Use of Cryoneurolysis Therapy for the Management of Idiopathic Trigeminal Neuralgia.

How Do You Treat Trigeminal Neuralgia in Your Practice?

Coexistence of glossopharyngeal neuralgia with atypical trigeminal neuralgia in a young girl

Comparison of repeat GK-SRS for refractory or recurrent trigeminal neuralgia: Does dose matter

Objective To assess the feasibility, indications and therapeutic effect of repeatgamma knife radiosurgery for treatment of primary trigeminai neuralgia. Methods From January 1995to February 2006, 277 patients with primary trigeminal neuralgia underwent stereotactic radiosurgerytargeting the cistemal trigeminal nerve with a maximal central dose of 70-80 Gy. A second gamma kniferadiosurgery with a maximal central dose of 65-80 Gy was performed in 23 patients with refractory and15 with recurrent trigeminal neuralgia after the primary surgery. The 50% isodose line encompassed thetarget area for radiation. The trigeminal root entry zone was included in a single target area in 33 patients,and in 5 patients, two target areas were chosen. Results All patients were followed up for 12 to 108months (mean 55 months) by telephone. The pain relief lasted for 1 to 180 days (mean 120 days) after thesecond gamma knife radiosurgery. The primary stereotactic radiosurgery resulted in a complete or partialpain relief rate of 91.7%(254/277). In the 23 patients with refractory trigeminal neuralgia, the secondradiosurgery achieved a pain relief rate of 73.9% (17/23), significantly lower than the rate of 100%(15/15) in the 15 patients with recurrent trigeminal neuralgia (P=0.045). Facial numbness or paresthesiaoccurred in 30 patients (10.8%) after the primary radiosurgery, and in another 8 patients (21.1%) after thesecond surgery. Conclusion Gamma knife stereotactic radiosurgery is safe and effective and causesfew complications for relieving trigeminal neuralgia. A repeat gamma knife stereotactic radiosurgery isalso effective for management of recurrent or refractory trigeminal neuralgia, especially in recurrentcases. Key words: Trigeminal neuralgia; Stereotactic radiosurgery; Gamma knife

Background: Trigeminal neuralgia is characterized by brief episodes of sharp, shock-like, unilateral pain in the area of distribution of the Trigeminal nerve. Objective: This study seeks to assess the efficacy of medical treatment of patients suffering from Trigeminal neuralgia. Methods: A preliminary descriptive study of patients with Trigeminal neuralgia attending the Oral Medicine clinic of a tertiary institution in western Africa, using information from their case notes. Results: A total of 16 patients with Trigeminal neuralgia were assessed. 9 (56.3%) were females, 7 (43.8%) were males with age range of 29-80 years. All the patients presented with sharp, shock-like pain with sudden onset. With the institution of medical therapy, there was reduction of pain in 85% of patients within 6 months of therapy, while 4 (30.8%) were completely pain free after institution of therapy. Recurrence of the condition occurred in 8 cases, with 2 of the patients presenting with periods of complete remission of pain for a period of 3-4 months before recurrence. None of the patients have had the option of surgical intervention as an alternative to medical treatment since the response to medical treatment was good in majority of cases. Conclusion: There is no definite cure for this condition, therefore the ability to control pain to improve the quality of life of patients is of importance. Medical therapy (either monotherapy or multi-drug therapy) has been shown to be an effective treatment modality in managing this debilitating condition. Keywords: Trigeminal neuralgia, pain, medical therapy

Objective To assess the value of contrast - enhanced three - dimensional spoiled gradient recalled (3D - SPGR ) sequence in the preoperative visualization of neurovascular compression (NVC) in patients with trigeminal neuralgia(TN) and to evaluate the relationship between clinical symptoms of neuralgia related to trigeminal branches and the sites of trigeminal nerve compression.Method Thirty -seven patients(21 males,16 females; the age ranged from 26 to 81 years with a mean age of 55.3 years) with unilateral typical TN underwent preoperative contrast - enhanced 3D - SPGR sequence.The vascular contact with the trigeminal nerve at the root entry zone (REZ) was reviewed by an experienced neuroradiologist,who was blinded to the clinical details.The imaging results were compared with the operative findings and clinical symptoms related to trigeminal branches in patients.Results In 37 patients with TN,contrast - enhanced 3D - SPGR sequence identified surgically verified neurovascular contact in 35 of 36 symptomatic nerves.Based on surgical findings,the sensitivity of MR imaging was 97.2％ and the specificity 100％.Agreement between the position ( medial,lateral,cranial,and caudal) of the compressing vessel relative to the trigeminal nerve defined by MR imaging and findings at surgery was good( K =0.81 ;95％ confidence interval,0.56 ～ 1.00).Twelve(85.7％ ) of 14 patients with symptoms related to the maxillary division had their NVC at the medial site of the REZ.Thirteen(81.3％ ) of 16 patients with symptoms related to the mandibular division had their NVC at the lateral site of the REZ.A statistically significant difference was observed between the NVC site and the clinically manifested symptoms in the branches of the trigeminal nerve( P ＜ 0.001 ).Conclusions Contrast - enhanced 3D - SPGR sequence is useful in detection of NVC in patients with TN.Anatomic relationships defined by this method may be useful in predicting surgical findings. Key words: Magnetic resonance imaging; Microvascular decompression; Neurovascular compression; Trigeminal neuralgia; Comparative studies

