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Li B, Huang L, Luo C, Jin Y, Zhong X, Wang G, Xu Z, Chen J, Huang S, Zhao H, Gao M. Radiological characteristics predicting early poor drug response in patients with hemifacial spasm. Neurol Sci 2024; 45:3217-3224. [PMID: 38347297 DOI: 10.1007/s10072-024-07389-9] [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: 11/25/2023] [Accepted: 02/04/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES Patients with hemifacial spasm (HFS) often resort to botulinum toxin injections or microvascular decompression surgery when medication exhibits limited effectiveness. This study aimed to identify MRI and demographic factors associated with poor drug response at an early stage in patients with HFS. METHODS We retrospectively included patients with HFS who underwent pre-therapeutic MRI examination. The presence, location, severity, and the offending vessels of neurovascular compression were blindly evaluated using MRI. Drug responses and clinical data were obtained from the medical notes or phone follow-ups. Logistic regression analysis was performed to identify potential factors. RESULTS A total of 116 patients were included, with an average age at the time of first examination of 50.4 years and a median duration of onset of 18 months. Forty-nine (42.2%) patients reported no symptom relief. Thirty-seven (31.9%) patients reported poor symptom relief. Twenty-two (19.0%) patients reported partial symptom relief. Eight (6.9%) patients achieved complete symptom relief. The factors that were statistically significant associated with poor drug responses were contact in the attach segment of the facial nerve and aged 70 and above, with an odds ratio of 7.772 (p = 0.002) and 0.160 (p = 0.028), respectively. CONCLUSIONS This study revealed that mild compression in the attach segment of the facial nerve in pre-therapeutic MRI increases the risk of poor drug responses in patients with HFS, while patients aged 70 and above showed a decreased risk. These findings may assist clinician to choose optimal treatment at an early stage.
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Affiliation(s)
- Bo Li
- Department of Radiology, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China
- Sun Yat-Sen University, Guangzhou, 510080, Guangdong Province, China
| | - Linwen Huang
- Department of Radiology, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China
| | - Chun Luo
- Department of Radiology, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China
| | - Yabin Jin
- Institute of Translational Medicine, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China
| | - Xuguang Zhong
- Department of Functional Neurosurgery, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China
| | - Guofu Wang
- Department of Functional Neurosurgery, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China
| | - Zhifeng Xu
- Department of Radiology, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China
| | - Jingxian Chen
- Department of Radiology, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China
| | - Shengqiao Huang
- Department of Radiology, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China
| | - Hai Zhao
- Department of Radiology, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China.
| | - Mingyong Gao
- Department of Radiology, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China.
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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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Zhu C, Jiang C, Xu W, Wang J, Chong Y, Liang W. Microvascular decompression for young onset primary trigeminal neuralgia: a single-center experience. Neurosurg Rev 2023; 46:69. [PMID: 36917289 DOI: 10.1007/s10143-023-01978-6] [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: 11/18/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023]
Abstract
This study aims to explore the causes of primary young onset trigeminal neuralgia (TN) and the clinical outcomes of these patients. From May 2015 to December 2020, 19 primary TN patients with onset age under 30 years underwent microvascular decompression (MVD) in Nanjing Drum Tower Hospital. In this study, the clinical characteristics, surgical outcomes, and postoperative complications of these patients were analyzed retrospectively. Of the 19 patients, 5 were males and 14 were females, and the pain was located on the right side in 10 cases (52.6%). Vascular compression was observed in 17 patients, including 14 cases of superior cerebellar artery (SCA) alone, 2 cases of superior petrosal vein (SPV) alone, and 1 case of SCA and SPV combined. Two patients had no neurovascular conflict, and nerve combing was performed. After surgery, 18 patients got immediate pain relief; 1 patient improved but still had occasional pain. With a mean follow-up of 42.7 ± 22.3 months, one patient was found to have a relapse 45 months after MVD. Surgical complications including mild facial numbness in two patients and hearing impairment in one patient. Neurovascular compression is the main cause of young onset primary TN, and the most commonly encountered vascular was SCA. MVD is a safe and effective treatment for these patients.
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Affiliation(s)
- Chunran Zhu
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210009, Jiangsu, China.,Department of Neurosurgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, Jiangsu, China
| | - Chengrong Jiang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210009, Jiangsu, China
| | - Wu Xu
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210009, Jiangsu, China
| | - Jing Wang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210009, Jiangsu, China
| | - Yulong Chong
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210009, Jiangsu, China
| | - Weibang Liang
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210009, Jiangsu, China. .,Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210009, Jiangsu, China.
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Sun J, Wang M, Zhang L, Yu Y. A meta-analysis of the effectiveness and safety of microvascular decompression in elderly patients with trigeminal neuralgia. J Clin Neurosci 2022; 99:22-34. [DOI: 10.1016/j.jocn.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/30/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022]
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Microvascular decompression for pediatric onset trigeminal neuralgia: patterns and variation. Childs Nerv Syst 2022; 38:767-772. [PMID: 35034138 DOI: 10.1007/s00381-021-05432-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/03/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Pediatric trigeminal neuralgia has been rarely reported in the literature, which were only 28 cases. Although microvascular decompression (MVD) has been widely accepted as effective therapy for trigeminal neuralgia, the etiology and surgical treatment of pediatric ones are seldom addressed. We report our experience with MVD for pediatric trigeminal neuralgia patients with emphasis on the vascular conflict patterns and surgical skills. METHODS This retrospective report included 11 pediatric TN patients, who underwent MVD and were followed for 3-86 months. The data were retrospectively analyzed with emphasis on the clinical features. RESULTS This series included 4 boys and 7 girls with average age of 13 ± 3.4 years old, their onset age were from 7 to 18 years old. The singular vein and combined artery/vein conflictions account for 7/11. 9 (81.8%) patients achieved immediate excellent outcomes. One recurrence was observed after 5 months and refused the second surgery. CONCLUSIONS The etiology of pediatric onset trigeminal neuralgia is still vascular conflict, whose patterns are different from adults, of which combined artery/vein and singular venous compression patterns have a much more higher proportion. Because of the smaller operative space and fragile-thin venous wall with adhesion to other structures, it is much more difficult to decompress the trigeminal nerve among pediatric patients. Sufficient arachnoid release, full exploration, and decompression along the trigeminal nerve were necessary, which will increase the excellent rate among pediatric patients.
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Sun J, Zhu J, Zhang L, Yu Y. The effectiveness and safety of neurosurgical treatment via retrosigmoid approach in elderly patients with trigeminal neuralgia. J Clin Neurosci 2021; 92:27-32. [PMID: 34509257 DOI: 10.1016/j.jocn.2021.07.045] [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: 03/25/2021] [Revised: 05/25/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effectiveness and safety of retrosigmoid approach in treating older patients with trigeminal neuralgia (TN). METHODS In this retrospective study, 49patients (65 and over, elderly group) and 85 patients (under 65, young group) underwent MVD, MVD + PSR or PSR for idiopathic TN from July 2009 to December 2018. The two groups were compared for immediate, long-term pain outcome and postoperative complications. All perioperative data were collected from medical records and telephone interviews. The pain outcomes were assessed with the Barrow Neurological Institute (BNI) pain score. RESULTS The length of follow-up was 13.2 to 124.8 months. 91.8% of the elderly patients and 89.4% of the young patients achieve "Good" immediate pain outcome (BNI I-II), the proportion were 73.5% and 60.0%, respectively, in long-term pain outcome. No statistically significant differences existed in the immediate and long-term pain outcome between the elderly and young patients (P = 0.768 and P = 0.116, respectively). In the grouping analysis, whether in the pure MVD group or the PSR-related group, the immediate and long-term pain outcomes of elderly patients were not significantly different from those of younger patients. Meanwhile, there was no significant difference in the incidence of neurological and non-neurological complications between two groups. CONCLUSIONS Compared with young patients, the treatment for TN in elderly patients via retrosigmoid approach has the same favorable pain outcome. The safety of this procedure for elderly TN patients is similar to that in young patients.
