD. Results: A total of 35 patients (16 male (46%)) with a mean age of 55.4 (SD 15) years were included in this study. The BDI revealed that 24 (68.8%) patients harbored mild-to-extreme depression preoperatively (2.4 ± 1.4), which improved to 1.2 (±0.6, p < 0.0001). Pain acceptance also changed from 64 (±11.3) to 67.7 (±9.3, p = 0.006). Perceived stress decreased from 46.9 (±21.9) to 19.6 (±18.6) (p < 0.0001) postoperatively, and pain decreased from 31.0 (±11.7) to 9.4 (±12.9, p < 0.0001). Microvascular decompression reduced the mean BNI pain score significantly from 4.6 to 1.8 postoperatively (p < 0.00001). Conclusions: Depression and perceived stress are prevalent in patients with idiopathic TN. Adequate treatment not only provides a high rate of satisfaction through pain relief, but also leads to immediate and significant improvements in depression and stress. Thus, in patients with TN who do not reach an adequate and timely pain reduction through medical management and develop signs of depression, early treatment with microvascular decompression should be considered.
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Affiliation(s)
| | | | | | | | - Christian F. Freyschlag
- Department of Neurosurgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (M.B.)
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Kloock T, Hellige M, Kloock A, Feige K, Niebuhr T. Application of the HRE-S to 140 horses with trigeminal-mediated headshaking and the association of clinical signs with diagnosis, therapy, and outcome. Front Vet Sci 2024; 11:1329054. [PMID: 38645651 PMCID: PMC11027008 DOI: 10.3389/fvets.2024.1329054] [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: 10/27/2023] [Accepted: 03/15/2024] [Indexed: 04/23/2024] Open
Abstract
Background Horses with trigeminal-mediated headshaking (TMHS) exhibit different headshaking patterns (HSPs), electric shock-like jerking, signs of nasal irritation, and painful facial expressions. The History Rest and Exercise Score (HRE-S) was developed to objectively clarify the severity of the condition in affected horses. This score considers the history and severity of clinical signs at rest and exercise. This study aimed to assess the frequency of different clinical signs and their individual associations with diagnosis, treatment, and outcome in horses diagnosed with TMHS.The clinical records of horses presented with headshaking (HS) at the Clinic for Horses, University of Veterinary Medicine Hannover, between 2006 and 2021 were assessed retrospectively for clinical signs, diagnosis, and treatment. A total of 140 horses were included in the study. Video recordings were evaluated using the HRE-S and compared to the score described by Talbot. Following discharge, owners were interviewed via telephone about the outcome. Correlations between the presence and severity of clinical signs, diagnosis, and outcome were evaluated. Results The following clinical signs were significantly correlated with a higher HRE-S and grade by Talbot: HS at walk (independently of HSP) (52.9%, 74/140), increased total number of demonstrated HSP (independent of the dominant HSP) (more than one HSP per horse in 91.4%, 128/140), signs of nasal irritation (75.9%, 104/137), painful facial expression (67.8%, 80/118), and electric shock-like jerking (77.5%, 107/138). Diagnosis and outcome do not correlate with the presence of the above-mentioned clinical signs. Conclusion The HRE-S was confirmed as a valid tool to evaluate disease severity in a cohort of 140 horses with HS. Additionally, clinical signs identified as indicators for higher disease severity may have a stronger negative effect on patient welfare, but they do not correlate with diagnosis or outcome.
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Affiliation(s)
- Tanja Kloock
- Clinic for Horses, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Maren Hellige
- Clinic for Horses, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Anke Kloock
- Department of Cell Biology, NYU Langone Medical Center, New York City, NY, United States
| | - Karsten Feige
- Clinic for Horses, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Tobias Niebuhr
- Clinic for Horses, University of Veterinary Medicine Hannover, Hanover, Germany
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Sanabria Duarte J, Benzecry de Almeida D, Arcie GM, Coelho Neto M, Sousa de Meneses M, Ramina R. Intraoperative neurophysiological mapping of trigeminal nerve: A surgical advancement in neurovascular decompression. World Neurosurg X 2024; 22:100359. [PMID: 38469385 PMCID: PMC10926354 DOI: 10.1016/j.wnsx.2024.100359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/13/2024] Open
Affiliation(s)
- Joel Sanabria Duarte
- Neurosurgery Departent, Neurological Institute of Curitiba, Paraná, 81210-310 , Brazil
| | | | | | - Mauricio Coelho Neto
- Neurosurgery Departent, Neurological Institute of Curitiba, Paraná, 81210-310 , Brazil
| | | | - Ricardo Ramina
- Neurosurgery Departent, Neurological Institute of Curitiba, Paraná, 81210-310 , Brazil
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Naderi Y, Rad M, Sadatmoosavi A, Khaleghi E, Khorrami Z, Chamani G, Shabani M. Compared to oxcarbazepine and carbamazepine, botulinum toxin type A is a useful therapeutic option for trigeminal neuralgia symptoms: A systematic review. Clin Exp Dent Res 2024; 10:e882. [PMID: 38558383 PMCID: PMC10982606 DOI: 10.1002/cre2.882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/13/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVES This review aimed to compare the effectiveness of three treatments: BTX A, CBZ, and OXB, in managing trigeminal neuralgia (TN). MATERIAL AND METHODS We conducted a thorough search for research articles related to our issue using specific keywords on several databases, including Cochrane Central Register of Controlled Trials, Science Direct, Scopus, PubMed, Elsevier, Springer Journals, Ovid Medline, EBSCO, and Web of Science. Our focus was on publications from 1965 to 2023. RESULTS We retrieved 46 articles from the search and reviewed them carefully. Out of these, we selected 29 articles that met the inclusion criteria. Among the selected articles, 11 investigated the effects of CBZ and OXB, while 18 explored the impact of BTX A on the improvement of TN symptoms. The response rate ranged between 56% and 90.5% for CBZ and between 90.9% and 94% for OXB. The response rate for BTX A ranged between 51.4% and 100%. All these three treatments had a remarkable effect on the improvement of TN. Importantly, findings highlighted that side effects of CBZ and OXB could lead to treatment discontinuation in some cases, whereas BTX A's side effects have been minimal and less frequent. CONCLUSIONS Consequently, BTX A emerges as a promising alternative for TN treatment. However, additional clinical trials are necessary to validate this finding, and further research is required to establish a standardized protocol for administering BTX A in TN.
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Affiliation(s)
- Yeganeh Naderi
- Oral and Dental Diseases Research CenterKerman University of Medical SciencesKermanIran
| | - Maryam Rad
- Oral and Dental Diseases Research CenterKerman University of Medical SciencesKermanIran
| | - Ali Sadatmoosavi
- Research Center for Modeling in HealthKerman University of Medical SciencesKermanIran
| | - Elham Khaleghi
- Research Center for Modeling in HealthKerman University of Medical SciencesKermanIran
| | - Zahra Khorrami
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision ScienceShahid Beheshti University of Medical ScienceTehranIran
| | - Goli Chamani
- Department of Dental Medicine, Karolinska InstituteScandinavian Center for Orofacial Neuroscience (SCON)HuddingeSweden
| | - Mohammad Shabani
- Neuroscience Research Center, Neuropharmacology InstituteKerman University of Medical SciencesKermanIran
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Teshome AA, Walle Ayehu G, Ashagrie BK, Baye ND, Ayenew AA, Mengstie MA, Yazie TS, Gebeyehu AA, Sisay Chanie E, Molla YM, Taye Jemberie M, Abate AW. Systematic review on the frequency of occurrence in nerve branches and the side of the face involved in trigeminal neuralgia and its clinical implication. Front Neurol 2024; 15:1362602. [PMID: 38601341 PMCID: PMC11004464 DOI: 10.3389/fneur.2024.1362602] [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: 12/28/2023] [Accepted: 02/26/2024] [Indexed: 04/12/2024] Open
Abstract
Purpose The purpose of this systematic review is to answer the focused question, "What is the commonly affected nerve branch and the side of the face involved in trigeminal neuralgia?" Types of studies reviewed This systematic review included studies reporting commonly affected trigeminal nerve branches and the side of the face involved in trigeminal neuralgia. To find the potential studies published, the authors utilized specific search databases such as PubMed, and Google scholar. Results Among 132 published studies, the authors selected only 11 to be included for this systematic review. The sample size ranged from 50 to 43,518 study subjects. This review identified that the mandibular branches of the trigeminal nerve were the most affected, followed by the maxillary branch. The review also identified that the right side of the face was predominantly affected. Conclusion and practical implications The authors of this review identified a higher occurrence of trigeminal neuralgia in the mandibular division of the nerve, commonly affected on the right side of the face. Further prospective-based research and meta-analysis are required to validate the commonly occurring trigeminal nerve branch and sidedness of the face involved with its clinical implications in trigeminal neuralgia.
