Atypical Trigeminal Neuralgia Research Articles

Volume maximised glycerol rhizolysis for trigeminal neuralgia: a single centre analysis of outcomes

Objectives Glycerol rhizotomy is an established treatment for medically refractory trigeminal neuralgia in select cases where microvascular decompression is contraindicated or not preferred. The standard approach is to inject a fixed volume of glycerol using Hartel’s technique into Meckel’s cave. We discuss a ‘volume-maximised’ technique of measuring the volume of Meckel’s cave using intra-operative fluoroscopy and injecting an equivalent volume of glycerol such that every patient receives a tailored quantity of glycerol dependent on the volume of Meckel’s cave. The safety and efficacy of this approach is analysed. Methods A retrospective analysis of 53 procedures where volume-maximised glycerol rhizolysis was utilised over a 7-year period (2012 –2018) at a single centre by the senior author was carried out. The incidence and duration of pain freedom and complications incurred over a median follow-up period of 8 years were analysed Results 37 procedures were carried out for typical trigeminal neuralgia, 13 for secondary trigeminal neuralgia, and 3 for atypical trigeminal neuralgia. Overall, pain freedom was achieved in 85% cases, and 92% in patients with typical trigeminal neuralgia. Median duration of pain freedom in patients with typical trigeminal neuralgia was 63 months, versus 6 months in those with secondary trigeminal neuralgia (p < 0.00001). 14 procedures (26.4%) resulted in mild and temporary complications. 54.7% of cases experienced hypoaesthesia in a distribution similar to or less extensive than the distribution of trigeminal neuralgia. The presence of hypoaesthesia post-procedure was highly predictive of longer pain freedom (95 months versus 8 months median pain freedom (p = 0.00003)). Conclusions Volume-maximised glycerol injection is safe and effective when compared to literature-reported outcomes post-standard volume glycerol injections. The duration of pain freedom achieved exceeds most literature-reported studies, with hypoaesthesia outcomes being comparable with previous studies. Pain freedom outcomes are more favourable in those with post-procedure hypoaesthesia.

Long-term results of microvascular decompression with video endoscopy in the treatment of patients with atypical trigeminal neuralgia

Background: The incidence of atypical trigeminal neuralgia (aNTN) varies from 1 to 7 per 100,000 population per year. The main cause of its development is compression of the trigeminal nerve (TN) root by a vein and/or artery in the cerebellar cistern. To date, the final tactics of treatment for patients with aNTN has not been specified. The effectiveness of conservative methods of therapy does not exceed 50%.&#x0D; The aim of this study was to evaluate the results of microvascular decompression using video endoscopy in the treatment of patients with atypical trigeminal neuralgia.&#x0D; Methods: In the period from 2014 to 2021, 34 patients with aNTN were operated on, of which 18 (53%) patients had neuropathic pain (more than 4 points on the DN4 scale), and 15 (44%) patients had transformation of classical trigeminal neuralgia into atypical neuralgia. The conservative therapy (carbamazepine, gabapentin, pregabalin), administered to all the patients in the preoperative period, was not accompanied by a significant relief of pain syndrome. The maximum intensity of pain upon admission to the hospital was, according to the visual analog scale (VAS), 10 points, according to the BNI (Barrow Neurological Institute) Pain Intensity Scale V (severe, persistent pain). All the patients underwent microvascular decompression of the trigeminal nerve root with the use of Teflon; in 12 (35%) patients, in addition to microscopy, video endoscopy was used. The average follow-up period after the surgery was 3.41.7 years (from 1 to 5 years).&#x0D; Results: In all (100%) patients, the pain was completely eliminated (BNI I) after the surgery. A total five-year excellent and good outcome of the disease on the J. Miller and BNI scale (I -II) was noted in 80% (n=27) of patients with aNTN. The risk of pain recurrence after microvascular decompression was 14% (n=3) in the first three years, and 34% (n=4) after 5 years. The use of video endoscopy made it possible to identify the blood vessels compressing the root of the trigeminal nerve with a minimal displacement of the cerebellum and cranial nerves when visualizing the neurovascular conflict.&#x0D; Conclusion: The microvascular decompression method with video endoscopy is effective in the treatment of patients with aNTN.

