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Trigeminal Neuralgia

Aldo Berti, George Ibars, Xiaodong Wu, Alex Sabo, Michelle Granville, Gail Suarez, James G Schwade, Robert E Jacobson
Stereotactic radiosurgery (SRS) has evolved as an accepted treatment for medication resistant trigeminal neuralgia. Initial results are very good but follow-up over three to five years shows a gradual return of pain in up to 50% of treated patients, often requiring further treatment. The results with repeat SRS using the isocentric Gamma Knife (GK) (Elekta, Stockholm, Sweden), especially in patients having initially good results, are very similar to the outcomes after the initial treatment although there is an increased risk of residual facial numbness secondary to the additional radiation dose to the trigeminal nerve...
May 9, 2018: Curēus
Mark G Bigder, Sandeep Krishnan, E Francis Cook, Anthony M Kaufmann
OBJECTIVE Patients with multiple sclerosis (MS)-associated trigeminal neuralgia (TN) have higher recurrence and retreatment rates than non-MS patients. The optimal management strategy and role for microsurgical rhizotomy (MSR) for MS-TN remains to be determined. The aim of this study was to report time to treatment failure (TTF) and pain scores following MSR compared to percutaneous and Gamma Knife procedures. METHODS Time to treatment failure was analyzed after MSR (n = 14) versus prior procedures (n = 53) among MS-TN patients...
July 13, 2018: Journal of Neurosurgery
R Y Yang, X J Wang, P X Zhao, Z Q Xu, C Chen, S Yang, Z Yang, F Z Jiang, Q An, J W Li, S Huang
Objective: To analyze the prognosis and untoward effect in recurrent refractory trigeminal neuralgia (RRTN) patients who underwent repeat Gamma Knife Radiosurgery treatment (GKRS) retrospectively, and to summarize the experience of repeat Gamma Knife Radiosurgery treatment of recurrent refractory trigeminal neuralgia. Methods: RRTN patients who treated with repeat GKRS during 1998.8.1 to 2014.10.1 in Gamma Knife treatment Center of the Fifth Affiliated Hospital of Zhengzhou University were involved. The factors influencing long-term prognosis and facial numbness adverse reactions were statistically analyzed...
July 3, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Srihari Sundararajan, Laurie A Loevner, Suyash Mohan
Trigeminal neuropathy manifests as episodic sharp, shooting pain in the maxillofacial region. Contributory etiologies are myriad, ranging from central pathology affecting its origin in the brainstem to peripheral processes affecting their distal-most insertion sites. We present a case of bilateral hypoplastic Meckel's caves in an adult patient leading to the clinical symptomology of trigeminal neuralgia. To the best of our knowledge, this is the only report of its kind highlighting this anatomic variant.
July 11, 2018: ORL; Journal for Oto-rhino-laryngology and its related Specialties
Ayami Katayama, Yasuaki Kanada, Mana Tsukada, Yuko Akanuma, Haruka Takemura, Takahiro Ono, Hiroki Suga, Hitoshi Mera, Tadashi Hisamitsu, Masataka Sunagawa
Background: Yokukansan (YKS), a traditional herbal (Kampo) medicine consisting of seven herbs, is effective in the treatment of pain disorders, such as headache, postherpetic neuralgia, fibromyalgia, and trigeminal neuralgia, and we have previously shown it to be effective against morphine analgesic tolerance in rats. It has been reported that orexin receptor antagonists prevent the development of morphine tolerance and that YKS inhibits the secretion of orexin A in the hypothalamus. This study examined whether the inhibition of the secretion of orexin A by YKS is one mechanism underlying its effect against morphine analgesic tolerance...
June 2018: Integrative Medicine Research
Musa Mufti, Christopher Shackles, Emaan Alvi, Jaya Nath
To emphasize the utility of contrast enhanced MRI for identifying the extent of disease in herpes zoster ophthalmicus with intracranial extension to help determine proper management. We present a rare case of herpes zoster ophthalmicus (HZ/HZO) with intracranial extension and MRI demonstration of involvement of the trigeminal nerve, the trigeminal nucleus, and the spinal trigeminal nucleus and tract. Herpes zoster is caused by reactivation of varicella zoster virus. Herpes zoster ophthalmicus with involvement of the ophthalmic division of the trigeminal nerve has been estimated to account for 10-20% of the cases (Yawn et al...