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Affiliation(s)
- Assefa Agegnehu Teshome
- Department of Biomedical Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gashaw Walle Ayehu
- Department of Biomedical Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Berhanu Kindu Ashagrie
- Department of Biomedical Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Nega Dagnaw Baye
- Department of Biomedical Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Atalo Agemas Ayenew
- Department of Biomedical Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biomedical Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Taklo Simeneh Yazie
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Asaye Alamneh Gebeyehu
- Department of Social and Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Ermias Sisay Chanie
- Department of Pediatrics and Child Health Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yalew Melkamu Molla
- Department of Pediatrics and Child Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Molla Taye Jemberie
- Department of Human Anatomy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Agmas Wassie Abate
- Department of Psychiatry, Dr. Ambachew Memorial Hospital, Amhara Regional Health Bureau, South Gondar Zone, Tach Gaynt, Ethiopia
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Chen K, Wu J, Mei H, Cai Y, Chai S, Shen L, Yang J, Xu D, Zhao S, Jiang P, Chen J, Xiong N. A nomogram based on radiomics and clinical information to predict prognosis in percutaneous balloon compression for the treatment of trigeminal neuralgia. Neurosurg Rev 2024; 47:109. [PMID: 38456944 DOI: 10.1007/s10143-024-02339-7] [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: 09/28/2023] [Revised: 02/22/2024] [Accepted: 03/02/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE To develop a clinical-radiomics nomogram based on clinical information and radiomics features to predict the prognosis of percutaneous balloon compression (PBC) for the treatment of trigeminal neuralgia (TN). METHODS The retrospective study involved clinical data from 149 TN patients undergoing PBC at Zhongnan Hospital, Wuhan University from January 2018 to January 2022. The free open-source software 3D Slicer was used to extract all radiomic features from the intraoperative X-ray balloon region. The relationship between clinical information and TN prognosis was analyzed by univariate logistic analysis and multivariate logistic analysis. Using R software, the optimal radiomics features were selected using the least absolute shrinkage and selection operator (Lasso) algorithm. A prediction model was constructed based on the clinical information and radiomic features, and a nomogram was visualized. The performance of the clinical radiomics nomogram in predicting the prognosis of PBC in TN treatment was evaluated using the area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA). RESULTS A total of 149 patients were eventually included. The clinical factors influencing the prognosis of TN in univariate analysis were compression severity score and TN type. The lasso algorithm Max-Relevance and Min-Redundancy(mRMR) was used to select two predictors from 13 morphology-related radiomics features, including elongation and surface-volume ratio. A total of 4 predictors were used to construct a prediction model and nomogram. The AUC was 0.886(95% confidence interval (CI), 0.75 to 0.96), indicating that the model's good predictive ability. DCA demonstrated the nomogram's high clinical applicability. CONCLUSION Clinical-radiomics nomogram constructed by combining clinical information and morphology-related radiomics features have good potential in predicting the prognosis of TN for PBC treatment. However, this needs to be further studied and validated in several independent external patient populations.
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Affiliation(s)
- Keyu Chen
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Ji Wu
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Hao Mei
- Department of Radiology, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Yuankun Cai
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Songshan Chai
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Lei Shen
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Jingyi Yang
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Dongyuan Xu
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Shiyu Zhao
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Pucha Jiang
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Jincao Chen
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Nanxiang Xiong
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China.
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Yasir SA, Khan AA, Somair S, Nawaz R, Asif H, Ullah S. Mental Nerve Neurectomy: A Comparison of Titanium Screw Versus Gutta-Percha Oburation of the Mental Foramen. Cureus 2024; 16:e56426. [PMID: 38638765 PMCID: PMC11024583 DOI: 10.7759/cureus.56426] [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] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVE This study aims to compare the two mental foramen obturating techniques in parameters like operator's ease, postoperative displacement of obturation material, and remission of pain after peripheral neurectomy in patients with trigeminal neuralgia. STUDY DESIGN This study adopts a single-centered comparative analytical approach. PLACE AND DURATION OF STUDY This study was performed in the Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry (AFID), from October 1, 2023, to February 10, 2024. METHODOLOGY Sixty patients fulfilling the inclusion criteria were included and divided into two groups (30 each), and peripheral neurectomy was performed under local anesthesia. In one group, gutta-percha sticks were used to obturate the foramina, and in the other group, titanium screws were used. Postoperatively, the operator's ease, postoperative displacement, and relapse of pain were recorded. RESULTS Titanium screws were easy to handle, and there was no relapse of pain because of no displacement postoperatively when compared with gutta-percha sticks, which were hard to manipulate and showed a relapse of pain. CONCLUSIONS Titanium screws have better postoperative outcomes when compared with gutta-percha sticks in terms of the operator's ease, relapse of pain, and postoperative displacement.
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Affiliation(s)
- Syed Ammar Yasir
- Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, PAK
| | - Ali Akhtar Khan
- Department of Oral and Maxillofacial Surgery, Combined Military Hospital, Rawalpindi, PAK
| | - Sana Somair
- Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, PAK
| | - Ramsha Nawaz
- Department of Orthodontics, Armed Forces Institute of Dentistry, Rawalpindi, PAK
| | - Hamza Asif
- Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, PAK
| | - Saadat Ullah
- Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, PAK
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Alfaifi AJ, Wasli OS, Almalki TM, Alqassim AY. Trigeminal Neuralgia Secondary to Herpes Simplex Virus Type 1 Infection Treated With Oral Acyclovir. Cureus 2024; 16:e54128. [PMID: 38487110 PMCID: PMC10939157 DOI: 10.7759/cureus.54128] [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] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
Trigeminal neuralgia (TN) is characterized by episodic electric, shock-like facial pain. Though often idiopathic, herpes simplex virus type 1 (HSV-1) reactivation can rarely cause symptomatic TN. We report the case of a 30-year-old woman who developed oral HSV-1 lesions followed by right-sided TN pain. MRI of the brain did not reveal neurovascular compression. TN pain completely resolved with oral acyclovir treatment alone, without anticonvulsants. This highlights the importance of considering atypical etiologies such as HSV-1 reactivation in TN evaluation. Early antiviral therapy may treat underlying inflammation and provide sustained symptom relief in HSV-associated TN.
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Affiliation(s)
| | | | | | - Ahmad Y Alqassim
- Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
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28
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Ryan K, Crighton A. Trigeminal neuralgia and trigeminal neuropathic pain. Br Dent J 2024; 236:323-328. [PMID: 38388612 DOI: 10.1038/s41415-024-7068-6] [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: 10/11/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/24/2024]
Abstract
It is very important that the dental team are aware of the varied presentations of pain in the mouth, face and other parts of the trigeminal region which are not directly caused by teeth or oral structures. Our understanding of underlying causes in this complex area is evolving. Ultimately, patients who present with what may at first seem to be oral or dental problems will require specialist input in secondary care with potential for use of systemic medications. This article reviews the common non-dental pains encountered in the orofacial region related to dysfunction of the trigeminal nerve.
