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Trigeminal neuralgia and nerve

Omar Viswanath, Roxanna Rasekhi, Rekhaben Suthar, Mark R Jones, Jacquelin Peck, Alan D Kaye
PURPOSE OF REVIEW: Headaches encompass a broad-based category of a symptom of pain in the region of the head or neck. For those patients who unfortunately do not obtain relief from conservative treatment, interventional techniques have been developed and are continuing to be refined in an attempt to treat this subset of patients with the goal of return of daily activities. This investigation reviews various categories of headaches, their pathophysiology, and types of interventional treatments currently available...
March 19, 2018: Current Pain and Headache Reports
Shunchang Ma, Pankaj K Agarwalla, Harry R van Loveren, Siviero Agazzi
BACKGROUND AND IMPORTANCE: Persistent trigeminal artery (PTA) is a rare but important anatomic variant that contributes to trigeminal neuralgia (TN). Microvascular decompression (MVD) of the responsible vessel(s) away from the trigeminal nerve provides the most complete and durable relief from TN. The role and technique of MVD for TN associated with a PTA has not been fully defined in the literature. Furthermore, assessment of PTA anatomy intraoperatively with a microscope is challenging...
March 14, 2018: Operative Neurosurgery (Hagerstown, Md.)
Hongchuan Guo, Xu Wang, Chunyu Song, Zihao Song, Jiantao Liang, Gang Song, Yuhai Bao
OBJECTIVE: To retrospectively analyze the clinical data of 4 patients with trigeminal neuralgia (TN) secondary to osteoid osteoma (OO) of petrous bone and discuss the treatment experiences for this rare disease. METHOD: Between January 2008 and December 2016, 4 patients diagnosed as TN secondary to OO of petrous bone received surgical treatment in Xuan Wu Hospital of Capital Medical University. We summarized the characteristics and treatment experiences of this rare disease through retrospective review of the clinical information, imaging features, surgical details and follow up outcomes of all those 4 patients...
March 15, 2018: World Neurosurgery
Aldo Berti, Michelle Granville, Robert E Jacobson
A case of an extremely healthy, active, 96-year-old patient, nonsmoker, is reviewed. He was initially treated for left V1, V2, and V3 trigeminal neuralgia in 2001, at age 80, with stereotactic radiosurgery (SRS) with a dose of 80 Gy to the left retrogasserian trigeminal nerve. He remained asymptomatic for nine years until his trigeminal pain recurred in 2010. He was first treated medically but was intolerant to increasing doses of carbamazepine and gabapentin. He underwent a second SRS in 2012 with a dose of 65...
January 12, 2018: Curēus
Loraine Van Slyke, Mia Scott
HIV pre-exposure prophylaxis (PrEP) with emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF) fixed-dose combination (FTC/TDF) is undergoing rapid scale-up in the United States. While FTC/TDF is typically well tolerated, to our knowledge, cranial nerve pathology associated with FTC/TDF has not been previously described. We report the case of a 35-year-old patient who began FTC/TDF PrEP and developed acute trigeminal neuralgia. The neurologic symptoms resolved after treatment discontinuation and recurred upon rechallenge, resulting in permanent discontinuation of PrEP treatment...
January 2018: Journal of the International Association of Providers of AIDS Care
Pini Koplovitch, Marshall Devor
Ectopic impulse discharge (ectopia) generated in the soma of afferent neurons in dorsal root ganglia (DRGs) following nerve injury is thought to be a major contributor to neuropathic pain. The DRG is thus a prime interventional target. The process of electrogenesis (impulse generation) in the DRG is far more sensitive to systemically administered Na channel blockers than the process of impulse propagation along sensory axons. It should therefore be possible to selectively suppress DRG ectopia with local application of membrane stabilizing agents without blocking normal impulse traffic...
March 12, 2018: Pain
Qian Du, Chi Zhang, Xiaofeng Zhu, Xiaoying Liang, Chi Zhang, Vivek Verma, Kenneth Follet, Shuo Wang, Qiyong Fan, Rongtao Ma, Sumin Zhou, Dandan Zheng
OBJECTIVES: To apply advanced statistical and computational methodology in evaluating the impact of anatomical and technical variables on normal tissue dosimetry of trigeminal neuralgia (TN) stereotactic radiosurgery (SRS). METHODS: Forty patients treated with LINAC-based TN SRS with 90 Gy maximum dose were randomly selected for the study. Parameters extracted from the treatment plans for the study included three dosimetric output variables: the maximum dose to the brainstem (BSmax), the volume of brainstem that received at least 10 Gy (V10BS), and the volume of normal brain that received at least 12 Gy (V12)...