Minimally invasive trigeminal ablation in patients with refractory trigeminal neuralgia who are ineligible for intracranial intervention

Background: Trigeminal neuralgia (TN) is a common cause of craniofacial pain with many medical and surgical therapies, all of which are imperfect. We examine the use of botulinum toxin type-A (BTX-A) as an intermediary approach in surgical practices. Methods: We retrospectively identified TN patients seen by both pain neurology and neurosurgery at our center. Demographics were collected. Pain intensity was assessed using the numerical rating scale (NRS) and compared from baseline to after BTX-A treatment via paired t test. Responder status was assessed, and success of BTX-A was determined for each cohort. Doses of common medications were compared between baseline visit and the most recent BTX-A administration visit. Results: Thirty-one patients underwent BTX-A therapy for TN, 24 (77%) female and 7 (23%) male. Mean age was 62.5 ± 3.1 years and 29 (94%) identified as white. When divided into cohorts according to indication, 11 (35%) failed prior TN surgery, 9 (29%) either declined surgery or were poor surgical candidates, 4 (13%) had multiple sclerosis, 4 (13%) had trigeminal neuropathic pain, and 3 (10%) had atypical TN with pain in additional dermatomes outside the trigeminal distribution. Significant reductions in NRS from baseline to following initial BTX-A treatment were seen in the declined/high risk for surgery (p = 0.004) and those who failed prior TN surgery (p = 0.035) groups. No significant variation in demographics was found between any two groups (p > 0.05 for all). Finally, there was no significant reduction in total daily dose of gabapentin, carbamazepine, oxcarbazepine, baclofen, or lamotrigine in BTX-A responders (p > 0.05 for all). Discussion: Indication is an important predictor for BTX-A, with classical TN patients exhibiting the highest response rates. This research highlights the viability of BTX-A as an important tool in the arsenal of providers seeking to treat TN in a minimally invasive manner.

Background Although medical treatment is the mainstay of therapy, in trigeminal neuralgia (TN), patients failing to respond to it make them candidates to ablative or nonablative procedures.Objective The aim of this study was to compare the outcome of Microvascular decompression (MVD) and radiofrequency (RF) thermocoagulation in the management of TN affecting the mandibular and maxillary divisions.Materials and Methods Retrospective analysis of the data of 40 patients suffering from intractable classical TN affecting the maxillary or mandibular divisions or both was carried out. Twenty patients were operated upon by MVD of the trigeminal nerve; and 20 had RF ablation of the maxillary or mandibular divisions of the trigeminal nerve or both.Results In MVD the overall successful outcome was achieved in 16 patients (80%), while the failure was in 4 patients (20%) of which 3 had a fair outcome and 1 patient had a poor outcome. Whereas in RF the overall successful outcome was achieved in 17 patients (85%), while the failure was in 3 patients (15%) of which 2 had a fair outcome and 1 patient had a poor outcome. Outcome was insignificantly different between both groups (p-value 0.806).Conclusion MVD and RF ablation represent safe and efficacious surgical choices for addressing TN that encompasses both the mandibular and maxillary divisions. Long-term follow-up studies demonstrate that MVD consistently yields favorable outcomes, establishing it as the preferred primary surgical technique, unless contraindicated by the patient's general health and specific needs.