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Affiliation(s)
- Kevin Ryan
- Department of Oral Medicine, Glasgow Dental Hospital and School, NHS Greater Glasgow and Clyde, UK.
| | - Alexander Crighton
- Department of Oral Medicine, Glasgow Dental Hospital and School, NHS Greater Glasgow and Clyde, UK
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29
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Zhang F, Ni Y, Luo G, Zhang Y, Lin J. Independent association of the Meckel's cave with trigeminal neuralgia and development of a screening tool. Eur J Radiol 2024; 171:111272. [PMID: 38154423 DOI: 10.1016/j.ejrad.2023.111272] [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: 02/13/2023] [Revised: 11/13/2023] [Accepted: 12/14/2023] [Indexed: 12/30/2023]
Abstract
PURPOSE To 1) investigate the association of the properties of the Meckel's cave (MC) with TN occurrence (i.e., affected vs. unaffected nerves) and whether such association was independent of neurovascular contact (NVC); and 2) develop an objective screening tool for TN. MATERIALS AND METHODS Two hundred and nineteen trigeminal nerves were included. (The severity of) NVC was identified for individual nerve, and a set of 107 radiomic features were extracted to characterize various properties of each MC. Both procedures were primarily based on magnetic resonance imaging sequences. A radiomic score (Rad-score) was constructed for each MC to integrate the features associated with TN occurrence. Independent t-test and logistic regression were conducted to assess the association and develop the screening tool mentioned above. RESULTS Twelve features were selected to build the Rad-score, with the Inverse Difference Moment Normalized (IDMN) having the greatest weight. The Rad-score was significantly (p ≤ 0.05) higher in the affected compared to the unaffected nerves, irrespective of NVC. The Rad-score and NVC were incorporated in the regression model/screening tool, which demonstrated an acceptable discriminating ability (C-statistic = 0.84). CONCLUSION This study has identified a potential association of the properties/features of the MC with TN occurrence, probably involving the demyelination and axonal injury of the trigeminal ganglion within the MC as suggested by the IDMN. Such association may be independent of NVC. This finding may provide new insight into the etiology and/or pathophysiology of TN. The screening tool, which demonstrated an acceptable discriminating ability, may contribute to an improvement in its diagnosis.
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Affiliation(s)
- Fang Zhang
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yang Ni
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Guoxuan Luo
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yong Zhang
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
| | - Jinzhi Lin
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, China.
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Mousavi SH, Lindsey JW, Westlund KN, Alles SRA. Trigeminal Neuralgia as a Primary Demyelinating Disease: Potential Multimodal Evidence and Remaining Controversies. THE JOURNAL OF PAIN 2024; 25:302-311. [PMID: 37643657 DOI: 10.1016/j.jpain.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023]
Abstract
Trigeminal neuralgia is a heterogeneous disorder with likely multifactorial and complex etiology; however, trigeminal nerve demyelination and injury are observed in almost all patients with trigeminal neuralgia. The current management strategies for trigeminal neuralgia primarily involve anticonvulsants and surgical interventions, neither of which directly address demyelination, the pathological hallmark of trigeminal neuralgia, and treatments targeting demyelination are not available. Demyelination of the trigeminal nerve has been historically considered a secondary effect of vascular compression, and as a result, trigeminal neuralgia is not recognized nor treated as a primary demyelinating disorder. In this article, we review the evolution of our understanding of trigeminal neuralgia and provide evidence to propose its potential categorization, at least in some cases, as a primary demyelinating disease by discussing its course and similarities to multiple sclerosis, the most prevalent central nervous system demyelinating disorder. This proposed categorization may provide a basis in investigating novel treatment modalities beyond the current medical and surgical interventions, emphasizing the need for further research into demyelination of the trigeminal sensory pathway in trigeminal neuralgia. PERSPECTIVE: This article proposes trigeminal neuralgia as a demyelinating disease, supported by histological, clinical, and radiological evidence. Such categorization offers a plausible explanation for controversies surrounding trigeminal neuralgia. This perspective holds potential for future research and developing therapeutics targeting demyelination in the condition.
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Affiliation(s)
- Seyed H Mousavi
- Division of Multiple Sclerosis and Neuroimmunology, Department of Neurology, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - John W Lindsey
- Division of Multiple Sclerosis and Neuroimmunology, Department of Neurology, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Karin N Westlund
- Department of Anesthesiology & Critical Care Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Sascha R A Alles
- Department of Anesthesiology & Critical Care Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Rugnath R, Orzechowicz C, Newell C, Carullo V, Rugnath A. A Literature Review: The Mechanisms and Treatment of Neuropathic Pain-A Brief Discussion. Biomedicines 2024; 12:204. [PMID: 38255308 PMCID: PMC10812949 DOI: 10.3390/biomedicines12010204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 01/24/2024] Open
Abstract
Classically, neuropathic pain is described as a pain caused by a lesion or disease of the somatosensory system. However, one must note that the presence of somatosensory pathology alone does not guarantee a progression to neuropathic pain. This is due, in part, to the fact that neuropathic pain is a notoriously complex disease process, involving sensitization of both the central and peripheral nervous systems. Its causes are also numerous and varied, including trauma, the compression of a nerve, autoimmune disorders, diabetes, and infections. Due to the various manifestations, causes, and symptoms of neuropathic pain, the treatment of this disease process has proved challenging for generations of physicians. This section aims to elaborate on newly proposed mechanisms for pharmacological and targeted therapies, such as neurostimulation, which aim to reduce the negative somatosensory effects of neuropathic pain.
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Affiliation(s)
| | | | | | | | - Anesh Rugnath
- Department and Anesthesiology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (R.R.)
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32
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Xi L, Liu X, Shi H, Han W, Gao L, Wang L, Liu J, Ren Y, Du Y, Liu G. Comparative safety and efficacy of percutaneous radiofrequency thermocoagulation and percutaneous balloon compression in CT-guided and local anesthesia for recurrent trigeminal neuralgia. Front Neurol 2024; 14:1336261. [PMID: 38249730 PMCID: PMC10797886 DOI: 10.3389/fneur.2023.1336261] [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: 11/10/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Background There are several ways to treat trigeminal neuralgia (TN); however, TN may recur after treatment. Although microvascular decompression (MVD) is considered an effective treatment for trigeminal neuralgia, patients with recurrence may not be willing to undergo craniotomy. Objective This study compared the safety and efficacy of percutaneous radiofrequency thermocoagulation and percutaneous balloon compression for treating recurrent trigeminal neuralgia. Methods This was a prospective non-randomized controlled study. A total of 52 with recurrent TN were scheduled to undergo surgery in our Hospital from January-June 2021. The patients were classified into percutaneous radiofrequency thermocoagulation (PRT) and percutaneous balloon compression (PBC) groups based on the treatment. All surgeries were performed under computed tomography guidance and local anesthesia. Post-operative complications were also observed. Pain was assessed using the visual analog scale (VAS) and Barrow Neurological Institute (BNI) scale. Efficacy indices were evaluated at 3, 6, 12, and 18 months after surgery. Results During follow-up, the efficacy rates of the two methods within 18 months were 76.0 and 88.9%, respectively. All patients had hypoesthesia on the affected side, and no severe complications. Notably, 5 patients (20%) in the PRT group with multiple-branch pain, including the first branch of the trigeminal nerve (V1) pain in the PRT group, received radiofrequency therapy for the supraorbital notch (foramen) after puncture of the foramen ovale. However, multiple pain episodes resolved with only one operation in the PBC group. Conclusion CT-guided percutaneous radiofrequency thermocoagulation and percutaneous balloon compression under local anesthesia may be good options for treating recurrent trigeminal neuralgia. Percutaneous balloon compression may be recommended when multiple branches are involved, particularly in cases of V1 neuralgia.