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Affiliation(s)
- Junwei Sun
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, Chaoyang District 100029, China
| | - Jialin Zhu
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, Chaoyang District 100029, China
| | - Li Zhang
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, Chaoyang District 100029, China
| | - Yanbing Yu
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, Chaoyang District 100029, China.
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Maeda A, Araki K, Yamada C, Nakayama S, Shirozu K, Yamaura K. Treatment of trigeminal and glossopharyngeal neuralgia in an adolescent: a case report. JA Clin Rep 2021; 7:61. [PMID: 34365546 PMCID: PMC8349942 DOI: 10.1186/s40981-021-00465-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 12/03/2022] Open
Abstract
Background Hyperactive dysfunction syndrome (HDS) refers to a constellation of symptoms developing from cranial nerve overactivity caused by neurovascular compression at the root entry or exit zone near the brainstem. Although the combined features of HDS are seen in the elderly, there are no reports of such cases in adolescents, to date. Case presentation A 17-year-old male was diagnosed with right glossopharyngeal neuralgia and treated with microvascular decompression. He experienced new-onset right facial pain later and was diagnosed with right trigeminal neuralgia, which required prompt radiofrequency thermocoagulation of the right mandibular nerve. Follow-up in the third post-treatment year revealed the absence of symptom recurrence. Discussion We report the treatment of a rare case of adolescent-onset combined HDS presenting as trigeminal and glossopharyngeal neuralgia. This report highlights the possibility of combined hyperactive dysfunction syndrome in younger age groups. It is crucial to establish a diagnosis early on for prompt management.
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Affiliation(s)
- Aiko Maeda
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maedashi Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan.
| | - Kenzo Araki
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maedashi Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Chiaki Yamada
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maedashi Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Shoko Nakayama
- Operating Rooms, Kyushu University Hospital, Fukuoka, Japan
| | - Kazuhiro Shirozu
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medicine, Fukuoka, Japan
| | - Ken Yamaura
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medicine, Fukuoka, Japan
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Young-onset trigeminal neuralgia: a clinical study and literature review. Acta Neurochir (Wien) 2021; 163:1617-1621. [PMID: 33864143 DOI: 10.1007/s00701-021-04848-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Trigeminal neuralgia (TN) primarily occurs in elderly adults and is thought to be induced by neurovascular compression. However, a few children and young adults may present with the clinical features of TN. In this study, we aim to retrospectively assess the data of young patients with TN from a single center. METHODS Of 783 consecutive patients with TN treated at our center between 2007 and 2017, 11 young patients under the age of 30 years with TN met the inclusion criteria and were enrolled. Their clinical records, surgical treatments, and long-term outcomes were obtained and analyzed. RESULTS All the 11 patients with TN underwent microvascular decompression (MVD). The average age at symptom onset was 24 years (range, 14-29 years), and the average age at the time of surgery was 28.9 years (range, 25-35 years). Further, 5 patients had left-sided symptoms, and 6 had right-sided symptoms. Surgery revealed only venous compression in 3 patients, only arterial compression in 5 patients, and both venous and arterial compression in 3 patients. The average duration of symptoms was 4.9 years, and the average follow-up duration was 7.4 years (range, 4.5-12.9 years). The long-term outcome was excellent in 9 patients and good in 2 patients, and there were no long-term complications. CONCLUSIONS The symptoms and surgical findings presented in this cohort for young-onset TN are similar to those reported in elderly adults. MVD appears to be a safe and effective treatment for young patients with TN.
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Seo HJ, Park CK, Choi MK, Ryu J, Park BJ. Clinical Outcome of Percutaneous Trigeminal Nerve Block in Elderly Patients in Outpatient Clinics. J Korean Neurosurg Soc 2020; 63:814-820. [PMID: 33105531 PMCID: PMC7671772 DOI: 10.3340/jkns.2020.0139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/17/2020] [Indexed: 11/27/2022] Open
Abstract
Objective Trigeminal neuralgia (TN) is a severe neuropathic condition that affects several elderly patients. It is characterized by uncontrolled pain that significantly impacts the quality of life of patients. Therefore, the condition should be treated as an emergency. In the majority of patients, pain can be controlled with medication; however, other treatment modalities are being explored in those who become refractory to drug treatment. The use of the trigeminal nerve block with a local anesthetic serves as an excellent adjunct to drug treatment. This technique rapidly relieves the patient of pain while medications are being titrated to effective levels. We report the efficacy and safety of percutaneous trigeminal nerve block in elderly patients with TN at our outpatient clinic.
Methods Twenty-one patients older than 65 years with TN received percutaneous nerve block at our outpatient clinic. We used bupivacaine (1 mL/injection site) to block the supraorbital, infraorbital, superior alveolar, mental, and inferior alveolar nerves according to pain sites of patients.
Results All patients reported relief from pain, which decreased by approximately 78% after 2 weeks of nerve block. The effect lasted for more than 4 weeks in 12 patients and for 6 weeks in two patients. There were no complications.
Conclusion Percutaneous nerve block procedure performed at our outpatient clinic provided immediate relief from pain to elderly patients with TN. The procedure is simple, has no serious side effects, and is easy to apply.
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Affiliation(s)
- Hyek Jun Seo
- Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Chang Kyu Park
- Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Man Kyu Choi
- Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Jiwook Ryu
- Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Bong Jin Park
- Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Korea
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Kasuya H, Tani S, Kubota Y, Yokosako S, Ohbuchi H, Arai N, Inazuka M, Chernov M. Characteristics and management of the offending veins in microvascular decompression surgery for trigeminal neuralgia. Neurosurg Rev 2020; 44:2337-2347. [PMID: 33111206 PMCID: PMC8338833 DOI: 10.1007/s10143-020-01411-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/21/2020] [Accepted: 10/05/2020] [Indexed: 11/23/2022]
Abstract
The optimal technique of microvascular decompression (MVD) for trigeminal neuralgia (TN) caused by venous conflict remains unclear. The objectives of this study are to characterize the offending veins identified during MVD for TN and to evaluate intraoperative technique applied for their management. From 2007 till 2019, 308 MVD surgeries were performed in 288 consecutive patients with TN, and in 58 of them, pure venous conflict was identified. In 44 patients, the offending vein was interrupted, as was done for small veins arising from the cisternal trigeminal nerve (CN V) or its root entry zone (REZ) causing their stretching (19 cases), small veins on the surface of REZ (9 cases), transverse pontine vein (TPV) compressing REZ or distal CN V (12 cases), and superior petrosal vein (SPV) using flow conversion technique (4 cases). In 14 other cases, the offending vein was relocated, as was done for the SPV or the vein of cerebellopontine fissure (8 cases), TPV (3 cases), and the vein of middle cerebellar peduncle (3 cases). Complete pain relief after surgery was noted in 49 patients (84%). No one patient experienced major neurological deterioration. Postoperative facial numbness developed in 14 patients (24%), and in 8 of them, it was permanent. In 14 patients, MRI demonstrated venous infarction of the middle cerebellar peduncle, which was associated with the presence of any (P = 0.0180) and permanent (P = 0.0002) facial numbness. Ten patients experienced pain recurrence. Thus, 39 patients (67%) sustained complete pain relief at the last follow-up (median, 48 months), which was significantly associated with the presence of any (P = 0.0228) and permanent (P = 0.0427) postoperative facial numbness. In conclusion, in cases of TN, small offending veins arising from REZ and/or distal CN V and causing their stretching may be coagulated and cut. In many cases, TPV can be also interrupted safely or considered as collateral way for blood outflow. The main complication of such procedures is facial numbness, which is associated with the venous infarction of middle cerebellar peduncle and long-term complete pain relief.
