Cases Of Trigeminal Neuralgia Research Articles

Chiari type 1.5 malformation as a cause of secondary trigeminal neuralgia: case report and literature discussion

BackgroundChiari syndrome is a very rare cause of secondary trigeminal neuralgia (TN). There are a few cases of TN associated with Chiari syndrome in the literature, and all of these cases were reported as Chiari type 1. In this report, we present a case of secondary trigeminal neuralgia caused by Chiari type 1.5 for the first time unlike the literature.Case presentationA 38-year-old male patient, who had frequent and severe attacks of pain under the orbit, at the chin and rim of the mouth, was evaluated with craniocervical Magnetic Resonance Imaging (MRI) and revealed Chiari type 1.5 malformation and syringomyelia.ConclusionsThe mechanism of TN associated with Chiari malformation is unclear. However, the main concepts emphasized in cases presented in the literature are compression and stretching. The rapid relief of pain after decompression surgery in these cases also supports this situation. It can be predicted that compression and tension forces will become more pronounced in Chiari type 1.5 malformation, in which the brainstem elongation and ventral pressure are more prominent. Decompression of the foramen magnum provides rapid and effective pain control in the treatment of TN accompanying Chiari 1.5 syndrome that does not respond to medical treatment.

Applying the Full Endoscopic Keyhole Technique to CPA Lesions: A Single-Center Study.

In recent years, endoscopy has become an increasingly common tool used during neurosurgical procedures. However, its application in treating cerebellopontine angle (CPA) lesions has not progressed as rapidly. In this study, the authors present their initial experience with surgically treating CPA lesions using a fully endoscopic keyhole retrosigmoid approach. They conducted a retrospective analysis of clinical data from patients who underwent endoscopic keyhole CPA surgery at their center between May 2017 and April 2022. They provide a comprehensive explanation of this method and an overview of the strategies that have been developed to achieve better clinical outcomes. The study included 107 patients, consisting of 10 cases of vestibular schwannoma, 21 cases of epidermoid cyst, 32 cases of trigeminal neuralgia, and 44 cases of hemifacial spasm. The authors analyzed the clinicodemographic details of the patients. Among the 31 tumor cases, gross total resection was achieved in 25 patients (80.6%), while near-total resection was performed in 6 patients (19.4%). In patients with trigeminal neuralgia, facial pain resolved in 31 out of 32 patients (96.9%). Similarly, facial convulsions disappeared or were relieved in all 44 patients (100%) with hemifacial spasms after the operation. Postoperative complications included facial nerve paresis (n=9, 8.4%), with improvement observed in 6 cases during follow-up, transient facial hypoesthesia (n=3, 2.8%), cerebrospinal fluid rhinorrhea (n=3, 2.8%), transient abducens paresis (n=1, 0.9%), and postoperative hemorrhage (n=1, 0.9%). Endoscopy provides improved deep illumination and, combined with close-up observation, enhances the visualization of structures within the CPA region. The fully endoscopic keyhole technique is a safe and effective method for managing CPA lesions.

Intraoperative application of indocyanine green and temporary venous occlusion test to assess collateral flow during microvascular decompression for venous-related trigeminal neuralgia: illustrative case.

In microvascular decompression (MVD) for vein-related trigeminal neuralgia (TN), determining whether transection of the offending vein is safe can be challenging. Here, the authors present a case of vein-related TN successfully treated by sacrificing the offending vein on the basis of findings from indocyanine green (ICG) video angiography and a temporary venous occlusion test to assess the collateral flow of the offending vessel. A 43-year-old man presented with TN, which had failed to respond to previous medical therapy. Gadolinium-enhanced magnetic resonance imaging (MRI) revealed that the transverse or superior petrosal vein was the offending vein. The patient underwent MVD. Because the transposition of the offending vein was anatomically challenging, a temporary vein occlusion test was performed using ICG video angiography. During and after temporary occlusion, bidirectional flow in the offending vein was observed, suggesting collateral flow even after vein occlusion. On the basis of these findings, the offending vein was transected, resulting in relief from pain without any complications. Postoperative MRI revealed no new lesions in the brainstem or the cerebellar hemisphere. The patient has been free from neuralgia for 6 months. The temporary vein occlusion test under ICG video angiography was useful for evaluating collateral flow in the offending vein in TN.