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Affiliation(s)
- Lulu Xi
- Department of Pain, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiaohui Liu
- Department of Pain, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Hongchen Shi
- Department of Pain, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Wenbiao Han
- Department of Pain, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Liqin Gao
- Department of Pain, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Li Wang
- Department of Pain, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Junpeng Liu
- Department of Pain, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yue Ren
- Department of Pain, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yuanyuan Du
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Guangzhao Liu
- Department of Pain, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Shah SN, Kaki P, Shah SS, Shah SA. A Pilot Study of Hypofractionated Radiosurgery for Trigeminal Neuralgia. Cureus 2024; 16:e53061. [PMID: 38410286 PMCID: PMC10896271 DOI: 10.7759/cureus.53061] [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: 09/10/2023] [Accepted: 01/27/2024] [Indexed: 02/28/2024] Open
Abstract
The primary late toxicity of radiosurgery treatment for trigeminal neuralgia (TN) is facial numbness due to trigeminal nerve dysfunction. Although most patients prefer loss of facial sensation to TN, severe loss of facial sensation can be debilitating. In order to try to obtain high pain control rates while minimizing the risk of late facial numbness, we elected to treat patients on the distal trigeminal nerve with a three-fraction regimen over consecutive days instead of one fraction. Our goal was to relieve the pain while also allowing the trigeminal nerve time to repair radiation damage between treatments in an attempt to minimize the risk of permanent facial numbness. Patients in a pilot study, approved by an Institutional Review Board (IRB), received a treatment regimen of 99 Gy, administered in three consecutive daily fractions of 33 Gy each, with the dosage targeted to the 80% line. This dose was selected to approximate a biologically equivalent dose of 80 Gy maximal dose to the trigeminal nerve. Forty-eight patients were treated with CyberKnife Radiosurgery (CKRS; 99 Gy/3 fractions) for TN from 2016 to 2022, with at least one year of follow-up. The Barrow Neurological Institute (BNI) scale was used to assess facial pain, and Kaplan-Meier analysis was used to assess adequate pain relief. Thirty-eight (84%) patients experienced adequate pain relief, defined as a BNI score of I-IIIb, after a median of 1.5 months following CKRS. Treatment failure (BNI=IV-V) occurred in 12 (25%) patients after a median of 6 months following initial pain relief. The actuarial probability of pain relief at 6, 12, and 24 months post-CKRS were 87.4%, 83.7%, and 83.7%, respectively. Facial numbness was experienced in 24 (50%) cases after a median of 10 months following CKRS. Typical facial pain (p=0.034) and vascular compression (p=0.039) were the only predictors of better treatment outcomes using univariate Cox survival analysis, and vascular compression (p= 0.037) was the only predictor in multivariate Cox survival analysis. Hypofractionated treatment to the distal trigeminal nerve segment does not appear to offer an advantage in treating TN, due to similar rates of pain relief but with an unacceptably high rate of late facial numbness.
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Affiliation(s)
- Sophia N Shah
- Radiation Oncology, Christiana Care Health System, Newark, USA
| | - Praneet Kaki
- Radiation Oncology, Christiana Care Health System, Newark, USA
| | - Sohan S Shah
- Radiation Oncology, Christiana Care Health System, Newark, USA
| | - Sunjay A Shah
- Radiation Oncology, Christiana Care Health System, Newark, USA
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Ali SMS, Shafique MA, Mustafa MS, Jafri SAA, Khalil S, Fatima H, Rangwala HS. Effectiveness of gamma knife radiosurgery in the management of trigeminal neuralgia associated with multiple sclerosis: a systematic review and meta-analysis. Neurosurg Rev 2023; 47:12. [PMID: 38091115 DOI: 10.1007/s10143-023-02246-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/06/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a chronic condition characterized by intense facial pain akin to electric shocks, often associated with the trigeminal nerve. It can be either idiopathic or secondary, with multiple sclerosis (Ms) being a significant contributing factor. Non-responsive patients may opt for minimally invasive procedures, such as gamma knife radiosurgery (GKRS), which offers precise, non-invasive treatment and is frequently chosen as a primary approach. This meta-analysis evaluates the long-term efficacy of GKRS in TN management in Ms patients. METHODS We conducted a focused search across various databases. Inclusion criteria encompassed studies with ≥ 30 patients using GKRS for TN in Ms, reporting pertinent clinical outcomes. Primary outcomes assessed GKRS efficacy through Barrow Neurological Institute Pain scores. Secondary outcomes encompassed bothersome numbness, facial numbness, and recurrence. Data analysis employed OpenMeta, random effect models, and odds ratios with 95% confidence intervals. Heterogeneity was assessed using I2 statistics. RESULTS Fourteen studies with 752 cases of GKRS for TN were included. Regarding the outcomes, 83% of patients experienced a positive initial pain response, while the overall treatment success rate was 51%. Additionally, 19.6% of patients reported facial numbness, 4.1% experienced bothersome numbness, and 40% faced recurrence. The odds ratio for positive initial pain response was 0.83 (95% CI, 0.76-0.89), while for treatment success, it was 0.51 (95% CI, 0.379-0.639). Facial numbness had an odds ratio of 0.196 (95% CI, 0.130-0.262), bothersome numbness had an odds ratio of 0.041 (95% CI, 0.013-0.069), and recurrence had an odds ratio of 0.403 (95% CI, 0.254-0.551). CONCLUSIONS In conclusion, treating trigeminal neuralgia in multiple sclerosis patients remains challenging. GKRS shows promise, but customized treatment approaches tailored to individual patient characteristics are urgently needed to address the unique challenges of this condition.
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Affiliation(s)
- Syed Muhmmad Sinaan Ali
- Department of Medicine, Liaquat National Hospital & Medical College, Stadium Road, Karachi, 74800, Pakistan
| | - Muhammad Ashir Shafique
- Department of Medicine, Jinnah Sindh Medical University, Iqbal Shaheed Rd, Karachi, 75510, Pakistan
| | - Muhammad Saqlain Mustafa
- Department of Medicine, Jinnah Sindh Medical University, Iqbal Shaheed Rd, Karachi, 75510, Pakistan
| | - Syed Ahsan Ali Jafri
- Department of Medicine, Liaquat National Hospital & Medical College, Stadium Road, Karachi, 74800, Pakistan
| | - Sara Khalil
- Department of Medicine, Liaquat National Hospital & Medical College, Stadium Road, Karachi, 74800, Pakistan
| | - Hareer Fatima
- Department of Medicine, Jinnah Sindh Medical University, Iqbal Shaheed Rd, Karachi, 75510, Pakistan
| | - Hussain Sohail Rangwala
- Department of Medicine, Jinnah Sindh Medical University, Iqbal Shaheed Rd, Karachi, 75510, Pakistan.
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Feng D, Zhang Y, Li D, Wang K, Yang F, Ding J, Wu W, Wang Y, Jia H. Percutaneous ballon compression for recurrent TN -a retrospective study of 33 cases. Front Neurol 2023; 14:1292804. [PMID: 38116114 PMCID: PMC10728714 DOI: 10.3389/fneur.2023.1292804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023] Open
Abstract
Objective To investigate the clinical efficacy of percutaneous microballoon compression in the treatment of recurrent TN. Methods This retrospective study included 33 patients who underwent percutaneous microballoon compression for the treatment of recurrent TN from March 2019 to May 2022. Postoperative pain recurrence and facial numbness were assessed according to the Barrow Neurological Institute (BNI) pain score. Patients' anxiety and sleep status during follow-up were assessed according to the Self-rating Anxiety Scale (SAS) and Pittsburgh Sleep Quality Index (PSQI). Results All patients (33 cases) were followed up for 12-38 months, with an average follow-up time of 23 months. On postoperative day 1, 31 patients (93.9%) reported no pain, and 2 patients were given drug treatment for pain relief, The total efficacy was 93.9%. Moreover, 2 patients (6.1%) reported significant pain relief 2 weeks postoperatively. There are many complications during and after PBC. The incidence of the trigeminocardiac reflex (TCR) during surgery was 100%, and the incidence of facial numbness, masseter muscle weakness, labial herpes and headache was 97, 60.6, 12.1 and 3%. No patient experienced severe facial numbness, hearing impairment, diplopia, injury to cranial nerves, Meningitis, intracranial haemorrhage or keratitis. 1 patient had recurrence of pain at 6 months post-op, which was relieved by oral medication. 81.8% suffered from anxiety and 54.5% had poor sleep quality before surgery. After the period of PBC, SAS and PSQI scores decreased continuously. There were significant improvements in anxiety and sleep status postoperatively compared with preoperatively. Conclusion PBC is a safe and effective option for the treatment of recurrent TN. The arduous and demanding nature of the clinical course subjects the patient to severe pain, mental, and physical stress. Thankfully, it significantly improves the symptoms of anxiety, depression, and sleep quality.