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Affiliation(s)
- Hidetoshi Kasuya
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan.
| | - Shigeru Tani
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Yuichi Kubota
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Suguru Yokosako
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Hidenori Ohbuchi
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Naoyuki Arai
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Mayuko Inazuka
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Mikhail Chernov
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
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Dong W, Jin SC, Allocco A, Zeng X, Sheth AH, Panchagnula S, Castonguay A, Lorenzo LÉ, Islam B, Brindle G, Bachand K, Hu J, Sularz A, Gaillard J, Choi J, Dunbar A, Nelson-Williams C, Kiziltug E, Furey CG, Conine S, Duy PQ, Kundishora AJ, Loring E, Li B, Lu Q, Zhou G, Liu W, Li X, Sierant MC, Mane S, Castaldi C, López-Giráldez F, Knight JR, Sekula RF, Simard JM, Eskandar EN, Gottschalk C, Moliterno J, Günel M, Gerrard JL, Dib-Hajj S, Waxman SG, Barker FG, Alper SL, Chahine M, Haider S, De Koninck Y, Lifton RP, Kahle KT. Exome Sequencing Implicates Impaired GABA Signaling and Neuronal Ion Transport in Trigeminal Neuralgia. iScience 2020; 23:101552. [PMID: 33083721 PMCID: PMC7554653 DOI: 10.1016/j.isci.2020.101552] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 02/07/2023] Open
Abstract
Trigeminal neuralgia (TN) is a common, debilitating neuropathic face pain syndrome often resistant to therapy. The familial clustering of TN cases suggests that genetic factors play a role in disease pathogenesis. However, no unbiased, large-scale genomic study of TN has been performed to date. Analysis of 290 whole exome-sequenced TN probands, including 20 multiplex kindreds and 70 parent-offspring trios, revealed enrichment of rare, damaging variants in GABA receptor-binding genes in cases. Mice engineered with a TN-associated de novo mutation (p.Cys188Trp) in the GABAA receptor Cl− channel γ-1 subunit (GABRG1) exhibited trigeminal mechanical allodynia and face pain behavior. Other TN probands harbored rare damaging variants in Na+ and Ca+ channels, including a significant variant burden in the α-1H subunit of the voltage-gated Ca2+ channel Cav3.2 (CACNA1H). These results provide exome-level insight into TN and implicate genetically encoded impairment of GABA signaling and neuronal ion transport in TN pathogenesis. Genomic analysis of trigeminal neuralgia (TN) using exome sequencing Rare mutations in GABA signaling and ion transport genes are enriched in TN cases Generation of a genetic TN mouse model engineered with a patient-specific mutation
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Affiliation(s)
- Weilai Dong
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA.,Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, NY, USA
| | - Sheng Chih Jin
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - August Allocco
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Xue Zeng
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA.,Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, NY, USA
| | - Amar H Sheth
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | | | - Annie Castonguay
- CERVO Brain Research Centre, Université Laval, Québec, QC, Canada
| | | | - Barira Islam
- University College London, School of Pharmacy, London, England
| | | | - Karine Bachand
- CERVO Brain Research Centre, Université Laval, Québec, QC, Canada
| | - Jamie Hu
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Agata Sularz
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan Gaillard
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Jungmin Choi
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA.,Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, NY, USA.,Department of Biomedical Sciences, Korea University College of Medicine, 02841 Seoul, Korea
| | - Ashley Dunbar
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | | | - Emre Kiziltug
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | | | - Sierra Conine
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Phan Q Duy
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Adam J Kundishora
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Erin Loring
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
| | - Boyang Li
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Qiongshi Lu
- Department of Biostatistics & Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Geyu Zhou
- Program of Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA
| | - Wei Liu
- Program of Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA
| | - Xinyue Li
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Michael C Sierant
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA.,Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, NY, USA
| | - Shrikant Mane
- Yale Center for Genome Analysis, West Haven, CT, USA
| | | | | | | | - Raymond F Sekula
- Department of Neurological Surgery, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - J Marc Simard
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Emad N Eskandar
- Department of Neurological Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, New York
| | | | | | - Murat Günel
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Jason L Gerrard
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Sulayman Dib-Hajj
- Center for Neuroscience & Regeneration Research, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Neurology; Yale University, New Haven, CT, USA
| | - Stephen G Waxman
- Center for Neuroscience & Regeneration Research, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Neurology; Yale University, New Haven, CT, USA
| | - Fred G Barker
- Harvard Medical School, Boston, MA, USA.,Cancer Center, Massachusetts General Hospital, Boston, MA, USA.,Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Seth L Alper
- Division of Nephrology and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Mohamed Chahine
- CERVO Brain Research Centre, Université Laval, Québec, QC, Canada.,Department of Medicine, Université Laval, Québec, QC, Canada
| | - Shozeb Haider
- University College London, School of Pharmacy, London, England
| | - Yves De Koninck
- CERVO Brain Research Centre, Université Laval, Québec, QC, Canada.,Department of Psychiatry and Neuroscience, Université Laval, Québec, QC, Canada
| | - Richard P Lifton
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA.,Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, NY, USA
| | - Kristopher T Kahle
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA.,Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.,Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
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12
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Soni P, Potter T, Soni PP, Estemalik E, Recinos PF, Kshettry VR. Outcomes of microvascular decompression for trigeminal neuralgia with purely venous compression: A systematic review and meta-analysis. Clin Neurol Neurosurg 2020; 198:106230. [PMID: 32949856 DOI: 10.1016/j.clineuro.2020.106230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Microvascular decompression (MVD) is a commonly-used treatment option for medically-refractory trigeminal neuralgia (TN) with arterial neurovascular compression. Pain control and recurrence rates after MVD in patients with purely venous compression are not well understood. In this systematic review and meta-analysis, we studied outcomes after MVD in patients with purely venous compression and reviewed the operative management in these patients. METHODS We performed a systematic review and meta-analysis following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. We searched PubMed, Google Scholar, and Scopus databases for studies reporting surgical outcomes after MVD for purely venous compression. Pain control and recurrence rates were extracted and summarized. Studies that reported outcomes after mobilization/decompression compared with coagulation/transection of compressive veins were reviewed. RESULTS We identified and included 24 studies with a total of 330 patients in this study. 75.6 % of patients achieved a Barrow Neurological Institute (BNI) I pain score with a mean follow-up of 38.0 months. Pain recurred in 23.1 % of patients at a mean follow-up of 51.4 months. There was no significant difference in pain control outcomes between patients with mobilization/decompression and patients with coagulation/transection of compressive veins. CONCLUSION After MVD in patients with venous compression alone, pain control rates were similar to those reported for arterial compression, though recurrence rates were higher. There was no difference between vein coagulation/transection compared to mobilization/decompression. Further studies are needed to determine the optimal treatment paradigm for patients with purely venous compression.