July 10, 2018: Emergency Radiology
Toru Satoh, Takanobu Yagi, Keisuke Onoda, Masahiro Kameda, Tatsuya Sasaki, Tomotsugu Ichikawa, Isao Date
OBJECTIVE Offending vessels at the site of neurovascular contact (NVC) in patients with trigeminal neuralgia (TN) and hemifacial spasm (HFS) may have specific hemodynamic features. The purpose of this study was to investigate the wall shear stress (WSS) of offending vessels at NVCs by conducting a computational fluid dynamics (CFD) analysis. METHODS The authors retrospectively analyzed the cases of 20 patients (10 with TN and 10 with HFS) evaluated by 3D CT angiography and used the imaging findings for analysis of the hemodynamic parameters...
July 6, 2018: Journal of Neurosurgery
Christoph Sproll, Bernd Turowski, Rita Depprich, Norbert R Kübler, Marion Rapp, Julian Lommen, Henrik Holtmann
Ganglionic local opioid analgesia (GLOA) describes the application of low-dose opioids close to sympathetic as, for example, to the superior cervical ganglion. GLOA can be effective in different pain syndromes affecting the head and face region and has been considered to be a safe technique with few complications reported so far. We present the case of a patient who received a single, transoral GLOA for a refractory trigeminal neuralgia. The patient subsequently developed an extensive epidural abscess at the craniocervical junction, requiring ultimately transoral odontoid resection and dorsal stabilisation...
2018: Case Reports in Medicine
Hak-Cheol Ko, Jin-Gyu Choi, Byung-Chul Son
Although pathologic vascular contact between the occipital artery and the greater occipital nerve (GON) at the crossing point in the nuchal subcutaneous layer can cause occipital neuralgia, referred hemifacial trigeminal pain from chronic occipital neuralgia owing to this cause is extremely rare.A 61-year-old female patient with left-sided occipital neuralgia for 4 years presented with a new onset of left-sided hemifacial pain. Decompression of the left GON from pathologic contacts with the occipital artery resulted in immediate relief for hemifacial pain and chronic occipital neuralgia...
July 4, 2018: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Junxia Wang, Xing Fu, Xinyu Zhao
To introduce the experience of JIN Bohua , the capital Chinese medicine master, in the differentiation of acupuncture and the treatment on trigeminal neuralgia with fire needle and filiform needle. Regarding the diagnosis of trigeminal neuralgia, Professor JIN focuses on the coordination of meridian differentiation and zangfu differentiation. For the treatment, the fire needling technique and common filiform needling technique are used in combination. According to meridian differentiation, the acupoints are selected and stimulated with fire needle...
June 12, 2018: Zhongguo Zhen Jiu, Chinese Acupuncture & Moxibustion
S Saccomanno, F Greco, E DE Corso, D Lucidi, R Deli, A D'Addona, G Paludetti
Eagle's syndrome is a condition associated with the elongation of the styloid process or calcification of the stylohyoid ligament, clinically characterised by throat and neck pain, radiating into the ear. In this report, we describe the case of a 60-year-old woman who presented with a severe unilateral trigeminal and glossopharyngeal neuralgia. The patient was subjected to conservative therapy for four months and did not report improvement of the symptoms. After several consultations with different physicians, a diagnosis was accomplished by radiological investigation (multidetector computer tomography with multi-planar reconstructions and 3D volumetric reconstructions)...
April 2018: Acta Otorhinolaryngologica Italica
Dumot Chloé, Sindou Marc
Good knowledge of anatomy of veins is of crucial importance for the functional surgery of the cranial nerve (CN) disorders, especially microvascular decompression (MVD) for trigeminal neuralgia (TN), hemifacial spasm (HFS) and vago-glossopharyngeal neuralgia (VGPN). Although controversial, veins may be involved in neurovascular conflicts (NVCs) and may constitute dangerous obstacles to the access of the CNs. With the aims to estimate implications of veins in those pathologies and evaluate the linked surgical difficulties, the authors carried out a review of the literature from 2000 to end of February 2018...
June 29, 2018: World Neurosurgery
Hiroki Toda, Koichi Iwasaki, Naoya Yoshimoto, Yoshihito Miki, Hirokuni Hashikata, Masanori Goto, Namiko Nishida
OBJECTIVE In microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm, the bridging veins are dissected to provide the surgical corridors, and the veins of the brainstem may be mobilized in cases of venous compression. Strategy and technique in dissecting these veins may affect the surgical outcome. The authors investigated solutions for minimizing venous complications and reviewed the outcome for venous decompression. METHODS The authors retrospectively reviewed their surgical series of microvascular decompression for trigeminal neuralgia and hemifacial spasm in patients treated between 2005 and 2017...