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Affiliation(s)
- Dongwei Feng
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Yaxin Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Dong Li
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Kang Wang
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Fan Yang
- Nuclear magnetic laboratory, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Jianan Ding
- Interventional Department, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Weize Wu
- Department of Pathology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Yunhe Wang
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Heping Jia
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
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Takei M, Takizawa K, Okada A, Otani N, Noma N. Trigeminal Neuralgia With Concomitant Continuous Pain Due to Vertebrobasilar Dolichoectasia: A Case Report. Cureus 2023; 15:e49953. [PMID: 38179368 PMCID: PMC10765555 DOI: 10.7759/cureus.49953] [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] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
This passage discusses a case of trigeminal neuralgia (TN) with continuous pain and hemifacial spasm caused by vertebrobasilar dolichoectasia, a rare condition. The patient experienced ongoing orofacial pain, which initially led to dental treatments. After unsuccessful medication (carbamazepine), the patient underwent microvascular decompression to alleviate nerve compression by the elongated vertebral artery. This report highlights the challenge of treating such cases due to the unique nature of neurovascular compression. Additionally, it introduces the concept of TN with concomitant continuous pain and emphasizes the need for comprehensive diagnosis, as vertebrobasilar artery elongation is associated with various symptoms, including TN and hemifacial spasms.
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Affiliation(s)
- Miki Takei
- Department of Oral Medicine, Nihon University School of Dentistry, Tokyo, JPN
| | - Keita Takizawa
- Department of Oral Medicine, Nihon University School of Dentistry, Tokyo, JPN
| | - Akiko Okada
- Department of Oral Medicine, Nihon University School of Dentistry, Tokyo, JPN
| | - Naoki Otani
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, JPN
| | - Noboru Noma
- Department of Oral Medicine, Nihon University School of Dentistry, Tokyo, JPN
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Martinez DM, Huh BK, Javed S. Case report: use of high-intensity laser therapy for treatment of trigeminal neuralgia. Pain Manag 2023; 13:709-716. [PMID: 38189105 DOI: 10.2217/pmt-2023-0112] [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: 01/09/2024] Open
Abstract
Trigeminal neuralgia represents a form of chronic facial pain that is characterized by its incapacitating nature. The current therapeutic approaches encompass pharmacological agents with carbamazepine or non-pharmacologic options including utilization of percutaneous rhizotomy, Gamma knife radiosurgery or microvascular decompression may be indicated in certain cases. While the interventions may be effective, medications have negative side effects and procedures are invasive which can pose challenges for patients with various comorbidities. High-intensity laser therapy (HILT) has demonstrated safety and efficacy for many types of chronic pain such as musculoskeletal, autoimmune and neuropathic. Herein, we demonstrate the benefits of HILT therapy in the management of trigeminal neuralgia in a 72 year-old patient with a complex history of facial surgery and radiation who had failed pharmacological treatments and denied any invasive procedures.
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Affiliation(s)
- Diego M Martinez
- Tilman J. Fertitta Family College of Medicine, University of Houston, 5055 Medical Cir, Houston, TX 77204, USA
- Department of Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Billy K Huh
- Department of Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Saba Javed
- Department of Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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38
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Gaul C, Fan W, Heindl LM, Jürgens T. [Differential diagnostics of chronic eye pain from a neurological perspective-What can also lie behind it]. DIE OPHTHALMOLOGIE 2023; 120:1226-1232. [PMID: 37999753 DOI: 10.1007/s00347-023-01958-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
Periorbital pain and pain in the eye may arise from nociceptive processes such as chronic ocular surface destruction and inflammation, from neuropathic processes or often from a combination of different mechanisms. An important differential diagnosis are primary headache disorders and other neurological diseases, for example of inflammatory origin, which trigger secondary pain. Chronic eye pain therefore requires interdisciplinary collaboration in the diagnostics and treatment.
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Affiliation(s)
- Charly Gaul
- Kopfschmerzzentrum Frankfurt, Dalbergstr. 2a, 65929, Frankfurt, Deutschland.
| | - Wanlin Fan
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Ludwig M Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Tim Jürgens
- Klinik und Poliklinik für Neurologie, Kopfschmerzzentrum Nord-Ost, Universitätsmedizin Rostock, Rostock, Deutschland
- Neurologische Klinik, KMG Klinikum Güstrow, Güstrow, Deutschland
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Amaya Pascasio L, De La Casa-Fages B, Esteban de Antonio E, Grandas F, García-Leal R, Ruiz Juretschke F. Microvascular decompression for trigeminal neuralgia: A retrospective analysis of long-term outcomes and prognostic factors. Neurologia 2023; 38:625-634. [PMID: 37996213 DOI: 10.1016/j.nrleng.2021.03.010] [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: 08/25/2020] [Accepted: 03/02/2021] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Microvascular decompression is considered to be the most effective and only etiological surgical treatment for classical trigeminal neuralgia, relieving the neurovascular compression found in up to 95% of cases. This study aims to report the long-term outcomes and to identify prognostic factors in a series of patients with trigeminal neuralgia treated by microvascular decompression. METHODS A retrospective observational study of 152 consecutive patients operated by microvascular decompression with at least six months of follow-up. The surgical results, including pain relief according to the Barrow Neurological Institute pain scale, complications and the medical treatment during the follow-up period were reviewed. Binary regression analysis was performed to identify factors associated with a good long-term outcome. RESULTS A total of 152 patients with a mean age of 60 years and a mean follow-up of 43 months were included. At the final follow-up visit, 83% of the patients had achieved significant relief of the pain and 63% could reduce the absolute drug doses by 50% or more. The most frequent complications were wound infection (4.5%) and CSF fistula (7%). Being over 70 years of age and having paroxysmal pain were associated with a long-term pain relief. CONCLUSIONS Our results support the notion that microvascular decompression is an effective and safe therapy in patients with trigeminal neuralgia. A multidisciplinary approach with an early referral to a neurosurgical unit many be beneficial in patients who are refractory to pharmacological treatment.
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Affiliation(s)
- L Amaya Pascasio
- Neurology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
| | - B De La Casa-Fages
- Neurology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Neurosciences Area, Instituto Investigacion Sanitaria Gregorio Marañon, Madrid, Spain
| | - E Esteban de Antonio
- Neurology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - F Grandas
- Neurology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Neurosciences Area, Instituto Investigacion Sanitaria Gregorio Marañon, Madrid, Spain
| | - R García-Leal
- Neurosurgery Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - F Ruiz Juretschke
- Neurosurgery Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
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Zamarud A, Park DJ, Ung TH, McCleary TL, Yoo KH, Soltys SG, Lim M, Chang SD, Meola A. Stereotactic Radiosurgery for Medically Refractory Trigeminal Neuralgia Secondary to Stroke: A Systematic Review and Clinical Case Presentation. World Neurosurg 2023; 179:e366-e373. [PMID: 37640262 DOI: 10.1016/j.wneu.2023.08.092] [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: 04/05/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a paroxysmal, unilateral, brief, shock-like pain in ≥1 divisions of the trigeminal nerve. It can result from multiple causes; however, TN secondary to stroke is very rare. METHODS We present the case of TN secondary to pontine infarction treated with incremental doses of neuropathic pain medication for >5 years before conservative management failed. He was then treated with stereotactic radiosurgery (SRS). Additionally, we conducted a systematic review using standard PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines for all the cases of TN with brainstem stroke from 1976 to 2022. RESULTS Our patient was an 82-year-old man. Magnetic resonance imaging demonstrated a pontine lesion consistent with stroke. The Barrow Neurological Institute (BNI) score at presentation was 5. He received a marginal dose of 60 Gy to the 80% isodose line in a single fraction to a volume of 0.05 cm3. The immediate post-treatment BNI score was 0 and remained at 0 for 3 months, when he experienced recurrence. The recurrence was treated with oxcarbazepine. His pain remained well controlled with a lower dose of oxcarbazepine, and he had no adverse effects at 1 year of follow-up with a BNI score of 3. The systemic review identified 21 case reports with a combined cohort of 25 patients with TN secondary to stroke. Only 3 patients were treated with SRS, 2 of whom reported symptom improvement at 6 months and 8 months of follow-up with no adverse events. CONCLUSIONS Our case and literature review demonstrate durable and effective treatment with SRS, which can be considered a safe and effective treatment option for patients with stroke-associated TN.