A case of invasive sinus mycosis identified with occipital pain and atypical trigeminal neuralgia

A case of invasive sinus mycosis identified with occipital pain and atypical trigeminal neuralgia

Botulinum Toxin as an Effective Treatment for Trigeminal Neuralgia in Surgical Practices

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.

Atypical odontalgia and trigeminal neuralgia: psychological, behavioral and psychopharmacological approach in a dental clinic – an overview of pathologies related to the challenging differential diagnosis in orofacial pain

Orofacial pain represents a challenge for dentists, especially if it does not have an odontogenic origin. Orofacial neuropathic pain may be chronic, is arduous to localize and may develop without obvious pathology. Comorbid psychiatric disorders, such as anxiety and depression, coexist and negatively affect this condition. This article presents one case of atypical odontalgia and one of trigeminal neuralgia treated with psychological and psychopharmacological tailored and adapted therapies, after conventional medications had failed. Additionally, an overview of the pathologies related to the challenging differential diagnosis in orofacial pain is given. A 68-year-old man complained of chronic throbbing and burning pain in a maxillary tooth, which worsened upon digital pressure. Symptoms did not abate after amitriptyline therapy; psychological intervention along with antianxiety drug were supplemented and antidepressant agent dosage were incremented. The patient reported improvement and satisfaction with the multidisciplinary approach to his pathology. A 72-year-old man complained of chronic stabbing, intermittent, sharp, shooting and electric shock-like pain in an upper tooth, radiating and following the distribution of the trigeminal nerve. Pain did not recur after psychological intervention and a prescription of antidepressant and antianxiety agents, while carbamazepine therapy had not been sufficient to control pain. Due to concerns with comorbid psychiatric disorders, we adopted a patient-centered, tailored and balanced therapy, favorably changing clinical outcomes. Comorbid psychiatric disorders have a negative impact on orofacial pain, and dentists should consider adopting tailored therapies, such as psychological counselling and behavioral and psychopharmacologic strategies, besides conventional treatments. They also must be familiar with the signs and symptoms of orofacial pain, obtaining a comprehensive view of the pathologies concerning the differential diagnosis. A prompt diagnosis may prevent pain chronicity, avoiding an increase in complexity and a shift to orofacial neuropathic pain and legal claims.

Refractory atypical trigeminal neuralgia associated with reactivated herpesvirus infection: pathogenetic link and efficacy of combination antiviral therapy.

The online version contains supplementary material available at 10.1007/s13337-022-00769-9.

Trigeminal Ganglioneuroma: A rare case of trigeminal neuralgia caused by Meckel’s cavum tumor: a case report and review of the literature

Background: Ganglioneuroma (GN) is a rare benign tumor originating from the sympathetic nerves, and its origination from the trigeminal nerves is even rarer. Only six cases of GN originating from the trigeminal nerve have previously been reported. Aim: To report a very rare case of GN arising in Mikel's cave revealed by atypical trigeminal neuralgia. Case report: A 24-Year-old Moroccan man presented left trigeminal neuralgia. Intracranial MRI showed a 4.4 x 2.5 x 3 cm well-circumscribed multilobular mass in the posterior middle fossa and the petroclival area with compression to the medial temporal lobe. The tumor appeared homogeneously hypointense on T1WI, and hyperintense on T2WI and T2WI-Flair, and showed heterogeneous moderate enhancement. Bone window petrous CT scan showed thinning and remodeling bone on the left petrous apex. The preoperative diagnosis was cystic schwannoma. The patient underwent a subtemporal extradural approach with total removal of the lesion. The histological and immunohistochemically study confirmed the diagnosis of GN. Postoperative was marked by left keratitis for two months. No recurrence was documented on 3 years follow-up. Conclusion: we described a benign and extremely rare trigeminal ganglioneuroma. This case is the seven-reported case in the literature. The subtemporal interdural approach must be considered in the surgical approach of trigeminal Meckel's GN. Trigeminal GN should be considered in the differential diagnosis of the tumor found in Mickel's cavum.

Predictive and prognostic factors for outcome of microvascular decompression in trigeminal neuralgia.