July 2018: Neurosurgical Focus
Vinayak Narayan, Amey R Savardekar, Devi Prasad Patra, Nasser Mohammed, Jai D Thakur, Muhammad Riaz, Anil Nanda
OBJECTIVE Walter E. Dandy described for the first time the anatomical course of the superior petrosal vein (SPV) and its significance during surgery for trigeminal neuralgia. The patient's safety after sacrifice of this vein is a challenging question, with conflicting views in current literature. The aim of this systematic review was to analyze the current surgical considerations regarding Dandy's vein, as well as provide a concise review of the complications after its obliteration. METHODS A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines...
July 2018: Neurosurgical Focus
Evgenii Belykh, Naomi R Onaka, Xiaochun Zhao, Claudio Cavallo, Kaan Yagmurlu, Ting Lei, Vadim A Byvaltsev, Mark C Preul, Peter Nakaji
OBJECTIVE: We describe and quantitatively assess minimally-invasive keyhole retrosigmoid approaches targeted to the upper, middle, and lower cranial nerve (CN) complexes of the cerebellopontine angle (CPA). METHODS: Anatomical dissections were performed on 10 sides of five fixed, silicone-injected cadaveric heads. Surgical views through various trajectories were assessed in endoscopic videos and 3D interactive virtual reality microscope views. Surgical freedom and angles of attack to the proximal and distal areas of CN complexes of the CPA were compared among upper, lower keyholes and conventional retrosigmoid craniotomy using neuronavigation...
June 27, 2018: World Neurosurgery
C Michael Honey, Anthony M Kaufmann
OBJECTIVE: Classical Trigeminal Neuralgia (cTN) is rarely caused by ectatic vertebrobasilar artery (eVB) compression of the trigeminal nerve. These patients present a surgical challenge and are often not considered for microvascular decompression (MVD) due to assumed risk. METHODS: A review of patients who were surgically treated by the senior author between 1997 and 2016 with an admitting diagnosis of cTN was performed. Details of the surgery were documented including the technique for maintaining vascular decompression, complications, and the length of stay...
June 26, 2018: World Neurosurgery
Hidetoshi Kasuya, Yasuhiro Kuroi, Suguru Yokosako, Hirokazu Koseki, Shigeru Tani
OBJECTIVE: The surgical approach for the trigeminal nerve involves veins connected to the superior petrosal and tentorial sinus; therefore, we should pay special attention to these veins. Intra- and postoperative bleeding was investigated using our database. METHODS: We analyzed a prospectively accumulated database of 247 microvascular decompression (MVD) surgeries for trigeminal neuralgia (TN) over the past 10 years. Intra- and postoperative bleeding were confirmed with surgical records, videos, and CT...
June 26, 2018: World Neurosurgery
Manjul Tripathi, Aman Batish
No abstract text is available yet for this article.
June 29, 2018: Journal of Neurosurgery
Aya Kodama-Takahashi, Koji Sugioka, Tomoko Sato, Koichi Nishida, Keiichi Aomatsu, Masahiko Fukuda, Yoshikazu Shimomura
Purpose: To report a case of persistent corneal epithelial defect that had occurred after a trigeminal nerve block. Case Presentation: A 75-year-old female had suffered from postherpetic neuralgia for 8 years. She underwent Gasserian ganglion block surgery and noticed declining visual acuity in the right eye on the following day. She presented with severe hyperemia and corneal epithelial defects in the right eye and experienced remarkable reduction of sensitivity in the right cornea...
2018: Case Reports in Ophthalmological Medicine
Jonathan Wallach, Allen L Ho, Lily H Kim, Aadel A Chaudhuri, Navjot Chaudhary, Francisco Vaz-Guimaraes, Steven D Chang
For medically-refractory trigeminal neuralgia (TN), microvascular decompression (MVD) is the first-line treatment, and has demonstrated the greatest efficacy and durability. However, due to potential surgical complications, a bias may exist against performing MVD in elderly patients. We sought to determine through a quantitative analysis whether MVD in the elderly is a safe and effective procedure for TN. We completed a Pubmed/SCOPUS literature search up to 12/2016 for eligible studies on MVD for TN. Only research articles with age stratification of results were included...
June 25, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
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