Sara Garcia-Isidoro, Victor Omar Castellanos-Sanchez, Elvira Iglesias-Lopez, Sara PerpiñaMartinez
BACKGROUND: Trigeminal neuralgia is a chronic disease characterized by intense facial pain caused by trigeminal nerve affectation. Usually affects adults from 50 years of age, being more frequent in women. Additionally, it presents serious psychological effects that often lead to depression, which is why it is considered highly disabling. The therapeutic approach is based on the modification of nerve activity through electrical, surgical or chemical stimulation in specific regions of the nervous system...
July 28, 2020: Current Neuropharmacology
David Qixiang Chen, Jidan Zhong, Powell P W Chu, Cathy Meng Fei Li, Mojgan Hodaie
Imaging of trigeminal neuralgia (TN) has demonstrated key DTI based diffusivity alterations in the trigeminal nerve, however imaging has primarily focused on the peripheral nerve segment due to previous limitations in reliably segmenting small fiber bundles across multiple subjects. We used Selective Automated Group Integrated Tractography (SAGIT) to study 36 TN subjects (right sided pain) and 36 sex matched controls, to examine the trigeminal nerve (CN V), pontine decussation (TPT), and thalamocortical fibers (S1)...
July 21, 2020: Pain
Kristen Zayan, Elizabeth R Felix, Anat Galor
Transcutaneous electrical nerve stimulation (TENS) has been used for its analgesic effects for chronic pain, including facial pain. Here, we summarize how the electrical stimulation of branches of the trigeminal nerve via TENS has been utilized to reduce pain resulting from trigeminal neuralgia, temporomandibular joint disorder, migraine and other headache types, and ocular pain sensations. TENS has been used for both short-term (one session) and long-term (multiple sessions) pain control with little to no adverse effects reported by subjects...
July 21, 2020: Progress in Neurological Surgery
Christopher J Winfree
Trigeminal branch stimulation is a type of peripheral nerve stimulation (PNS) used to treat a variety of craniofacial pain disorders. Common indications include trigeminal neuralgia, trigeminal neuropathic pain, trigeminal deafferentation pain, trigeminal postherpetic neuralgia, supraorbital neuralgia, and migraine headaches. Supraorbital and infraorbital arrays are the most common electrode configurations, although preauricular, mandibular branch, and subcutaneous peripheral nerve field stimulation arrays have also been described...
July 17, 2020: Progress in Neurological Surgery
Sheng Cheng Wei, Rui Yu, Qinghu Meng, Chuncheng Qu
OBJECTIVE: To explore the surgical efficacy of microvascular decompression(MVD) when the recent magnetic resonance tomography angiography(MRA) is unable to determine the relationship between blood vessels and nerves in patients with trigeminal neuralgia(TN). MATERIALS AND METHODS: The MRI images of 146 patients with TN who underwent MVD from January 2016 to December 2019 were analyzed retrospectively. The relationship between nerves and vessels was categorized as no contact, suspicious contact, and clear contact...
July 10, 2020: Clinical Neurology and Neurosurgery
Victor Sabourin, Jacob Mazza, Tomas Garzon, Jeffrey Head, Donald Ye, Anthony Stefanelli, Fadi Al-Saiegh, Pascal Lavergne, James Evans
OBJECTIVE: Microvascular decompression remains the first line surgical treatment for trigeminal neuralgia when an offending vessel can be identified causing neurovascular compression. However, there are patients without neurovascular compression who either develop trigeminal neuralgia or have recurrence after MVD. In addition, patients with venous and less severe arterial compression are known to have reduced efficacy after microvascular decompression. Internal neurolysis (IN), is a surgical technique of separating the fascicles of the trigeminal nerve and may be a good option for trigeminal neuralgia patients without vascular compression...
July 13, 2020: World Neurosurgery
Camila Lino de Oliveira, Liciane Fernandes Medeiros, Vanessa Silva de Souza, Bettega Costa Lopes, Fabricio Finamor de Oliveira, Luana Xavier Marques, Iraci Lucena da Silva Torres, Andressa de Souza
Trigeminal neuralgia (TN) is a type of neuropathic pain characterized by intense pain; although anticonvulsants are used as an option to relieve pain, adverse side effects can decrease patient adherence. In this context, a low dose of naltrexone is effective in relieving pain in other pain conditions. Thus, the objective of the present study was to evaluate the analgesic effect of low-dose naltrexone on facial mechanical allodynia in a rat model of TN, as well as its effect(s) on biomarkers in the central nervous system (tumor necrosis factor-alpha, brain-derived neurotrophic factor [BDNF], interleukin [IL]-10, and toll-like receptor-4)...