Trigeminal neuralgia (TN) is a disease characterized by recurring, short-lived, electric shock-like pain experienced on one side of the face. Microvascular decompression (MVD) is one of the most effective surgical interventions for resolving TN caused by neurovascular compression. This study aimed to determine the predictive and prognostic factors of surgical outcomes. This retrospective cohort study enrolled patients diagnosed with TN who underwent MVD at our hospital during 2013-2019. The demographic information, pain character, peri-operative Barrow Neurological Institute (BNI) scale, medication, operative finding were recorded. And the outcome was Outcomes were divided into drug-free and drug-dependent group. Predisposing factors for each outcome were analyzed by one-way analysis of variance, followed by a Mann-Whitney U test or Kruskal-Wallis test. A total of 104 consecutive patients received MVD to treat TN, and 88 patients were enrolled in this study. The overall postoperative drug-free outcome was 72.7%. A significant difference in drug-free outcomes was observed for patients with typical TN (80.8%) compared with patients with atypical TN (33.33%, p = 0001). When severe venous compression was encountered during MVD, the drug-free outcome fell to 50% (10/20, p = 0.009). The Mann-Whitney U test indicated typical TN as a positive predictive factor of a drug-free outcome, whereas severe venous compression was a negative predictive factor. The patients with preoperative BNI score of 4 had better improvement than others (p = 0.045). Age, onset duration, and arterial loop had no specific difference in this study. In our study, atypical TN and severe venous compression were associated with poor outcomes. Regrouping atypical TN into precise diagnosis represents an immediate priority according to our result. The preoperative BNI score could be used as an effective predictive tool for the outcome of MVD surgery.

Recurrence Rates After Microvascular Decompression in Patients With Primary Trigeminal Neuralgia and Its Influencing Factors: A Systematic Review and Meta-Analysis Based on 8,172 Surgery Patients

Background: Primary trigeminal neuralgia (PTN) is known to reoccur following microvascular decompression (MVD) surgery. However, the rates and contributing factors related to PTN recurrence remain controversial. The purpose of this study was to explore the postoperative recurrence rates and related influencing factors of patients with PTN after MVD. Additionally, recurrence rates after different treatments were compared to provide guidelines for clinicians.Methods: We conducted systematic reviews and meta-analyses in accordance with the preferred reporting items of the PRISMA guidelines. We searched nine databases, namely, the PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, CBM, CNKI, VIP, and Wanfang databases, from establishment to July 13, 2020, selecting for studies about the long-term postoperative efficacy of MVD in the treatment of PTN. Factors associated with higher recurrence rates after MVD and long-term postoperative results of other treatments underwent formal meta-analysis, where odds ratios (ORs) with the corresponding 95% confidence intervals (CIs) were calculated. The dose-response model was used to inspect the associations between several factors and higher recurrence rates.Results: Seventy-four studies (8,172 patients, 32 case series studies, and 42 non-randomized controlled trials) were analyzed in our research. Overall, 956 out of 8,172 patients relapsed, and the pooled recurrence rate was 0.096 (0.080–0.113). Influencing factors of relatively higher recurrence rates included atypical trigeminal neuralgia symptoms, lack of nerve groove, non-arterial compression, patients who were 50–60 years old, and longer disease duration. Dose–response analysis showed that the recurrence rate had a significant trend with the published year and the follow-up time. Simultaneously, the recurrence rate of MVD treatment was much lower than that of conventional drug treatment, gamma knife surgery, percutaneous balloon compression, and radiofrequency thermocoagulation. When the surgical technique was improved or combined with partial sensory rhizotomy (PSR), the postoperative recurrence rates were significantly reduced.Conclusions: Even for PTN patients who have a successful operation, ~10% of them will still relapse. This research identifies several factors that can affect the recurrence rate. Compared with other operations, MVD has a relatively lower recurrence rate. Our analysis suggests that improved surgical techniques and combining PSR and MVD will yield better results.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42020159276.

Cavernous Sinus Meningioma: Tumor Decompression for Trigeminal Neuralgia and Anterior Tibial Artery Graft High-Flow Bypass for Brain Ischemia: 2-Dimensional Operative Video.