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Affiliation(s)
- Aroosa Zamarud
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - David J Park
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Timothy H Ung
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Tamra-Lee McCleary
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Kelly H Yoo
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Antonio Meola
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
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Kalluri AL, So RJ, Ran KR, Xie ME, Kilgore C, Nair SK, Huang J, Bettegowda C, Xu R. Preoperative Characteristics and Postoperative Pain Outcomes in Trigeminal Neuralgia With Concomitant Autoimmune Disease. Neurosurgery 2023; 93:1075-1081. [PMID: 37306434 DOI: 10.1227/neu.0000000000002549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/06/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Although the association between multiple sclerosis and trigeminal neuralgia (TN) is well established, little is known about TN pain characteristics and postoperative pain outcomes after microvascular decompression (MVD) in patients with TN and other autoimmune diseases. In this study, we aim to describe presenting characteristics and postoperative outcomes in patients with concomitant TN and autoimmune disease who underwent an MVD. METHODS A retrospective review of all patients who underwent an MVD at our institution between 2007 and 2020 was conducted. The presence and type of autoimmune disease were recorded for each patient. Patient demographics, comorbidities, clinical characteristics, postoperative Barrow Neurological Institute (BNI) pain and numbness scores, and recurrence data were compared between groups. RESULTS Of the 885 patients with TN identified, 32 (3.6%) were found to have concomitant autoimmune disease. Type 2 TN was more common in the autoimmune cohort ( P = .01). On multivariate analysis, concomitant autoimmune disease, younger age, and female sex were found to be significantly associated with higher postoperative BNI score ( P = .04, <0.001, and <0.001, respectively). In addition, patients with autoimmune disease were more likely to experience significant pain recurrence ( P = .009) and had shorter time to recurrence on Kaplan-Meier analysis ( P = .047), although this relationship was attenuated on multivariate Cox proportional hazards regression. CONCLUSION Patients with concomitant TN and autoimmune disease were more likely to have Type 2 TN, had worse postoperative BNI pain scores at the final follow-up after MVD, and were more likely to experience recurrent pain than patients with TN alone. These findings may influence postoperative pain management decisions for these patients and support a possible role for neuroinflammation in TN pain.
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Affiliation(s)
- Anita L Kalluri
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
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Liu M, Wang Y, Li S, Hou X, Li T, Xu Z, Chen F, Zhou Y, Xia L, Wang W. Attenuates reactive oxygen species: induced pyroptosis via activation of the Nrf2/HO-1 signal pathway in models of trigeminal neuralgia. Sci Rep 2023; 13:18111. [PMID: 37872210 PMCID: PMC10593956 DOI: 10.1038/s41598-023-44013-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/03/2023] [Indexed: 10/25/2023] Open
Abstract
In this study, we examined the impact of demyelinating and neuroinflammation on trigeminal neuralgia (TN) by utilizing models of chronic constriction injury to the infraorbital nerve (CCI). The CCI rats were treated with either VX-765 (an inhibitor of caspase-1) or a control solution of PBS/DMSO to observe the effects on neurobehavioral and neuropathological outcomes. The histochemical changes, pyroptosis-related proteins were assessed using immunohistochemistry, Elisa, and western blotting. RSC96 cells were pretreated with belnacasan (VX-765, an inhibitor of caspase-1), Gasdermin D(GSDMD)-targeting siRNAs, cobalt protoporphyrin (CoPP) or zinc protoporphyrin (Znpp) before being exposed to H2O2. Following these treatments, the Reactive oxygen species (ROS) level, cell viability, percentage of pyroptosis, pyroptosis-related proteins, nuclear factor erythroid 2-related factor 2 (Nrf2) and HO-1 level was measured. The scanning electron microscopy revealed increased ball-like bulge and membrane pore formation in the CCI group. In the CCI and CCI+ Vehicle groups, we found ROS level and expression of pyroptosis-related proteins increased. While, treatment with VX-765resulted in a decreased expression of GSDMD, IL-1, IL-18, and caspase-1 decreased. In the in-vitro study, RSC96 cells showed mild pyroptosis and overall mild edema after being exposed to H2O2. The ROS level, percentage of pyroptosis, pyroptosis-related proteins, Nrf2 and HO-1 level increased significantly in the H2O2 group. While, the percentage of pyroptosis and pyroptosis-related proteins decreased significantly in the H2O2 + VX-765 group, H2O2 + siRNA group, and H2O2 + VX-765 + siRNA group. After treatment with HO-1-inhibitor Znpp and HO-1-activator Copp, the percentage of pyroptosis and pyroptosis-related proteins increased and decreased significantly respectively. In conclusions, the pyroptosis of Schwann cell in the CCI model generated the demyelination of TN nerve. The ROS is an upstream event of NLRP3 inflammasome activation which induced eventual pyroptosis. The Nrf2/HO-1 signaling pathway could protect the H2O2-induced pyroptosis in RSC96 cells.
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Affiliation(s)
- Mingxing Liu
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, People's Republic of China
| | - Yongyi Wang
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, People's Republic of China
| | - Shengli Li
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, People's Republic of China
| | - Xiaoqun Hou
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, People's Republic of China
| | - Tong Li
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, People's Republic of China
| | - Zhiming Xu
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, People's Republic of China
| | - Feng Chen
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, People's Republic of China
| | - Yong Zhou
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, People's Republic of China
| | - Lei Xia
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200092, China.
| | - Weimin Wang
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, People's Republic of China.
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Wang F, Ma A, Wu Z, Xie M, Lun P, Sun P. Development and validation of radiomics models for the prediction of diagnosis of classic trigeminal neuralgia. Front Neurosci 2023; 17:1188590. [PMID: 37877009 PMCID: PMC10591183 DOI: 10.3389/fnins.2023.1188590] [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: 03/17/2023] [Accepted: 09/18/2023] [Indexed: 10/26/2023] Open
Abstract
The study aims to develop a magnetic resonance imaging (MRI)-based radiomics model for the diagnosis of classic trigeminal neuralgia (cTN). This study involved 350 patients with cTN and 100 control participants. MRI data were collected retrospectively for all the enrolled subjects. The symptomatic side trigeminal nerve regions of patients and both sides of the trigeminal nerve regions of control participants were manually labeled on MRI images. Radiomics features of the areas labeled were extracted. Principle component analysis (PCA) and least absolute shrinkage and selection operator (LASSO) regression were utilized as the preliminary feature reduction methods to decrease the high dimensionality of radiomics features. Machine learning methods were established, including LASSO logistic regression, support vector machine (SVM), and Adaboost methods, evaluating each model's diagnostic abilities using 10-fold cross-validation. All the models showed excellent diagnostic ability in predicting trigeminal neuralgia. A prospective study was conducted, 20 cTN patients and 20 control subjects were enrolled to validate the clinical utility of all models. Results showed that the radiomics models based on MRI can predict trigeminal neuralgia with high accuracy, which could be used as a diagnostic tool for this disorder.