July 13, 2020: Neuroscience Letters
Sebastian Müller, Eya Khadhraoui, Ali Khanafer, Marios Psychogios, Veit Rohde, Levent Tanrikulu
BACKGROUND: Balanced Steady State Free Precession (b-SSFP) sequences and the newly developed Fast-Spin-Echo (FSE)-sequences enable an optimized visualization of neurovascular compression (NVC) in patients with trigeminal neuralgia (TN). Arterial conflicts are mostly associated with a favorable outcome of microvascular decompression (MVD) compared to venous conflicts. An additional Time-of-Flight (TOF) angiography provides the differentiation between offending arteries and veins and a precise counselling of the patient concerning postoperative pain relief...
July 14, 2020: BMC Neurology
Hun Ho Park, Woo Hyun Kim, Hyun-Ho Jung, Jong Hee Chang, Kyu-Sung Lee, Won Seok Chang, Chang-Ki Hong
Trigeminal neuralgia (TN) is an excruciating pain that can occur with petroclival meningiomas (PCMs). Gamma knife radiosurgery (GKRS) is an appealing option for small PCMs, but the role of microsurgery (MS) compared to GKRS is not well defined for small PCMs with regard to TN relief. From January 2009 to September 2019, 70 consecutive patients were treated by GKRS or MS for newly diagnosed, small (< 3.5 cm) PCMs with TN. GKRS or MS were performed for 35 patients each. The surgical outcome and TN control according to Barrow Neurological Institute (BNI) score were retrospectively analyzed and compared between GKRS and MS...
July 8, 2020: Neurosurgical Review
Pantaleo Romanelli, Cynthia Chuang, Antonio Meola, Radhika M Bodduluri, John R Adler
Introduction The treatment of trigeminal neuralgia (TN) is one of the most demanding of all radiosurgery procedures, requiring accurate delivery and sharp dose fall off. ZAP-X®, a new, innovative frameless radiosurgical device, maybe an attractive platform for the treatment of TN and other functional brain disorders. Here, we compared the dosimetry of ZAP-X plans for a single patient to that generated by a well-established dedicated radiosurgery device, the CyberKnife. Methods Radiosurgery plans that delineated the cranial nerve from a single patient's fused computed tomography and magnetic resonance imaging (CT-MR) data set were planned on both the ZAP-X and CyberKnife, with the latter serving as a validated benchmark...
May 27, 2020: Curēus
Pantaleo Romanelli, Giancarlo Beltramo
Selective dorsal rhizotomy is an established surgical treatment to improve the neurological and functional status of children with spastic cerebral palsy and adults with spasticity and pain caused by a variety of brain and spinal injuries. This procedure requires a dorsolumbar laminectomy to expose the appropriate dorsal rootlets, which are sectioned according to the presence of sustained electromiographic discharges. Image-guided robotic radiosurgery targeting the intracisternal sensory root of the trigeminal nerve has been described as a safe and effective non-invasive treatment for trigeminal neuralgia, a paroxystic pain disorder which often responds poorly to medical therapy...
May 27, 2020: Curēus
Lina Raffaella Barzaghi, Luigi Albano, Claudia Scudieri, Carmen Rosaria Gigliotti, Francesco Nadin, Antonella Del Vecchio, Pietro Mortini
OBJECTIVE: Gamma knife radiosurgery (GKRS) is a well-defined treatment for trigeminal neuralgia (TN). The aim of this study is to determine how the GKRS planning might change on the basis of the patient's own anatomy and how to best choose the target location. METHODS: Trigeminal cisternal length, ponto-trigeminal angle and distance between middle of the shot and emergence were evaluated in 112 consecutive GKRS plans for TN. Correlations with pain outcomes and facial hypoesthesia were analyzed...
June 26, 2020: World Neurosurgery
Melissa Anne Whitman, Artrish Jefferson, Thais Pincelli, Devang K Sanghavi
Glossopharyngeal neuralgia (GN) is a rare pain syndrome caused by compression of the glossopharyngeal nerve. It is typically idiopathic and often goes misdiagnosed because of its similarities to trigeminal neuralgia. Vago-glossopharyngeal neuralgia, an even rarer subset of GN, occurs when the pain is accompanied by syncope and/or arrhythmia. Here, we present the case of a 54-year-old man with oropharyngeal cancer that metastasised to areas within his left carotid sheath. He presented with numerous intermittent episodes of pain, accompanied by vagal episodes...