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Affiliation(s)
- Pranay Soni
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Tamia Potter
- Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Payal P Soni
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Emad Estemalik
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Psychiatry, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Pablo F Recinos
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Varun R Kshettry
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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13
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Ayele BA, Mengesha AT, Zewde YZ. Clinical characteristics and associated factors of trigeminal neuralgia: experience from Addis Ababa, Ethiopia. BMC Oral Health 2020; 20:244. [PMID: 32883250 PMCID: PMC7469363 DOI: 10.1186/s12903-020-01227-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/23/2020] [Indexed: 01/03/2023] Open
Abstract
Background Trigeminal neuralgia (TN) is considered one of the most painful illnesses known to medical practice. Little is known about TN in Ethiopia. Our study aimed to assess clinical characteristics, treatment, and associated factors of TN. Method A cross-sectional study was conducted on a total of 61 patients with confirmed Trigeminal neuralgia visiting outpatient neurology clinics of two government teaching Hospitals and two private health facilities in Addis Ababa, Ethiopia between June 2019 and March 2020. Results Our participants’ age range between 21 and 78 years with mean ± SD age of 50.7 ± 14.2 years. Males accounted for 50.8%. Twenty-five (41%) reported a prior history of one or more tooth extraction on the painful side. In the majority (68.9%) of the patient’s right side of the face was affected. The mandibular nerve was the commonly involved branch (47.5%). Fifty-five (90.2%) of patients fulfilled criteria for classical TN and 9.8% had symptomatic TN. The majority of the participants reported mixed types of pain such as burning, lancinating, and electric shock-like. Well defined trigger zone was identified in one-third (36%) of cases. Carbamazepine was the most commonly prescribed drug with a median dose of 600 mg (IQR: 400 – 1000 mg). Two-third of the patients reported prominent satisfaction. The mean (± SD) dose of carbamazepine used to control the pain was significantly higher among those with dental extraction history as compared to those with no history of dental extraction (736 ± 478.6 mg Vs 661.1 ± 360.4 mg, respectively, T = − 2.06, p = 0.04 95% CI:-213.41 to − 2.98). A statistically significant number of patients who had single branch involvement reported prominent satisfaction with their treatment as compared to those who had more than one branch involvement. (95% CI: 1.3–3.8: p = 0.006). Conclusion The majority of our patients had Classical TN in the mandibular nerve distribution on the right side of the face and well satisfied with carbamazepine only treatment. Furthermore, we observed a higher proportion of dental extraction among our patients, hinting at the scale of miss and delayed-diagnoses. Thus, we recommend conducting a well-designed prospective study to support our findings.
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Affiliation(s)
- Biniyam Alemayehu Ayele
- Department of Neurology, School of Medicine College of Health Sciences, Addis Ababa University, PO Box 6396, Liberia Street, Lideta sub-city, Addis Ababa, Ethiopia.
| | - Abenet Tafesse Mengesha
- Department of Neurology, School of Medicine College of Health Sciences, Addis Ababa University, PO Box 6396, Liberia Street, Lideta sub-city, Addis Ababa, Ethiopia
| | - Yared Zenebe Zewde
- Department of Neurology, School of Medicine College of Health Sciences, Addis Ababa University, PO Box 6396, Liberia Street, Lideta sub-city, Addis Ababa, Ethiopia
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14
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Magown P, Ko AL, Burchiel KJ. The Spectrum of Trigeminal Neuralgia Without Neurovascular Compression. Neurosurgery 2020; 85:E553-E559. [PMID: 31329945 DOI: 10.1093/neuros/nyz048] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 01/29/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In trigeminal neuralgia type 1 (TN1), neurovascular compression (NVC) is often assumed to be the pain initiating mechanism. NVC can be surgically addressed by microvascular decompression (MVD). However, some patients with TN1 present without NVC (WONVC). OBJECTIVE To characterize and analyze the clinical spectrum of a TN1 patient population WONVC. METHODS A retrospective chart review of patients presenting with TN1 between 2007 and 2017 was performed. Patients who were potential candidates for MVD surgery underwent high-resolution imaging with 3-dimensional (3D) reconstruction to address the presence, or absence, of NVC. Demographic data about the populations with NVC (WNVC) and WONVC were collected. RESULTS Of 242 patients with TN1, 32% did not have NVC. Patients WONVC were on average 10.6 yr younger than those WNVC. TN1 onset in patients WONVC was more frequent below 48.7 yr, and the opposite was found in patients WNVC. Compared to patients WNVC, those WONVC were predominantly female (odds ratio 4.8), on average were 4 yr younger at symptom onset (34.7 yr) and 7.8 yr younger at first clinic visit, and had a 3.7 yr shorter symptom duration. CONCLUSION Patients presenting with TN1 WONVC were predominantly females in their mid-30s with short symptom duration. In the absence of NVC, this subgroup of TN1 patients has limited surgical options, and potentially a longer condition duration that must be managed medically or surgically. This population WONVC might provide insights into the true pathophysiology of TN1.
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Affiliation(s)
- Philippe Magown
- Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew L Ko
- Neurological Surgery, University of Washington Medical Center, Seattle, Washington
| | - Kim J Burchiel
- Neurological Surgery, Oregon Health & Science University, Portland, Oregon
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15
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Debta P, Sarode G, Sarode S, Gadbail A, Debta FM, Swain SK, Mishra E, Sahu MC. Natural history of trigeminal neuralgia-A hospital-based retrospective study. Oral Dis 2020; 26:647-655. [PMID: 31872491 DOI: 10.1111/odi.13263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 12/07/2019] [Accepted: 12/12/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The objective of this study was to assess the natural history of trigeminal neuralgia (TN) and pretrigeminal neuralgia (PTN) in a hospital-based sample using a retrospective and descriptive study design. METHODS This study followed a retrospective study design, which yielded a sample size of 216 patients who were reclassified as per the new classification and diagnostic grading for practice and research proposed by the American Academy of Neurology. Based on an in-depth analysis of patient history and the treatments administered, a possible state of PTN prior to TN development was determined. RESULTS TN shows a female predilection with predominantly unilateral involvement. A total of 45.83% of patients had left-side involvement with V3 primarily affected. Additionally, 11.11% of patients did not have any clinically apparent trigger zone, while 68.05% had a single trigger zone. Twenty-one patients were found to have suspected PTN prior to TN. The time interval between PTN onset and TN development ranged from 6 months to 6 years. The PTN pain varied, and the clinical overlap between the site of PTN and the site of future TN was 100%. CONCLUSION An in-depth patient history can serve as a reliable modality for TN diagnosis. PTN should be considered as a differential diagnosis for pain of orofacial origin because of its overlapping features with other painful conditions.