A 62-yr-old man with left cavernous sinus tumor presented with atypical trigeminal neuralgia refractory to medical treatment. He received Gamma Knife (Elekta) radiation for the tumor. However, the facial pain worsened after radiation. Neuropsychological testing done for memory problems had revealed mild neurocognitive disorder. Neurological examination showed trigeminal distribution numbness and partial abducens nerve paralysis. Imaging revealed an enhancing left cavernous sinus and supra-cavernous mass. Angiography revealed severe stenosis of the left cavernous internal carotid artery (ICA). Computed tomography (CT) perfusion study showed diminished blood flow on the left side, and ischemic changes were seen in fluid-attenuated inversion-recovery (FLAIR) magnetic resonance imaging (MRI). Surgical resection of the tumor was preferred over ablative treatment for trigeminal neuralgia because of its effectiveness in improving cranial nerve (CN) function.1 The patient underwent staged surgeries. In the first stage, the tumor was partially excised with decompression of the trigeminal ganglion and nerve root in the lateral cavernous sinus wall, Meckel's cave. Postoperatively, MR angiography revealed worsening of the left ICA caliber. Therefore, a high-flow bypass from the external carotid artery to the middle cerebral artery (MCA) was performed with an anterior tibial artery graft. The patient recovered initially but developed enterococcus meningitis postoperatively, which was promptly identified and treated with antibiotics. At 1-yr follow-up, the graft was patent, and the patient had significant relief of his facial pain and cognitively improved. This 2-dimensional video demonstrates the technique of partial excision of cavernous sinus meningioma with CN decompression, and the technique of a high-flow bypass from the external carotid artery to M2 MCA segment using an anterior tibial artery graft. The patient gave informed consent for surgery and video recording. All relevant patient identifiers have been removed from the video and accompanying radiology slides.

Fluoroscopically guided mandibular nerve block: a modified lateral approach

Background and objectivesMandibular nerve blocks are indicated for atypical face pain and trigeminal neuralgia. We hypothesized that a modified lateral approach, which entailed a combination of lateral and anterior approach...

A Typical Presentation of Trigeminal Neuralgia Induced by Intracranial Hypertension Mimicking Sinusitis

Trigeminal neuralgia is a chronic pain syndrome that affects the trigeminal nerve. Trigeminal neuralgia is broadly classified into two major subtypes as typical and atypical trigeminal neuralgia. The former is described as repetitive attacks of sharp, severe, excruciating pain with pain-free intervals while the latter is characterized by dull burning facial pain. Facial pain is the main feature of the trigeminal neuralgia but it could be the symptoms of multiple sinogenic and non-sinogenic disorders, it is difficult to distinguish sinogenic pain caused due to sinusitis from non-sinogenic facial pain caused by other etiologies such as trigeminal neuralgia, migraine and idiopathic intracranial hypertension to avoid imprecise treatment at early stages and for a better prognosis. Here, we present the case of a 56-years-old woman, who presented with trigeminal neuralgia mimicking chronic sinusitis. Delayed diagnosis can result in a poor quality of life, unnecessary intervention, and financial burden.

Trigeminal neuralgia in details

Also known as Suicide disease which affects 150,000 per year. Trigeminal neuralgia is a chronic pain disorder of face characterized by electric shock limited to divisions of one or more divisions of trigeminal nerve. There are two types known one is Typical trigeminal neuralgia (TN1) and other is Atypical trigeminal neuralgia (TN2).TN1 is more severe than TN2 and has sudden shock like pain whereas TN2 has constant burning pain. Treatments include medication such as Anticonvulsants and Surgery has 7 procedures which are used to relief pain for a period of time. Trigeminal neuralgia is also known as Tic dolourex Prospolgia, Fothergill's disease and lastly Suicide disease. Keywords: Neuralgia, Prospolgia, Fothergill's disease.

Radiofrequency thermocoagulation in cases of atypical trigeminal neuralgia: a retrospective study