March 9, 2018: Medical Physics
Max Shutran, David Mosbach, Zachary Tataryn, Knarik Arkun, Julian K Wu
BACKGROUND AND IMPORTANCE: Malignant peripheral nerve sheath tumors (MPNST) are relatively rare tumors of peripheral nerves that are notable for their locally aggressive nature, ability to metastasize, poor prognosis, and association with Neurofibromatosis type I. We present the case of a patient with a trigeminal nerve MPNST who developed an unusual metastasis to the corpus callosum, in the absence of any other central nervous system or systemic metastatic disease. We review the pathology and presentation of MPNST...
March 5, 2018: Neurosurgery
Min Wu, Xianming Fu, Ying Ji, Wanhai Ding, Dali Deng, Yehan Wang, Xiaofeng Jiang, Chaoshi Niu
BACKGROUND: Microvascular decompression (MVD) of the trigeminal nerve is the most effective treatment for trigeminal neuralgia (TN). However, when encountering with classical trigeminal neuralgia caused by venous compression, the procedure becomes much more difficult, and failure or recurrence due to incomplete decompression may become frequent. This study aimed to investigate the anatomical variation of the culprit veins, and discuss the surgical strategy for different types respectively...
March 3, 2018: World Neurosurgery
Amitesh Dubey, Nishtha Yadav, Shailendra Ratre, Vijay Singh Parihar, Yad Ram Yadav
BACKGROUND: Although most surgeons are employing endoscope as an adjunct to the microscope in microvascular decompression, a full endoscopic technique is less commonly performed. The present study is aimed to evaluate results of 230 patients of endoscopic vascular decompression. METHODS: A retrospective study was carried out in a tertiary care hospital. Patients with typical neuralgia, with or without preoperatively detected vascular compression, were advised to undergo vascular decompression...
February 24, 2018: World Neurosurgery
Jehad Zakaria, Michael Wemhoff, Douglas Anderson
Vascular compression of neural structures has long been established as an etiology for dysfunction of multiple cranial nerves. Classically, as is the case of trigeminal neuralgia, vascular compression by an offending artery and sometimes vein exerting pressure at the root entry zone of the trigeminal nerve can lead to the characteristic pain syndrome. In these cases, microvascular decompression is an effective, durable surgical intervention to relieve the neuralgia. In this report, we present a unique case of a patient with direct compression of the medulla oblongata by an arachnoid cyst and associated vascular loops, with subsequent resolution of the patient's symptoms following fenestration of cyst and microvascular decompression...
February 24, 2018: World Neurosurgery
Vadim Gospodarev, Vikram Chakravarthy, Casey Harms, Hannah Myers, Brett Kaplan, Esther Kim, Matthew Pond, Kenneth De Los Reyes
BACKGROUND: Trigeminal neuralgia (TGN) causes severe unilateral facial pain. The etiology is hypothesized to be segmental demyelination of the trigeminal nerve root via compression by the superior cerebellar artery (SCA). Microvascular decompression (MVD) allows immediate and long-term pain relief. Preoperative evaluation includes MRI (magnetic resonance imaging) and/or MRA (magnetic resonance angiography) of the brain. Having a pacemaker is a contraindication for MRI. There have been isolated reports of using computed tomography (CT) cisternography scans for radiation planning for TGN...
February 21, 2018: World Neurosurgery
John P Marinelli, Jamie J Van Gompel, Michael J Link, Matthew L Carlson
No abstract text is available yet for this article.
February 21, 2018: World Neurosurgery
Shujing Yao, Jiashu Zhang, Yining Zhao, Yuanzheng Hou, Xinghua Xu, Zhizhong Zhang, Ron Kikinis, Xiaolei Chen
OBJECTIVE: To address the feasibility and predictive value of multimodal image-based virtual reality in detecting and assessing features of neurovascular confliction (NVC), particularly regarding the detection of offending vessels, degree of compression exerted on the nerve root, in patients who underwent microvascular decompression (MVD) for non-lesional trigeminal neuralgia (TN) and hemi-facial spasm (HFS). METHODS: This prospective study includes 42 consecutive patients who underwent MVD for classic primary TN or HFS...
February 21, 2018: World Neurosurgery
Michael Zhang, Layton A Lamsam, Matthew K Schoen, Swapnil S Mehta, Geoffrey Appelboom, John K Adler, Scott G Soltys, Steven D Chang
INTRODUCTION: CyberKnife stereotactic radiosurgery (SRS) for trigeminal neuralgia (TGN) administers non-isometric, conformational high-dose radiation to the trigeminal nerve with risk of subsequent hypoesthesia. METHODS: We performed a retrospective, single-institution review of 66 TGN patients, treated by CyberKnife, to compare outcomes from two distinct treatment periods (standard dosing, N = 38 and reduced dosing, N = 28). Standard and reduced dosing permitted a maximum brainstem dose of 45 Gy and 25 Gy, respectively, each with a prescription dose of 60 Gy...