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Affiliation(s)
- Priyanka Debta
- Department of Oral Pathology and Microbiology, Institute of Dental Science, Bhubaneswar, India
| | - Gargi Sarode
- Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Sachin Sarode
- Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Amol Gadbail
- Department of Dentistry, Indira Gandhi Government Medical College and Hospital, Nagpur, India
| | - Fakir Mohan Debta
- Department of Oral Medicine and Radiology, SCB Dental College and Hospital, Cuttack, India
| | - Santosh Kumar Swain
- Department of Otorhinolaryngology, IMS and SUM Hospital, Siksha "O" Anusandhan, Deemed to be University, Kalinganagar, Bhubaneswar, India
| | - Ekagrata Mishra
- Department of Oral Medicine and Radiology, SCB Dental College and Hospital, Cuttack, India
| | - Mahesh Chandra Sahu
- Division of Microbiology, ICMR-National Institute of Occupational Health, Ahmedabad, India
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16
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Wu S, Lian Y, Zhang H, Chen Y, Wu C, Li S, Zheng Y, Wang Y, Cheng W, Huang Z. Botulinum Toxin Type A for refractory trigeminal neuralgia in older patients: a better therapeutic effect. J Pain Res 2019; 12:2177-2186. [PMID: 31410051 PMCID: PMC6643497 DOI: 10.2147/jpr.s205467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/27/2019] [Indexed: 12/31/2022] Open
Abstract
Background Some studies have indicated that a local injection of Botulinum Toxin Type A (BTX-A) is a promising therapy for trigeminal neuralgia (TN). However, BTX-A treatment is still ineffective for approximately 10-43% of patients. We therefore investigated which factors are associated with the therapeutic effect in BTX-A treatment of medically refractory, classical TN. Methods We performed a retrospective cohort study with a total of 104 patients who were receiving BTX-A injection for medically refractory classical TN between August 2013 and October 2016. A VAS score, pain attack frequency per day as well as patients' overall response to treatment and side effects were evaluated in 104 patients with TN who were receiving BTX-A. Results A total of 87 patients reported successful results; 41 stated that their pain was completely controlled while 46 reported adequate pain relief, totaling 83.7%. Our study suggests that treatment success was higher in patients 50 or older (OR=3.66, 95% CI: 1.231-10.885). Univariate and multivariate analyses demonstrated that the patient's age was independently associated with treatment outcome (OR=1.72, 95% CI: 1.063-2.282), with ≥50 years being a significant predictor of pain relief (P=0.020 and P=0.033, respectively). Seventeen patients (16.3%) reported mild side effects. Conclusion A local injection of BTX-A may be a safe and efficient treatment for classical TN which lasts for several months. BTX-A is a novel strategy which is particularly worth trying for particularly middle-aged and elderly patients who cannot tolerate drug side effects and may be afraid of serious complications from microvascular decompression.
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Affiliation(s)
- Shouyi Wu
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Haifeng Zhang
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Yuan Chen
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Chuanjie Wu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Shuang Li
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Yake Zheng
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Yuhan Wang
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Wenchao Cheng
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Zhi Huang
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
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17
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Karki P, Yamagami M, Takasaki K, Bohara M, Hosoyama H, Hanada T, Yamasaki F, Hanaya R, Arita K. Microvascular Decompression in Patients Aged 30 Years or Younger. Asian J Neurosurg 2019; 14:111-117. [PMID: 30937020 PMCID: PMC6417338 DOI: 10.4103/ajns.ajns_266_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: The aim of this study was to identify the etiology of hemifacial spasm (HFS) and trigeminal neuralgia (TN) in patients aged 30 years or younger and to examine the efficacy of microvascular decompression (MVD). Patients and Methods: Between 1996 and 2012, 228 HFS and 190 TN patients underwent MVD at Atsuchi Neurosurgical Hospital. Of these, 7 patients were 30 years of age or younger at the time of treatment (HFS: n = 6, TN: n = 1). Assessments were based on their medical history and on magnetic resonance imaging, magnetic resonance angiography, surgical, and follow-up findings. Results: The age of the 6 HFS patients ranged from 23 to 30 years (mean 27.8 ± 1.8 [standard deviation] years) at the time of surgery; the earliest symptom onset was in an 11-year-old boy. We noted vascular variations in 5 patients, a duplicate posterior inferior cerebellar artery in 2 patients, a short basilar artery in 1 patient, and an aberrant arterial course in 2 patients. At the latest follow-up, 1–69 months after MVD, 5 of the HFS patients were asymptomatic and the 6th had mild residual symptoms. A 23-year-old TN female underwent straightening of the trigeminal nerve by separation of a thickened arachnoid membrane from the nerve and dislocation of a small branch of the superior cerebellar artery from the distal end of the root exit zone. While she continued to experience occasional facial pain 48 months after the operation, she required no medication because surgery yielded significant pain amelioration. Conclusion: Although the pathogenesis of early-onset HFS and TN remains unclear, our findings suggest that vascular variations may be related to the etiology of vascular compression symptoms in patients with HFS or TN. MVD was useful for the treatment of neurovascular compression symptoms in young patients.
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Affiliation(s)
- Prasanna Karki
- Department of Neurosurgery, Nepalgunj Medical College and Teaching Hospital, Nepalgunj, Nepal.,Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.,Division of Neurosurgery, Atsuchi Neurosurgical Hospital, Kagoshima, Japan
| | - Masayuki Yamagami
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.,Division of Neurosurgery, Atsuchi Neurosurgical Hospital, Kagoshima, Japan
| | - Koji Takasaki
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.,Division of Neurosurgery, Atsuchi Neurosurgical Hospital, Kagoshima, Japan
| | - Manoj Bohara
- Department of Neurosurgery, Nepalgunj Medical College and Teaching Hospital, Nepalgunj, Nepal.,Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hiroshi Hosoyama
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Tomoko Hanada
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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18
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Recommandations pour le diagnostic et la prise en charge de la névralgie trigéminale classique. Neurochirurgie 2018; 64:285-302. [DOI: 10.1016/j.neuchi.2018.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 03/20/2018] [Accepted: 04/08/2018] [Indexed: 12/26/2022]
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19
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Cervera-Martinez C, Martinez-Manrique JJ, Revuelta-Gutierrez R. Surgical Management of Familial Trigeminal Neuralgia With Different Inheritance Patterns: A Case Report. Front Neurol 2018; 9:316. [PMID: 29867726 PMCID: PMC5949332 DOI: 10.3389/fneur.2018.00316] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/20/2018] [Indexed: 01/03/2023] Open
Abstract
Introduction Trigeminal neuralgia is a disorder characterized by unilateral electric shock-like pain, distributed in one or more trigeminal nerve branches and triggered by usually innocuous stimuli. Among the few case reports and literature reviews on familial trigeminal neuralgia (FTN), the results of several suggest the involvement of genes associated with biochemical alterations or atherosclerotic vascular malformations. Background We present four cases of FTN within two families (family A: two brothers; family B: two sisters). All patients were submitted to surgical treatment by the same surgeon. Discussion Cases 1 and 2 (family A) exhibited FTN with an uncommon autosomal recessive pattern and clinical features consistent with previous literature reviews and case reports. However, in cases 3 and 4 (family B), we found FTN with a dominant autosomal pattern and an unusual physiopathology characterized by arachnoid adhesions. Conclusion We conclude, in this case report, that there are several inheritance patterns as well as physiopathology that may be involved in FTN, and that both patterns described in our reported cases were successfully managed with surgery.