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Affiliation(s)
- Fuxu Wang
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Anbang Ma
- Shanghai Xunshi Technology Co., Ltd., Shanghai, China
| | - Zeyu Wu
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mingchen Xie
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Peng Lun
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Peng Sun
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
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Carrillo-Ruiz JD, Covaleda-Rodríguez JC, Díaz-Martínez JA, Vallejo-Estrella A, Navarro-Olvera JL, Velasco-Campos F, Armas-Salazar A, Cid-Rodríguez FX. Minimally Invasive Retrosigmoidal Parasterional Burr-Hole Approach: Technique and Neuropathic Pain Amelioration after Microvascular Decompression of the Trigeminal Nerve. Biomedicines 2023; 11:2707. [PMID: 37893080 PMCID: PMC10603898 DOI: 10.3390/biomedicines11102707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Trigeminal neuralgia, a common condition in clinical practice, often occurs due to vascular compression caused by aberrant or ectopic arterial or venous vessels. Microvascular decompression through a minimally invasive retrosigmoidal approach has shown high rates of pain control, low complication rates, and excellent therapeutic results. OBJECTIVE To describe the surgical technique and clinical outcomes in terms of pain relief after microvascular decompression of the trigeminal nerve through a minimally invasive retrosigmoidal parasterional burr-hole technique. METHODS A group of patients with trigeminal neuralgia refractory to medical management who underwent microvascular decompression were examined. The records of the patients were considered retrospectively (2016-2018), and the outcomes were considered based on the Visual Analogue Scale (VAS) and the Barrow Neurological Institute Pain Scale (BNIPS) added to a technical note of the surgical technique for a minimally invasive retrosigmoidal parasterional burr-hole. RESULTS Twenty-two patients were evaluated, and clinical assessment after surgical intervention showed a decrease in pain according to the VAS, resulting from an average preoperative state of 9.5 ± 0.37 to a postoperative condition of 1.32 ± 1.28, exhibiting statistically significant changes (p < 0.0001, d = 9.356). On the other hand, in relation to the BNIPS scale, a decrease from an average preoperative status of 4.55 ± 0.25 to a postoperative status at 12 months of 1.73 ± 0.54 was also demonstrated, showing significant changes (p < 0.0001, d = 3.960). CONCLUSION Microvascular decompression of the trigeminal nerve through a minimally invasive retrosigmoidal parasterional burr-hole is feasible and can be a safe and effective technique for the management of pain. However, further research employing larger sample sizes and longer follow-up periods is necessary.
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Affiliation(s)
- José Damián Carrillo-Ruiz
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
- Coordination of Neuroscience, Faculty of Psychology, Mexico Anahuac University, Mexico City 52786, Mexico
- Research Direction, General Hospital of Mexico, Mexico City 06720, Mexico
| | - Juan Camilo Covaleda-Rodríguez
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
- Unit of Functional Neurosurgery and Stereotactic, Olaya Polyclinic Center, Bogota 111411, Colombia
| | - José Armando Díaz-Martínez
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
- Department of Neurosurgery, Hospital Universitario “Dr. José Eleuterio González”, Monterrey 64460, Mexico
| | - Antonio Vallejo-Estrella
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
| | - José Luis Navarro-Olvera
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
| | - Francisco Velasco-Campos
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
| | - Armando Armas-Salazar
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
- Postgraduate Department, School of Higher Education in Medicine, National Polytechnic Institute, Mexico City 07360, Mexico
| | - Fátima Ximena Cid-Rodríguez
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
- Postgraduate Department, School of Higher Education in Medicine, National Polytechnic Institute, Mexico City 07360, Mexico
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Wenger TA, Strickland BA, Liu KQ, Attenello FJ. Commentary: Right Retrosigmoid Craniotomy for Microvascular Decompression and Glioneuronal Hamartoma Resection for Trigeminal Neuralgia: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e240-e241. [PMID: 37543739 DOI: 10.1227/ons.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 08/07/2023] Open
Affiliation(s)
- Talia A Wenger
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Ben A Strickland
- Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Kristie Q Liu
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Frank J Attenello
- Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Nair SK, Xie ME, Ran K, Kalluri A, Kilgore C, Halbert-Elliott K, Huang J, Lim M, Bettegowda C, Xu R. A Case Series of Stereotactic Radiosurgery First for Trigeminal Neuralgia: A History of Stereotactic Radiosurgery Does Not Complicate Microvascular Decompression. Oper Neurosurg (Hagerstown) 2023; 25:353-358. [PMID: 37432012 DOI: 10.1227/ons.0000000000000819] [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: 01/31/2023] [Accepted: 05/10/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The influence of prior stereotactic radiosurgery (SRS) on outcomes of subsequent microvascular decompression (MVD) for patients with trigeminal neuralgia (TN) is not well understood. To directly compare pain outcomes in patients undergoing primary MVD vs those undergoing MVD with a history of 1 prior SRS procedure. METHODS We retrospectively reviewed all patients undergoing MVD at our institution from 2007 to 2020. Patients were included if they underwent primary MVD or had a history of SRS alone before MVD. Barrow Neurological Institute (BNI) pain scores were assigned at preoperative and immediate postoperative time points and at every follow-up appointment. Evidence of pain recurrence was recorded and compared via Kaplan-Meier analysis. Multivariate Cox proportional hazards regression was used to identify factors associated with worse pain outcomes. RESULTS Of patients reviewed, 833 met our inclusion criteria. Thirty-seven patients were in the SRS alone before MVD group, and 796 patients were in the primary MVD group. Both groups demonstrated similar preoperative and immediate postoperative BNI pain scores. There were no significant differences between average BNI at final follow-up between the groups. Multiple sclerosis (hazard ratio (HR) = 1.95), age (HR = 0.99), and female sex (HR = 1.43) independently predicted increased likelihood of pain recurrence on Cox proportional hazards analysis. SRS alone before MVD did not predict increased likelihood of pain recurrence. Furthermore, Kaplan-Meier survival analysis demonstrated no relationship between a history of SRS alone and pain recurrence after MVD ( P = .58). CONCLUSION SRS is an effective intervention for TN that may not worsen outcomes for subsequent MVD in patients with TN.
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Affiliation(s)
- Sumil K Nair
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael E Xie
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kathleen Ran
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anita Kalluri
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Collin Kilgore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kyra Halbert-Elliott
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Marques DP, Chacur M, Martins DO. Photobiomodulation and vitamin B treatment alleviate both thermal and mechanical orofacial pain in rats. Photochem Photobiol Sci 2023; 22:2315-2327. [PMID: 37340216 DOI: 10.1007/s43630-023-00452-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/12/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE The present study investigates the efficacy of Photobiomodulation (PBM) and Vitamin B Complex (VBC) to relieve pain, both in separately and combined (PBM and VBC). METHODS Rats with chronic constriction injury of the right infraorbital nerve (CCI-IoN) or Sham surgery were used. PBM was administered at a wavelength of 904 nm and energy density of 6.23 J/cm2 and VBC (containing B1, B6 and B12) subcutaneously, both separately and combined. Behavioral tests were performed to assess mechanical and thermal hypersensitivity before and after CCI and after PBM, VBC, or PBM + VBC. The expression of inflammatory proteins in the trigeminal ganglion and the immunohistochemical alterations of Periaqueductal Gray (PAG) astrocytes and microglia were examined following CCI and treatments. RESULTS All testeds treatments reversed the painful behavior. The decrease in pain was accompanied by a decrease of Glial Fibrillary Acidic Protein (GFAP), a specific astrocytic marker, and Ionized calcium-binding adaptor molecule 1 (Iba-1), a marker of microglia, and decreased expression of Transient Receptor Potential Vanilloid 1 (TRPV1), Substance P, and Calcitonin Gene-Related Peptide (CGRP) induced by CCI-IoN in PAG and Trigeminal ganglion. Furthermore, both treatments showed a higher expression of Cannabinoid-type 1 (CB1) receptor in the trigeminal ganglion compared to CCI-IoN rats. Our results show that no difference was observed between groups. CONCLUSION We showed that PBM or VBC regulates neuroinflammation and reduces inflammatory protein expression. However, the combination of PBM and VBC did not enhance the effectiveness of both therapies alone.