BackgroundTrigeminal neuralgia (TN) is the most common cause of neuropathic facial pain. Atypical TN are usually refractory to conventional medical treatments and the standard microvascular decompression surgeries that lead to marked negative impact on the patient’s quality of life.ObjectiveThe aim of this study is to examine the efficacy and safety of radiofrequency (RF) ablation in cases with atypical TN that did not respond to standard medical treatments.MethodsOur study included 19 consecutive patients with refractory atypical TN for more than 6 months. Neurological examination and MRI brain did not reveal any significant correlated signs. RF thermocoagulation was performed under fluoroscopy guidance. Collected data included preoperative conditions, pre- and post-procedure visual analog scale (VAS) score, and complications. Patients were followed up for a period of 1-year duration to evaluate the long-term efficiency of the procedure.ResultsA total of 19 patients were recruited into the study (56.32 ± 13.48 years, 21% males, 79% females). Females outnumbered males (15 female patients, 79%) versus (4 male patients, 21%). There was more than 50% improvement in VAS score (16 patients, 79% versus 3 patients, 21%) (p < 0.05). Age was the only statistically significant factor were more elderly patients showed better improvement regarding VAS score (p < 0.05).ConclusionsRadiofrequency thermocoagulation is an effective and relatively safe procedure for alleviating atypical facial pain.

Current and Innovative Pharmacological Options to Treat Typical and Atypical Trigeminal Neuralgia.

Trigeminal neuralgia is a representative neuropathic facial pain condition, characterised by unilateral paroxysmal pain in the distribution territory of one or more divisions of the trigeminal nerve, triggered by innocuous stimuli. A subgroup of patients with trigeminal neuralgia [TN (previously defined as atypical TN)] also suffer from concomitant continuous pain, i.e. a background pain between the paroxysmal attacks. The aim of this review is to provide current, evidence-based, knowledge about the pharmacological treatment of typical and atypical TN, with a specific focus on drugs in development. We searched for relevant papers within PubMed, EMBASE, the Cochrane Database of Systematic Reviews and the Clinical Trials database (ClinicalTrials.gov), taking into account publications up to February 2018. Two authors independently selected studies for inclusions, data extraction, and bias assessment. Carbamazepine and oxcarbazepine are the first-choice drugs for paroxysmal pain. When sodium channel blockers cannot reach full dosage because of side effects, an add-on treatment with lamotrigine or baclofen should be considered. In patients with atypical TN, both gabapentin and antidepressants are expected to be efficacious and should be tried as an add-on to oxcarbazepine or carbamazepine. Although carbamazepine and oxcarbazepine are effective in virtually the totality of patients, they are responsible for side effects causing withdrawal from treatment in an important percentage of cases. A new, better tolerated, Nav1.7 selective state-dependent, sodium channel blocker (vixotrigine) is under development. Future trials testing the effect of combination therapy in patients with TN are needed, especially in patients with concomitant continuous pain and in TN secondary to multiple sclerosis.Electronic supplementary materialThe online version of this article (10.1007/s40265-018-0964-9) contains supplementary material, which is available to authorized users.

LINAC stereotactic radiosurgery for trigeminal neuralgia \u2013retrospective two-institutional examination of treatment outcomes

BackgroundIn this pooled 2-center series LINAC radiosurgery (SRS) has been applied as a treatment option for a subset of refractory trigeminal neuralgia (TN) patients. This study approached to retrospectively assess the efficacy and safety of LINAC SRS and to provide a brief overview addressed to the technical development from frame-based towards frameless robotic SRS.MethodsFrom 2001 to 2017 n = 55 patients (pts) were treated, n = 28 were female (51%), mean age: 66 years (range 36–93 years); TN etiology: 37 classic TN, 15 multiple sclerosis (MS)-related TN, 2 symptomatic TN, and 1 atypical TN. Previous treatment was present in n = 35 (63.6%) pts. (some multiple or combined) with n = 23 microsurgical vascular decompression and n = 17 percutaneous retrogasserian rhizotomy. A 6 MV LINAC (4–5 mm collimators) was applied in all pts. (n = 26 framebased - n = 29 frameless robotic). The dorsal root entry zone (DREZ) was targeted in n = 35 cases and the retrogasserian target in n = 20 pts. with a homogeneous dose for the entire study cohort (90 Gy). SRS outcome was measured using the Barrow Neurological Institute (BNI) score for pain and hypaesthesia and statistically evaluated by univariate and multivariate analyzes.ResultsMean follow-up (FU) was 30 months (2 lost FU); the total rate of post SRS BNI pain I-IIIa (=painfree w or w/o medication) was 69% (88% for the classic TN pts), 29% (38.8% classic TN) were classified as BNI pain I-II (=painfree w/o medication). A BNI hypaesthesia II-III was present in 9.4% (n = 5) and BNI hypaesthesia IV in n = 2. Between groups analysis demonstrated no correlation of SRS responsiveness with age, gender, MS- or not MS-associated TN, previous surgery, framebased/frameless robotic SRS. DREZ targeting significantly better suppressed TN compared to RG targeting (p = 0.01). Additionally, a statistical trend for a better BNI pain outcome (p = 0.07) along with a significant increase in BNI hypaesthesia (p = 0.01) was found when using a larger partial trigeminal 70 Gy volume.ConclusionOur retrospective analysis support LINAC SRS as an effective and safe treatment option in TN. Frameless robotic SRS of TN is safe when using a dedicated LINAC system. A target definition closer to the brainstem and tendencially a larger target volume were associated with a better outcome for pain.