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20
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Grazzi L, Sansone E, Rizzoli P. Atypical Facial and Head Pain in Childhood and Adolescence. Curr Pain Headache Rep 2018; 22:43. [PMID: 29725874 DOI: 10.1007/s11916-018-0698-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW This review will consider forms of atypical facial and head pain in children and adolescents. A brief and general overview of typical head and facial pains and treatments will be offered. Moreover, atypical head and face pain will be discussed with treatment options. RECENT FINDINGS The most recent literature including case reports will be evaluated; possible pathophysiological mechanisms, resulting disabilities, and family and social impact will be discussed. General indications for pharmacological treatment will be reviewed, when needed in more disabling cases. Also, non-pharmacological treatments that are especially suitable for this category of patients will be illustrated and discussed.
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Affiliation(s)
- Licia Grazzi
- 3rd Neurology Unit, Neuroalgology, Fondazione I.R.C.C.S. Istituto Neurologico "Carlo Besta", Milan, Italy.
| | - Emanuela Sansone
- 3rd Neurology Unit, Neuroalgology, Fondazione I.R.C.C.S. Istituto Neurologico "Carlo Besta", Milan, Italy
| | - Paul Rizzoli
- John Graham Headache Center, Brigham and Women Faulkner Hospital, Harvard Medical School, Boston, MA, USA
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21
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Bick SK, Huie D, Sneh G, Eskandar EN. Older Patients Have Better Pain Outcomes Following Microvascular Decompression for Trigeminal Neuralgia. Neurosurgery 2018; 84:116-122. [DOI: 10.1093/neuros/nyy011] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 01/09/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sarah K Bick
- Department of Neurosurgery, Mas-sachusetts General Hospital, Boston, Mas-sachusetts
| | - David Huie
- Department of Neurosurgery, Mas-sachusetts General Hospital, Boston, Mas-sachusetts
| | - Gabriel Sneh
- Department of Neurosurgery, Mas-sachusetts General Hospital, Boston, Mas-sachusetts
- School of Medicine, Harvard University, Boston, Massachusetts
| | - Emad N Eskandar
- Department of Neurosurgery, Mas-sachusetts General Hospital, Boston, Mas-sachusetts
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22
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Khan M, Nishi SE, Hassan SN, Islam MA, Gan SH. Trigeminal Neuralgia, Glossopharyngeal Neuralgia, and Myofascial Pain Dysfunction Syndrome: An Update. Pain Res Manag 2017; 2017:7438326. [PMID: 28827979 PMCID: PMC5554565 DOI: 10.1155/2017/7438326] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 04/12/2017] [Accepted: 04/24/2017] [Indexed: 12/21/2022]
Abstract
Neuropathic pain is a common phenomenon that affects millions of people worldwide. Maxillofacial structures consist of various tissues that receive frequent stimulation during food digestion. The unique functions (masticatory process and facial expression) of the maxillofacial structure require the exquisite organization of both the peripheral and central nervous systems. Neuralgia is painful paroxysmal disorder of the head-neck region characterized by some commonly shared features such as the unilateral pain, transience and recurrence of attacks, and superficial and shock-like pain at a trigger point. These types of pain can be experienced after nerve injury or as a part of diseases that affect peripheral and central nerve function, or they can be psychological. Since the trigeminal and glossopharyngeal nerves innervate the oral structure, trigeminal and glossopharyngeal neuralgia are the most common syndromes following myofascial pain dysfunction syndrome. Nevertheless, misdiagnoses are common. The aim of this review is to discuss the currently available diagnostic procedures and treatment options for trigeminal neuralgia, glossopharyngeal neuralgia, and myofascial pain dysfunction syndrome.
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Affiliation(s)
- Mohammad Khan
- Community Medicine, School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Shamima Easmin Nishi
- Orthodontic Unit, School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Siti Nazihahasma Hassan
- Hematology, School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Md. Asiful Islam
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Siew Hua Gan
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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Swain BP, Vidhya S, Jadon A, Chandra KN, Kumar S. Trigeminal Neuralgia in Pregnancy: A Management Challenge. Pain Pract 2017; 18:368-373. [PMID: 28574640 DOI: 10.1111/papr.12605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/25/2017] [Accepted: 05/28/2017] [Indexed: 12/18/2022]
Abstract
Pregnancy is known to aggravate pre-existing chronic painful conditions. Trigeminal neuralgia (TN), albeit a disease of the elderly, may afflict pregnant females, which can further complicate its management. Teratogenic effects of the commonly used drugs on the developing fetus limit pharmacological treatment. Moreover, safety of commonly performed interventional therapies is marred by their inherent fetomaternal effects and more importantly the risk for radiation effects on the fetus due to the use of fluoroscopy. This rare coexistence of TN in pregnancy has not been reported before. Here we present a case of TN in a young woman, whose pain was aggravated when she became pregnant, and she was treated successfully by conventional radiofrequency ablation of the Gasserian ganglion.
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Affiliation(s)
- Bhanu P Swain
- Department of Anesthesia and Critical Care, Tata Main Hospital, Jamshedpur, India
| | - Sri Vidhya
- Department of Anesthesia and Critical Care, Tata Main Hospital, Jamshedpur, India
| | - Ashok Jadon
- Department of Anesthesia, Tata Motors Hospital, Jamshedpur, India
| | - Kumar N Chandra
- Department of Anesthesia and Critical Care, Tata Main Hospital, Jamshedpur, India
| | - Sharad Kumar
- Department of Anesthesia and Critical Care, Tata Main Hospital, Jamshedpur, India
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French guidelines for diagnosis and treatment of classical trigeminal neuralgia (French Headache Society and French Neurosurgical Society). Rev Neurol (Paris) 2017; 173:131-151. [DOI: 10.1016/j.neurol.2016.12.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 12/19/2016] [Indexed: 12/19/2022]
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Dumot C, Brinzeu A, Berthiller J, Sindou M. Trigeminal neuralgia due to venous neurovascular conflicts: outcome after microvascular decompression in a series of 55 consecutive patients. Acta Neurochir (Wien) 2017; 159:237-249. [PMID: 27817008 DOI: 10.1007/s00701-016-2994-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 10/06/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Implication of veins as neurovascular conflict (NVC) in the genesis of trigeminal neuralgia (TN) remains a matter of debate. Few reports dealing with venous NVC have been published. The objective of this study is to describe the outcome in a historical cohort of consecutive patients with classical TN due to venous compression. METHODS All patients with TN treated by microvascular decompression (MVD) from 2005 to 2013 were included if a marked venous compression was found at the surgery either alone or accompanied by an artery. Patients were evaluated for clinical presentation, operative findings and the long-term outcome. Outcome was considered favourable if patients were classed as BNI I or II (i.e. not requiring any medication). Kaplan-Meier analysis was used to determine probability of a favourable outcome at 10 years of follow-up. RESULTS Out of the overall series of 313 patients having been treated by MVD and considered for the study, in 55 (17.5 %) a vein was the main compressive vessel; in 26 (8.3 %) it was the only compressive vessel. Probability of relief with no need for medication at 10 years was 70.6 %. The patients with focal arachnoiditis had a poor long-term outcome, i.e. BNI III-V, in 85.7 % compared with 20.8 % without arachnoiditis (p = 0.0037 Fisher's exact test). No differences in outcome were found between patients presenting with purely venous compression and patients with mixed compression. Outcome was similarly good for patients with atypical neuralgia when compared to patients with typical clinical presentation. CONCLUSIONS Venous NVC as a cause of TN is far from rare. MVD with complete liberation of the entire root in cases with clear-cut venous compression on imaging studies gives a good probability of long-term pain relief, thus encouraging to propose surgery for such patients.