Objective To explore the approach of trigeminal nerve block via pterygopalatine fossa under ultrasound-guidance in the treatment of trigeminal neuralgia. Methods Five patients with primary trigeminal neuralgia and two patients with trigeminal neuralgia after herpes zoster received trigeminal nerve block under ultrasound-guidance via sigmoid incisure of mandible into pterygopalatine fossa. Superficial sensory in the cutaneous distribution area of the branches of trigeminal nerve pain was observed respectively after 15 minutes. The efficacy was assessed by visual analogue scale (VAS) before and at 24 h, 1 month and 3 months after the treatment, and the occurrence of complications was observed as well. Results The branches V1, V2, V3 of trigeminal nerve were all blocked in 2 patients (29%) , V2 and V3 in 4 patients (57%) and V2 in 7 patients (100%) . The effective rate was 100% at 24 h, 1 month, 3 months after the treatment. VAS in 5 patients with primary trigeminal neuralgia was significantly lower at 3 months after the treatment than that before the treatment, without obvious decrease in two patients with trigeminal neuralgia after herpes zoster. One patient showed facial swelling for two hours, without other complication. Conclusion Trigeminal nerve block via pterygopalatine fossa under ultrasound-guidance is a safe and effective approach in the treatment of trigeminal neuralgia. Key words: Trigeminal nerve; Trigeminal neuralgia; Pterygopalatine fossa; Nerve block; Ultrasound-guidance

Trigeminal Neuralgia: Rapid Evidence Review.

Repeat gamma knife radiosurgery (GKRS) is considered to be an effective treatment for refractory or recurrent trigeminal neuralgia (TN). The purpose of this report was to demonstrate the relationship between the outcome of repeat GKRS and prior operative procedures on patients with recurrent or refractory TN. A retrospective analysis was performed on 34 patients with refractory or recurrent TN who had undergone repeat GKRS; 21 patients had undergone other types of procedures, 11 of whom had undergone more than three such procedures prior to radiosurgery. The maximum dose of the repeat procedure was between 60 and 75 Gy. The mean follow-up time was 21.6 months. The log-rank test and Fisher's exact test were used to analyze the data. Excellent pain relief was achieved in 14 patients (41.2%) after repeat GKRS, while a successful outcome occurred in 29 of 34 patients (85.3%). Better pain relief occurred in the patients who did not have a prior procedure or who had undergone fewer than three prior procedures (P=0.042). Twenty-four of 25 patients (96.0%) who had recurrent pain had a successful operation and five of nine patients (55.6%) who did not have significant relief of pain after the first procedure had a successful operation. The difference was statistically significant (P<0.01). Only four patients had mild complications. It is more likely to relieve pain in patients with recurrent or refractory TN who did not have a prior procedure or who had fewer than three procedures before undergoing their first GKRS. Moreover, it seems that patients who had a good response following the initial GKRS had better results after a repeat procedure.

Trigeminal neuralgia (TN) is a neurological syndrome characterized by paroxysmal, lightning-like, severe pain in the facial area innervated by the trigeminal nerve. Patients who do not respond well to drug treatment can undergo a nerve block, a traditional conservative treatment. Pulsed radiofrequency (PRF) is a nondestructive pain intervention technique. However, its treatment effectiveness for TN has rarely been reported and remains controversial among scholars. A recent single-center preliminary clinical study showed that high-voltage PRF was significantly effective in the treatment of TN. However, whether high-voltage PRF is a viable pain treatment option for TN patients who are unresponsive to drug treatment must still be confirmed with standardized clinical studies by utilizing conservative nerve block treatment as a control. To compare the effectiveness and safety of high-voltage PRF and nerve block for primary TN patients who have failed to respond to pharmacological treatment and who are seeking a better non-surgical treatment option. Prospective, multicenter, randomized, double-blind, controlled clinical trial. Three interventional pain management centers in Beijing, China. The study will include 134 consecutive patients with primary TN who have failed to respond to drug treatment. The patients will be randomly assigned to 2 groups, the nerve block group and the PRF group. The nerve block group will be slowly injected with 1.4 mL of a mixture of dexamethasone and lidocaine after 360 s of sham PRF treatment, and 0.5 mL of normal saline will be administered before the needle is withdrawn. The PRF group will undergo 360 s of 42°C PRF treatment at the highest output voltage that the patients can tolerate, after which the patients will be injected with the same concentration and volume of lidocaine and normal saline that the nerve block group receives. The Barrow Neurological Institute (BNI) pain intensity scale will be used to assess the degree of pain relief before and after the treatment. The effectiveness and safety of high-voltage PRF and nerve block to treat TN will be analyzed to determine significant differences in pain relief and functional improvement. The primary efficacy outcome measure is the response rate at one-year post-operation (BNI I-III/total number of cases∗100%). Secondary efficacy outcome measures include the response rate at postoperative day 1, week 1, week 2, month 1, month 3, month 6 and year 2, the patient satisfaction score (PSS) at various time points, the dosage of antiepileptic drugs (milligrams per day), and information regarding patients with a BNI score of IV or V who switch to other therapies. The effects of the waveform, treatment duration, frequency and other parameters of PRF deserve further investigation. This is the first multicenter, double-blind, randomized controlled study to compare the efficacy and safety of PRF and nerve block to treat TN patients who have failed to respond to drug treatment. Moreover, the value of PRF in TN treatment may need to be clinically clarified with evidence-based medical support and other advanced studies. Trigeminal neuralgia, effectiveness, safety, pulsed radiofrequency.