June 28, 2020: BMJ Case Reports
Fei Zeng, Mengye Zhu, Quan Wan, Yi Yan, Changxi Li, Yong Zhang
OBJECTIVES: To compare the advantages and disadvantages of V2 + V3 idiopathic trigeminal neuralgia using peripheral nerve radiofrequency (RF) thermocoagulation (PRF) via the foramen rotundum (FR) and foramen ovale (FO) with those of semilunar ganglion RF thermocoagulation (GRF) under local anesthesia, for exploring a new and available surgical method for patients with V2 + V3 idiopathic trigeminal neuralgia. PATIENTS AND METHODS: 102 patients with V2 + V3 idiopathic trigeminal neuralgia were enrolled in this prospective randomized controlled clinical trial, and they were divided into the PRF and GRF group randomly (n = 51 in both groups)...
June 17, 2020: Clinical Neurology and Neurosurgery
Nanna Brix Finnerup, Rohini Kuner, Troels Staehelin Jensen
Neuropathic pain caused by a lesion or disease of the somatosensory nervous system is a common chronic pain condition with major impact on quality of life. Examples include trigeminal neuralgia, painful polyneuropathy, postherpetic neuralgia and central poststroke pain. Most patients complain of an ongoing or intermittent spontaneous pain of e.g. burning, pricking, squeezing quality, which may be accompanied by evoked pain, particular to light touch and cold. Ectopic activity in e.g. nerve-end neuroma, compressed nerves or nerve roots, dorsal root ganglia, and the thalamus may in different conditions underlie the spontaneous pain...
June 25, 2020: Physiological Reviews
Wei Tian, Zhuangzhi Wang, Xin Meng, Jidian Zou, Pingping Yu
May 2020: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Ji Hye Hwang, Jaseung Ku
BACKGROUND: Trigeminal neuralgia is an oral facial pain that is limited to one or more parts of the trigeminal nerve. As it becomes chronic, it can seriously affect the quality of life of most patients, and it is expected to increase in incidence in modern aging society. The objective of this systematic review protocol is to provide methods for evaluating the effectiveness and safety of herbal medicines for idiopathic trigeminal neuralgia (ITN). METHODS: A total of 14 databases will be searched for studies uploaded from inception to the present date that investigated the treatment of ITN...
June 19, 2020: Medicine (Baltimore)
Sami Abu Hamdeh, Payam Emami Khoonsari, Ganna Shevchenko, Torsten Gordh, Hans Ericson, Kim Kultima
The main cause of trigeminal neuralgia (TN) is compression of a blood vessel at the root entry zone of the trigeminal nerve. However, a neurovascular conflict does not seem to be the only etiology and other mechanisms are implicated in the development of the disease. We hypothesized that TN patients may have distinct protein expression in the CSF. In this study, lumbar CSF from TN patients (n=17), scheduled to undergo microvascular decompression (MVD), and from controls (n=20) was analyzed and compared with mass spectrometry-based shotgun proteomics...
June 14, 2020: Journal of Pain: Official Journal of the American Pain Society
Smruti K Patel, Christopher Markosian, Osamah J Choudhry, Jeffrey T Keller, James K Liu
Although the symptoms of trigeminal neuralgia (TN) have been well described throughout the history of medicine, its etiology was initially not well understood by most surgeons. The standard procedure used to treat TN today, microvascular decompression (MVD), evolved due to the efforts of numerous neurosurgeons throughout the twentieth century. Walter Dandy was the first to utilize the cerebellar (suboccipital) approach to expose the trigeminal nerve for partial sectioning. He made unique observations about the compression of the trigeminal nerve by nearby structures, such as vasculature and tumors, in TN patients...
June 9, 2020: Acta Neurochirurgica
Dimitrios K Filippiadis, Dionysios Markoutsas, Argyro Mazioti, Grigorios Tsoukalos, Olympia Papakonstantinou, Panteleimon Stamatis, Alexis Kelekis, Dimitrios Tzavoulis
BACKGROUND: Trigeminal neuralgia (TN) is associated with multiple mechanisms involving peripheral and central nervous system pathologies. Among percutaneous treatments offered, radiofrequency thermocoagulation (RFT) is associated with longer duration of pain relief. Mostly due to anatomic variation, cannulation of the foramen ovale using the Hartel approach has a failure rate of 5.17%. OBJECTIVES: To report safety and efficacy of continuous RFT with an alternative to Hartel anterior approach under computed tomography (CT) guidance in patients with classic TN...
June 2020: Pain Physician
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