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Affiliation(s)
- Chloe Dumot
- Neurosurgical Department, Hospital Pierre Wertheimer, University Lyon 1, Lyon, France
| | - Andrei Brinzeu
- Neurosurgical Department, Hospital Pierre Wertheimer, University Lyon 1, Lyon, France.
- University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.
- Neurosurgical Department, Hopital Pierre Wertheimer, GHE, Service de Neurochirurgie A, 59 Bd. Pinel, 69500, Bron, France.
| | - Julien Berthiller
- Neurosurgical Department, Hospital Pierre Wertheimer, University Lyon 1, Lyon, France
| | - Marc Sindou
- Neurosurgical Department, Hospital Pierre Wertheimer, University Lyon 1, Lyon, France
- Clinique medico-chirurgicale Bretéché, Nantes, France
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Mousavi SH, Sekula RF, Gildengers A, Gardner P, Lunsford LD. Concomitant depression and anxiety negatively affect pain outcomes in surgically managed young patients with trigeminal neuralgia: Long-term clinical outcome. Surg Neurol Int 2016; 7:98. [PMID: 28168085 PMCID: PMC5223392 DOI: 10.4103/2152-7806.194145] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 09/21/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Onset of trigeminal neuralgia (TN) is uncommon in young adults with less favorable benefit from surgical interventions. The aim of this study was to evaluate the role of concomitant psychosomatic disorders in long-term surgical outcomes in this population. METHODS Twenty-one patients younger than 30 years of age were diagnosed initially as having medically refractory TN, and each patient underwent microvascular decompression (MVD) as initial surgical management. Correlation of clinical outcome and psychosomatic disorders (DSM-IV) was evaluated during a 15-year interval. RESULTS A total of 93 procedures were performed for the management of TN and subsequent iatrogenic craniofacial pain disorders. At a median of 81 months, 8 of 21 patients were free of facial pain. Fourteen patients with concomitant major depressive disorder (MDD) or other anxiety disorders underwent a higher median of procedures compared with 7 patients without known MDD or anxiety (4.5 versus 1 intervention, P = 0.038). Two of 14 patients who were diagnosed with MDD or other anxiety disorders were free of craniofacial pain, whereas 6 of 7 patients without mood or anxiety disorders were free of craniofacial pain (P = 0.0005). Thirteen patients developed treatment-related complications that required further surgical procedures. Presence of MDD or other anxiety disorders was associated with higher rate of complications (P = 0.026). One patient with past medical history of severe anxiety died of unknown causes. CONCLUSIONS In young patients with TN, comorbid MDD or anxiety disorders was associated with seeking multiple invasive procedures in multiple academic centers with limited benefit and high rates of surgical induced complications.
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Affiliation(s)
- Seyed H Mousavi
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Raymond F Sekula
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ariel Gildengers
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Trigeminal Neuralgia: Evaluation of the Relationship Between the Region of Neuralgic Manifestation and the Site of Neurovascular Compression Under Endoscopy. J Craniofac Surg 2016; 26:1596-9. [PMID: 26114522 DOI: 10.1097/scs.0000000000001525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to evaluate the relationship among the pain region, branches of trigeminal nerve, and the neurovascular compression (NVC) location. A total of 123 consecutive patients with trigeminal neuralgia (TN) underwent endoscope-assisted microvascular decompression according to positive preoperative tomographic angiography. V2 alone was in 51 cases and V3 alone was in 64 cases. The location of NVC was classified into cranial, caudal, medial, or lateral sites. Some patients with multiple regions were recorded as medial + cranial, lateral + cranial, medial + caudal, and lateral + caudal. Twenty-eight (71.8%) of 39 patients with TN (V2) had their NVC at the medial site of the nerve. Twenty-seven (64.3%) of 42 patients with TN (V3) had their NVC at the lateral site of the nerve. There was a statistically significant difference (P = 0.0011 < 0.01, χ2 test). Sixteen (69.6%) of 23 patients with TN(V2) had their NVC at the cranial site of the nerve. Thirty-four (69.4%) of 49 patients with TN (V3) had their NVC at the caudal site of the nerve. There was no statistical difference (P = 0.3097 > 0.01). Evaluation of the relationship between the pain region and the NVC location by endoscopic images during microvascular decompression is more accurate. The second branch is mostly distributed in the medial area, and third branch is mainly distributed in the lateral area.
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Ringkamp M, Wooten M, Carson BS, Lim M, Hartke T, Guarnieri M. Laser speckle imaging to improve clinical outcomes for patients with trigeminal neuralgia undergoing radiofrequency thermocoagulation. J Neurosurg 2016; 124:422-8. [PMID: 26274997 DOI: 10.3171/2015.1.jns14408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Percutaneous treatments for trigeminal neuralgia are safe, simple, and effective for achieving good pain control. Procedural risks could be minimized by using noninvasive imaging techniques to improve the placement of the radiofrequency thermocoagulation probe into the trigeminal ganglion. Positioning of a probe is crucial to maximize pain relief and to minimize unwanted side effects, such as denervation in unaffected areas. This investigation examined the use of laser speckle imaging during probe placement in an animal model. METHODS This preclinical safety study used nonhuman primates, Macaca nemestrina (pigtail monkeys), to examine whether real-time imaging of blood flow in the face during the positioning of a coagulation probe could monitor the location and guide the positioning of the probe within the trigeminal ganglion. RESULTS Data from 6 experiments in 3 pigtail monkeys support the hypothesis that laser imaging is safe and improves the accuracy of probe placement. CONCLUSIONS Noninvasive laser speckle imaging can be performed safely in nonhuman primates. Because improved probe placement may reduce morbidity associated with percutaneous rhizotomies, efficacy trials of laser speckle imaging should be conducted in humans.