February 14, 2018: World Neurosurgery
Saleem I Abdulrauf, Jorge F Urquiaga, Ritesh Patel, J Andrew Albers, Varun B Sampat, Meghan Baumer, Eric Marvin, Matthew Pierson, Raquel Kragel, Jodi Walsh
OBJECTIVE: The option of performing MVD under awake anesthesia protocol ("awake" MVD) was examined in this initial series to assess whether intraoperative pain evaluation can identify and mitigate insufficient decompression of the trigeminal nerve, improving surgical outcomes. Additionally, "awake" MVD could expand procedure indications for those with comorbidities that would prohibit general endotracheal anesthesia (GEA). METHODS: An IRB-approved prospective study of 10 consecutive adults who underwent MVD for TN was conducted...
February 13, 2018: World Neurosurgery
Joanna M Zakrzewska, Ning Wu, John Y K Lee, Brian Werneburg, Deborah Hoffman, Ying Liu
BACKGROUND AND AIM: Trigeminal neuralgia (TN) is a rare orofacial disorder characterized by severe unilateral paroxysmal pain in the region of the fifth cranial nerve. Clinical guidelines recommend carbamazepine (only US Food and Drug Administration-approved drug for TN) and oxcarbazepine as first-line therapies. We utilized the US Truven Health MarketScan database to examine treatment patterns among patients with TN. METHODS: Included patients were aged ≥18 years, newly diagnosed with TN (≥2 TN diagnoses ≥14 days apart; no diagnosis in the prior year), continuously enrolled 1 year pre-index, with ≥3 years' follow-up post-index...
February 19, 2018: Clinical Journal of Pain
Ronak H Jani, Marion A Hughes, Michael S Gold, Barton F Branstetter, Zachary E Ligus, Raymond F Sekula
BACKGROUND: While high-resolution imaging is increasingly used in guiding decisions about surgical interventions for the treatment of trigeminal neuralgia, direct assessment of the extent of vascular contact of the trigeminal nerve is still considered the gold standard for the determination of whether nerve decompression is warranted. OBJECTIVE: To compare intraoperative and magnetic resonance imaging (MRI) findings of the prevalence and severity of vascular compression of the trigeminal nerve in patients without classical trigeminal neuralgia...
February 6, 2018: Neurosurgery
Thien Nguyen, Courtney Duong, John P Sheppard, Seung Jin Lee, Amar U Kishan, Percy Lee, Stephen Tenn, Robert Chin, Tania B Kaprealian, Isaac Yang
Vestibular schwannomas (VS) are benign tumors stemming from the eighth cranial nerve. Treatment options for VS include conservative management, microsurgery, stereotactic radiosurgery, and fractionated radiotherapy. Though microsurgery has been the standard of care for larger lesions, hypo-fractionated stereotactic radiotherapy (hypo-FSRT) is an emerging modality. However, its clinical efficacy and safety have yet to be established. We conducted a systematic review and meta-analysis of manuscripts indexed in PubMed, Scopus, Web of Science, Embase, and Cochrane databases reporting outcomes of VS cases treated with hypo-FSRT...
March 2018: Clinical Neurology and Neurosurgery
Cheng-Chia Lee, Shin Tai Chong, Ching-Jen Chen, Sheng-Che Hung, Huai-Che Yang, Chung-Jung Lin, Chih-Chun Wu, Wen-Yuh Chung, Wan-Yuo Guo, David Hung-Chi Pan, Hsiu-Mei Wu, Jason P Sheehan, Ching-Po Lin
BACKGROUND: Diffusion tensor imaging (DTI) is a novel MRI technique that enables noninvasive evaluation of microstructural alterations in white matter of brain. Initially, DTI was used in intra- or inter-hemispheric association bundles. Recent technical advances are overcoming the challenges of imaging small white matter bundles, such as the cranial nerves. In this study, we use DTI to shed more light on the microstructure changes in long-standing trigeminal neuralgia. We also utilize DTI to study the effect of early stereotactic radiosurgery (SRS) on the microstructures of the trigeminal nerve and to predict the effectiveness of early SRS in the treatment of medically refractory trigeminal neuralgia (TN)...
February 3, 2018: Acta Neurochirurgica
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