Introduction:Trigeminal neuralgia (TN) is a severe neurological condition characterized by intense, paroxysmal, and disabling facial pain. Management can be especially challenging in patients refractory to pharmacological and surgical therapies. Gasserian ganglion stimulation (GGS) has emerged as a potential alternative in such cases; however, its use remains limited and underrepresented in current literature. Objective. To evaluate the clinical efficacy, pain evolution, and impact on quality of life in a cohort of patients with refractory TN treated with Gasserian ganglion stimulation at our institution.Method:We conducted a retrospective observational study of 10 adult patients with refractory TN who underwent GGS between January 2008 and May 2025. Demographic data, clinical history, TN subtype (according to Burchiel’s classification), affected territories, trigger points, and prior treatments were analyzed. Pain intensity was assessed using the Visual Analog Scale (VAS) and Barrow Neurological Institute (BNI) pain scale preoperatively, immediately postoperatively, at six months, and at final follow-up. Quality of life (QoL) and reduction in medication use were also evaluated. A female predominance (73%) was observed, with a mean age at diagnosis of 50 years. Based on Burchiel’s classification, 50% had type I TN, and 20% had deafferentation pain. Prior interventions were reported in 72% (n=8), predominantly radiofrequency thermocoagulation. Preoperatively, 60% (n=6) experienced severe pain (VAS 8–10), 30% (n=3) moderate pain (VAS 4–7), and 10% (n=1) mild pain (VAS 1–3). Immediately postoperatively, 50% (n=5) reported moderate pain, 30% (n=3) severe, and 20% (n=2) mild. A significant reduction in pain was observed (p=0.002). On the BNI scale, 60% (n=6) had a score of 4 preoperatively; at six months, 80% (n=8) achieved BNI ≤3b. At final follow-up, 50% (n=5) reached BNI 2, 30% (n=3) BNI 3b, and 20% (n=2) BNI 1 (p=0.0018). Following surgery, 90% reported fair to excellent QoL. At six months, 82% had reduced medication use, with only 27% continuing pharmacological treatment at final evaluation.Discussion: GGS appears to be a viable alternative for patients with refractory TN, especially those with multiple failed interventions. Our results align with international findings regarding procedural safety, sustained pain relief, and medication reduction. A trend was observed between the number of trigger points and pain severity, suggesting possible predictive factors, though statistical significance was not achieved in this limited sample.Conclusions:Gasserian ganglion stimulation is a safe and effective option for treating refractory TN, providing significant pain relief, high clinical response, and sustained improvements in quality of life. These findings support its inclusion as a therapeutic alternative in complex, recurrent, or treatment-resistant cases.

Trigeminal neuralgia (TN) produces incapacitating facial pain that reduces quality of life in patients. Thermal radiofrequency (RF) ablation of gasserian ganglion (GG) is associated with masseter weakness and unpleasant sensations along the distribution of the ablated nerve. Pulsed radiofrequency (PRF) of GG has minimal side effects but literature is inconclusive regarding its benefit in refractory TN. Increasing the duration of PRF application to 6 minutes in TN produced encouraging results. PRF application to the saphenous nerve for 8 minutes reported improved pain relief and patient satisfaction. We report successful management of two patients of classic TN, which were refractory to medical management and interventional nerve blocks. The lesion site were confirmed with motor and sensory stimulation through a 22 G, 10 cm RF needle with 5 mm active tip. Both the patients received four cycles of PRF at 42 °C with each cycle of 120 seconds (8 minutres). The visual analogue scale (VAS) in case 1 reduced from pre block score of 80 to score 10 postblock, while in case 2 the VAS reduced from pre-block score of 85 to score 15 postblock. During follow up both the patients are now pain free with minimal dose of carbamazepine at 12 and 6 months respectively. We used PRF for longer duration (8 minutes) in these patients, which resulted in improved VAS and WHOQOL-BREF score in these patients. PRF of mandibular division of GG for extended duration provided long-term effective pain relief and quality of life in patients of refractory classic TN. Key words: Trigeminal neuralgia pain, pulsed radiofrequency ablation, interventional approach