Case report of primary Sjögren Syndrome with simple trigeminal lesion as initial symptom

PurposeIt will provide a reference for early detection, early diagnosis and early treatment of atypical primary Sjogren syndrome with neurological impairment as the first symptom. MethodsCase report and Literature review. ResultsHere we report a 30-year-old woman diagnosed with trigeminal damage secondary to pSS who presented atypical trigeminal neuralgia of numbness of the right head and face and persistent prickling-like pain not associated with eating, talking or tooth-brushing, and had no “trigger point”. The patient further received rheumatoid immune factor tests, ophthalmic examinations, salivary gland emissioncomputed tomography(ECT) and lip biopsy, and found positive antinuclear antibodies (1:320), atypical xerophthalmia, impaired intake and excretion of bilateral salivary glands and degree II of lip biopsy. The patient received methylprednisolone and antiviral therapy, which showed very good outcome. ConclusionsClinically primary Sjögren Syndrome (pSS) combined with trigeminal lesion is common, but cases of pSS with trigeminal involvement as initial symptom have rarely been reported, which is easy to misdiagnose. This case suggested that the signs of simple trigeminal lesion, especially those with atypical manifestations, could be the early manifestation of other systemic diseases. Attention should be paid to identification of the pathogeny of the primary disease to achieve early identification, diagnosis and treatment.

Immediate and Long-Term Outcomes of Microvascular Decompression for Mixed Trigeminal Neuralgia

Classic trigeminal neuralgia (TN) involves sharp, shooting pain in any trigeminal nerve distribution, whereas atypical TN presents with constant aching, numbness, or burning that can appear with classic features, leading to a mixed presentation. Microvascular decompression (MVD) is an effective treatment for classic TN, but its utility in treating mixed TN has been less well studied. We retrospectively studied 73 adult patients with mixed TN and 386 patients with classic TN who underwent MVD between December 2007 and October 2016. Recorded variables included demographic data, graded radiologic and intraoperative findings, and graded pain outcomes in the immediate postoperative period (up to 3 months after MVD) and during long-term follow-up. The mean age of the 73 patients with mixed TN was 53.2 years. In terms of immediate postoperative outcomes, 67 patients (91.8%) experienced pain relief including improvement of atypical pain, whereas 6 patients (8.2%) had no pain relief. Having a preexisting pain syndrome (P= 0.001) or distortion of the trigeminal nerve intraoperatively (P= 0.001) was associated with poor surgical outcome in the patients with mixed TN. The mean duration of follow-up was 20.6 months. Forty-four patients (60.3%) developed recurrence of any TN pain. In comparison, 93% of the patients with classic TN experienced pain relief in the immediate postoperative period, and the recurrence rate was 19.9% in these patients. Patients with mixed TN suffer from both classic and atypical TN symptoms. Following MVD, 91.8% of our patients with mixed TN reported partial or complete pain relief, including improvement of atypical pain, in the immediate postoperative stage, compared with 93% of those with classic TN. Recurrence eventually developed in 60.3% of the patients with mixed TN.

Sphenopalatine ganglion radiofrequency ablation for management of atypical trigeminal neuralgia

Sphenopalatine ganglion radiofrequency ablation for management of atypical trigeminal neuralgia

Extensive Craniocervical Abscess after Transoral Ganglionic Local Opioid Analgesia at the Superior Cervical Ganglion for Atypical Trigeminal Neuralgia: Report of a Severely Complicated Case

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. This severe complication challenges the role of transoral infiltration therapies in analgetic medicine.