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Affiliation(s)
- Daniel Pereira Marques
- Departamento de Anatomia, Laboratory of Functional Neuroanatomy of Pain, Universidade de São Paulo Instituto de Ciências Biomédicas, São Paulo, São Paulo, Brazil
| | - Marucia Chacur
- Departamento de Anatomia, Laboratory of Functional Neuroanatomy of Pain, Universidade de São Paulo Instituto de Ciências Biomédicas, São Paulo, São Paulo, Brazil
| | - Daniel Oliveira Martins
- Departamento de Anatomia, Laboratory of Functional Neuroanatomy of Pain, Universidade de São Paulo Instituto de Ciências Biomédicas, São Paulo, São Paulo, Brazil.
- Division of Neuroscience/Hospital Sírio-Libânes, Street Daher Cutait, 69, São Paulo, São Paulo, 01308-060, Brazil.
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Zheng W, Wang L, Wang H, Zhou H, Du Q. Trigeminal neuralgia caused by vertebrobasilar dolichoectasia: efficacy of stepwise decompression technique. Acta Neurochir (Wien) 2023; 165:3019-3026. [PMID: 37353618 DOI: 10.1007/s00701-023-05691-7] [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: 03/13/2023] [Accepted: 06/15/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To explore and analyze the clinical efficacy of a stepwise decompression technique in the treatment of trigeminal neuralgia (TN) caused by vertebrobasilar dolichoectasia (VBD). METHODS A total of 918 patients with TN admitted to our hospital from June 2015 to May 2020 were divided into the VBD group (n = 61) and the conventional group (n = 857). The VBD group underwent stepwise decompression, while the conventional group received traditional microvascular decompression (MVD) surgery. Patients associated with the VBD were divided into direct compression (n = 14) and indirect compression group (n = 47) who had compression by other vessels in the presence of the VBD. Thereafter, the clinical data, intraoperative findings, efficacy, and complications were analyzed. RESULTS The curative ratio, efficacy, and recurrence rate for the VBD and conventional group were 83.6% and 89.6%, 93.4% and 95.3%, and 8.2% and 5.3%, respectively. The curative ratio, efficacy, and recurrence rate for the direct compression and indirect compression group were 85.7% and 83.0%, 92.9% and 93.6%, and 7.1% and 8.5%, separately. There were no significant differences in the curative ratio, efficacy, recurrence rate, and the incidence of complications between the two series (P > 0.05). CONCLUSION For TN caused by VBD, stepwise decompression not only reduces the direct compression of the trigeminal nerve by VBA but also allows identification and decompression of the actual vessels responsible for the compression. It has a good curative ratio, efficacy, and long-term pain relief rate, and it does not significantly increase the incidences of complications after surgery.
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Affiliation(s)
- Wenhao Zheng
- Department of Neurosurgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linjie Wang
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Heng Wang
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Haotian Zhou
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Quan Du
- Department of Neurosurgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Wu Z, Zhao Y, Liu J, Fan Y, Yang Y. Comparison of the safety and efficacy of radiofrequency thermocoagulation with percutaneous balloon compression for treating trigeminal neuralgia: a systematic review and meta-analysis. Front Neurol 2023; 14:1178335. [PMID: 37745662 PMCID: PMC10511761 DOI: 10.3389/fneur.2023.1178335] [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: 03/02/2023] [Accepted: 08/17/2023] [Indexed: 09/26/2023] Open
Abstract
Objective This study aimed to systematically assess the efficacy and complications of radiofrequency thermocoagulation (RFT) and percutaneous balloon compression (PBC) for treating trigeminal neuralgia (TN). Methods Chinese and English studies on RFT and PBC in the treatment of TN were systematically searched using CNKI, Wanfang Data, VIP, PubMed, EMBASE, Cochrane Library, and until December 31, 2022. Further, the literature was strictly screened using specific inclusion and exclusion criteria. The RevMan 5.4 software was used for data processing and meta-analysis. Results Overall, 16 studies with 3,326 patients were included. The results of meta-analysis revealed that no significant difference was present between the two groups in terms of the rate of efficacy immediately after surgery, 1 month after surgery, and 3 months after surgery (odds ratio [OR] = 0.73, 95% confidence interval [CI] 0.35-1.54, p = 0.41; OR = 0.41, 95% CI 0.13-1.32, p = 0.13; OR = 0.40, 95% CI 0.10-1.60, p = 0.20); however, at 12 months after surgery, the difference was statistically significant (OR = 0.27, 95% CI 0.10-0.75, p = 0.01). Notably, there was no significant difference in the postoperative sleep quality index between the two groups immediately after surgery and 1 month after surgery (SMD = -0.01, 95% CI -2.47 to 2.44, p = 0.99; SMD = 0.14, 95% CI -3.95 to 4.22, p = 0.95). Further, statistically significant differences were observed between the two groups in the incidence of postoperative masticatory muscle strength decline and oral herpes (OR = 0.37; 95% CI 0.21-0.63, p = 0.0003; OR = 0.25, 95% CI 0.10-0.61, p = 0.003). In addition, a statistically significant difference was found in the recurrence rate at 1-year follow-up (OR = 2.23, 95% CI 1.03-4.81, p = 0.04); however, no statistically significant differences were found in the recurrence rate at the 2-year follow-up (OR = 1.95, 95% CI 0.33-11.59, p = 0.46). Conclusion In the treatment of TN, both RFT and PBC can achieve good short-term efficacy, and no significant differences were noted between the outcomes of the two approaches. Compared with RFT, PBC may result in a lower pain score and recurrence rate in the medium and long terms, but it is a higher incidence of cold sores, and the decrease of masticatory muscle strength is more obvious.
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Affiliation(s)
- Zeyu Wu
- Department of Pain Management, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yongming Zhao
- Department of Pain Management, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jiang Liu
- Department of Pain Management, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yiyue Fan
- The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ying Yang
- Department of Pain Management, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
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Goel M, Patil NU, Singh R, John J, Upadhyay BR. Retreatment of Classical Tic Douloureux With Stereotactic Radiosurgery: A Scoping Review. Cureus 2023; 15:e45468. [PMID: 37859919 PMCID: PMC10583121 DOI: 10.7759/cureus.45468] [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] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Stereotactic radiosurgery (SRS), also known as gamma knife surgery (GKS), is a noninvasive procedure for treating tic douloureux (TD) or trigeminal neuralgia (TN). Due to a lack of sufficient evidence regarding the indication of SRS for the treatment of recurrent TD, the present scoping review was conducted to assess the effectiveness of repeated SRS procedures for managing recurrent TD. The literature search was performed from January 2012 to December 2022 on the PubMed, Scopus, and Web of Science databases. Of the 215 initial results obtained, 10 articles were finally selected for the review. Three studies used the SRS procedure for the third time in patients with recurrent TD. All studies were retrospective, with a mean maximal dose of 70-90 Gy and a cumulative dose of 120-180 Gy for two SRS treatments and 150-270 Gy for three SRS treatments. The target zone for irradiation was the retrogasserian zone (RGZ). Repeat SRS procedures led to pain relief in 80-90% of patients within one to four months and excellent pain relief in 50-90% of patients. Pain recurrence was noticed after one year in 20-40% of patients. Postoperative complications, such as trigeminal nerve deficits, facial numbness, and mild corneal dryness, were noted in the studies. The review concluded that repeat SRS is an effective and relatively safe procedure for pain management in patients with recurrent TD.
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Affiliation(s)
- Mahima Goel
- Department of Oral and Maxillofacial Surgery, Pacific Dental College and Research Centre, Udaipur, IND
| | - Nitin U Patil
- Department of Oral and Maxillofacial Surgery, Jawahar Medical Foundation's Annasaheb Chudaman Patil Memorial Dental College, Dhule, IND
| | - Romalpreet Singh
- Department of Conservative Dentistry and Endodontics, Desh Bhagat Dental College, Malout, IND
| | - Janice John
- Department of Oral and Maxillofacial Surgery, Jawahar Medical Foundation's Annasaheb Chudaman Patil Memorial Dental College, Dhule, IND
| | - Bipin R Upadhyay
- Department of Dentistry, K. J. Somaiya Medical College, Mumbai, IND
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