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Affiliation(s)
- Matthias Ringkamp
- Department of Neurological Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Matthew Wooten
- Department of Neurological Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Benjamin S Carson
- Department of Neurological Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michael Lim
- Department of Neurological Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Timothy Hartke
- Department of Neurological Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michael Guarnieri
- Department of Neurological Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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Docampo J, Gonzalez N, Muñoz A, Bravo F, Sarroca D, Morales C. Neurovascular study of the trigeminal nerve at 3 t MRI. Neuroradiol J 2015; 28:28-35. [PMID: 25924169 DOI: 10.15274/nrj-2014-10116] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study aimed to show a novel visualization method to investigate neurovascular compression of the trigeminal nerve (TN) using a volume-rendering fusion imaging technique of 3D fast imaging employing steady-state acquisition (3D FIESTA) and coregistered 3D time of flight MR angiography (3D TOF MRA) sequences, which we called "neurovascular study of the trigeminal nerve". We prospectively studied 30 patients with unilateral trigeminal neuralgia (TN) and 50 subjects without symptoms of TN (control group), on a 3 Tesla scanner. All patients were assessed using 3D FIESTA and 3D TOF MRA sequences centered on the pons, as well as a standard brain protocol including axial T1, T2, FLAIR and GRE sequences to exclude other pathologies that could cause TN. Post-contrast T1-weighted sequences were also performed. All cases showing arterial imprinting on the trigeminal nerve (n = 11) were identified on the ipsilateral side of the pain. No significant relationship was found between the presence of an artery in contact with the trigeminal nerve and TN. Eight cases were found showing arterial contact on the ipsilateral side of the pain and five cases of arterial contact on the contralateral side. The fusion imaging technique of 3D FIESTA and 3D TOF MRA sequences, combining the high anatomical detail provided by the 3D FIESTA sequence with the 3D TOF MRA sequence and its capacity to depict arterial structures, results in a tool that enables quick and efficient visualization and assessment of the relationship between the trigeminal nerve and the neighboring vascular structures.
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Affiliation(s)
- Jorge Docampo
- Magnetic Resonance Department, Fundación Científica del Sur; Lomas de Zamora, Argentina
| | - Nadia Gonzalez
- Magnetic Resonance Department, Fundación Científica del Sur; Lomas de Zamora, Argentina
| | - Alexandra Muñoz
- Magnetic Resonance Department, Fundación Científica del Sur; Lomas de Zamora, Argentina
| | - Fernando Bravo
- Dresden Music Cognition Laboratory, TU-Dresden, Dresden, Germany
| | - Daniel Sarroca
- Magnetic Resonance Department, Fundación Científica del Sur; Lomas de Zamora, Argentina
| | - Carlos Morales
- Magnetic Resonance Department, Fundación Científica del Sur; Lomas de Zamora, Argentina
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Amagasaki K, Abe S, Watanabe S, Naemura K, Nakaguchi H. Trigeminal neuralgia caused by a trigeminocerebellar artery. J Neurosurg 2014; 121:940-3. [DOI: 10.3171/2014.6.jns132292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This 31-year-old woman presented with typical right trigeminal neuralgia caused by a trigeminocerebellar artery, manifesting as pain uncontrollable with medical treatment. Preoperative neuroimaging studies demonstrated that the offending artery had almost encircled the right trigeminal nerve. This finding was confirmed intraoperatively, and decompression was completed. The neuralgia resolved after the surgery; the patient had slight transient hypesthesia, which fully resolved within the 1st month after surgery. The neuroimaging and intraoperative findings showed that the offending artery directly branched from the upper part of the basilar artery and, after encircling and supplying tiny branches to the nerve root, maintained its diameter and coursed toward the rostral direction of the cerebellum, which indicated that the artery supplied both the trigeminal nerve and the cerebellum. The offending artery was identified as the trigeminocerebellar artery. This case of trigeminal neuralgia caused by a trigeminocerebellar artery indicates that this variant is important for a better understanding of the vasculature of the trigeminal nerve root.
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Affiliation(s)
| | - Shoko Abe
- 2Radiology, Mitsui Memorial Hospital, Tokyo, Japan
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Cui W, Yu X, Zhang H. The serotonin transporter gene polymorphism is associated with the susceptibility and the pain severity in idiopathic trigeminal neuralgia patients. J Headache Pain 2014; 15:42. [PMID: 24950698 PMCID: PMC4080683 DOI: 10.1186/1129-2377-15-42] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 05/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the possible association between the serotonin transporter gene (5-HTTLPR) and rs 25531 polymorphism and the susceptibility and the pain severity in Trigeminal Neuralgia patients. METHODS A total of 244 TN patients and 280 age and sex matched healthy volunteer were recruited. 5-HTTLPR and rs 25531 genotyping were performed. All patients received the carbamazepine treatment and the treatment response was evaluated at 6 months. RESULTS The genotype distribution of 5-HTTLPR between TN patients and controls were significantly different. The TN Patients had a higher prevalence of short-short genotype than controls. The short-short genotype carriers are also significantly associated with higher pain severity and poorer carbamazepine treatment response compared to the long-long genotype carriers. In contrast, the rs 25531 polymorphism was not associated with the susceptibility to TN, neither with the pain severity and the treat response to carbamazepine. CONCLUSION The 5-HTTLPR polymorphism is associated with the susceptibility to TN and pain severity of TN.
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Affiliation(s)
- Wenyao Cui
- Department of Anesthesiology, The First Affiliated Hospital, China Medical University, 110001 NO,155 of Nanjingbei Street, Heping District, Shenyang, Liaoning Province, People's Republic of China.
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Etiologic exploration of magnetic resonance tomographic angiography negative trigeminal neuralgia. J Clin Neurosci 2014; 21:1349-54. [PMID: 24758727 DOI: 10.1016/j.jocn.2013.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 10/30/2013] [Accepted: 11/02/2013] [Indexed: 11/22/2022]
Abstract
Our objective was to explore the etiologic factors involved in trigeminal neuralgia with negative magnetic resonance tomographic angiography (MRTA) results. Clinical data from 341 patients with idiopathic trigeminal neuralgia who were treated with neurovascular decompression between March 2003 and December 2011 were retrospectively analyzed. The etiologic causes of preoperative MRTA-negative trigeminal neuralgia were categorized based on comparisons between preoperative MRTA and intraoperative endoscopic images. MRTA was highly sensitive (92.4%, 291/315) to neurovascular compression, whereas its specificity was 65.4% (17/26). Among the 24 false-negative cases, there were nine patients with petrosal vein compression, 12 with superior cerebellar artery compression, two with superior cerebellar arterial branch compression, and one patient with anterior inferior cerebellar artery compression. Among the 17 true-negative cases, three patients had arachnoid adhesions, one had a protruding temporal eminence, five had micro-cholesteatomas, and eight patients exhibited no compression. The factors responsible for the MRTA-negative results included small-diameter arterial vessels, veins with slow blood flow, arachnoid adhesions, protruding temporal eminences, micro-cholesteatomas, and other pathologies such as multiple sclerosis. Preoperative diagnoses of MRTA-negative patients need to integrate the MRI results from multiple sequences to discriminate between arteriolar compression, venous compression, and small compressive lesions. When narrow cerebellopontine angles are shown in MRTA, arachnoid adhesion and temporal eminence compression should be considered.
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Xiong NX, Zhao HY. Trigeminal neuralgia. J Neurosurg 2013; 119:1081-2. [PMID: 23952974 DOI: 10.3171/2012.12.jns11965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nan-Xiang Xiong
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and
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Thomas KL, Vilensky JA. The anatomy of vascular compression in trigeminal neuralgia. Clin Anat 2013; 27:89-93. [DOI: 10.1002/ca.22157] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 07/24/2012] [Accepted: 07/31/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Krystin L. Thomas
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Ft. Wayne, Indiana
| | - Joel A. Vilensky
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Ft. Wayne, Indiana
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