352 Outcomes After Microvascular Decompression for Sole Arterial Versus Venous Compression in Trigeminal Neuralgia

INTRODUCTION: In most cases of trigeminal neuralgia (TN), the trigeminal nerve is compressed by the arterial vasculature. METHODS: We retrospectively reviewed all patients undergoing microvascular decompression at our institution, identifying patients with either sole arterial or venous compression. We dichotomized patients into arterial or venous groups and obtained demographics and postoperative complications for each case. Barrow Neurological Index (BNI) pain scores were collected preoperatively, postoperatively, and at final follow-up, as well as recurrence of pain. Differences were calculated via Chi-squared tests and t-tests. Ordinal regression was used to account for variables known to influence TN pain. Kaplan-Meier analysis was used to determine recurrence-free survival. RESULTS: Of 1044 patients, 642 (61.7%) had either sole arterial or venous compression. 472 of these cases demonstrated arterial compression, and 170 displayed sole venous compression. Patients in the venous compression group were significantly younger (p < 0.001). Patients with sole venous compression demonstrated worse preoperative (p = 0.04) and final follow-up (p < 0.001) pain scores. Patients with sole venous compression had significantly higher rate of pain recurrence (p = 0.02) and BNI score at pain recurrence (p = 0.04). On ordinal regression, venous compression was found to independently predict worse BNI pain scores (OR = 1.66, p = 0.003). Kaplan-Meier analysis demonstrated a significant relationship between sole venous compression and increased risk of pain recurrence (p = 0.03). CONCLUSIONS: TN patients with sole venous compression demonstrate worse pain outcomes following MVD compared to those with only arterial compression.

Peripheral mental neurectomy followed by obliteration of mental foramen with autogenous bone graft under local Anastasia: An effective and simple technique for trigeminal neuralgia to prolong the remission.

Trigeminal neuralgia (TN) is characterized by recurrent brief shock, stabbing pain of the oro-facial structures unilaterally. The treatment mainly depends upon patient’s condition and severity of the disease. Medical management comes usually first to start. Patient becomes refractive to the medical management with time. Peripheral neurectomy is an alternative, effective and simple method of procedure, in which the avulsion of a peripheral branch of the nerve. It is the simple method that can be performed under local anesthesia, gives excellent pain relief to the patient with minimal risk. But, one problem associated with this is the nerve regeneration, causing the recurrence of neuralgia. To avoid this, here we present a treated case of trigeminal neuralgia by peripheral neurectomy of mental nerve followed by plugging the mental foramen with the autogenous bone graft. It successfully prolonged the pain remission without any complications.

Successful Ayurveda Management of Trigeminal Neuralgia

Trigeminal Neuralgia (TN) is a neuropathic pain syndrome which is characterized by critical unilateral paroxysmal facial pain. TN is a chronic pain disorder that affects the trigeminal nerve Attacks of pain are usually stimulated by tactile irritation within the part of the trigeminal nerve. TN leads with disability and poor quality of life, even when patients are taking conventionally treatments. Case- A 71 years old man consulted in Out-patient department of Sanjeevani Hospital, DSRRAU, Jodhpur, with the complains of sudden pain like electric shock on right side of the head which gets aggravated on touch patient and so MRI was done which was suggestive of patient suffering with trigeminal neuralgia. In the present case report patient was considered suffering from Anantvata and was treated with 2 sittings of leech therapy with oral medications like Ekangveer Ras, Mahavatavidhvansan ras, a mixture of Ashwagandha Churna, Bala churna, Godanti bhasma and Dashmool kwath with Anutaila Nasya, were also added to the treatment and the same continued for three months. According to symptoms, patient was diagnosed with TN. As per the outcomes, we can say that the cases of TN can be successfully managed with Ayurvedic treatment only and no surgical intervention is needed.

Management of a case of trigeminal neuralgia in pregnancy with radiofrequency ablation of the nerve

WHO in a publication about neurological disorders states, “adequate pain treatment is a human right and it is the duty of every health care system to provide it.” Pregnancy being a hyperestrogenic state, is a predisposing factor, for Trigeminal Neuralgia. Trigeminal neuralgia is a debilitating condition that causes serious morbidity to the patient, thus hampering the daily activities of a patient. Thus, it becomes imperative to effectively manage and treat patients with trigeminal neuralgia. Various treatment regimens are being practised to manage trigeminal neuralgia. Carbamazepine is the drug of choice but being teratogenic, it can not be used during pregnancy. Radiofrequency ablation is another treatment modality for treatment of trigeminal neuralgia which is safer compared to the medical management.

Efficacy andsafety ofpercutaneous balloon compression forbilateral trigeminal neuralgia: a retrospective study.

Percutaneous balloon compression (PBC) of the Gasserian ganglion is steadily gaining traction within the trigeminal neuralgia (TN) community. Bilateral trigeminal neuralgia (BTN) is a rare condition, and its treatment remains challenging. As far as we know, there are currently no research reports on the treatment outcomes of PBC for BTN.The purpose of this study is to meticulously evaluate the efficacy and safety of PBC for BTN in our medical institution. In this retrospective study, we collected and analyzed the medical records of all patients with BTN who underwent the PBC procedure at the Department of Neurosurgery at Hebei General Hospital from July 2017 to July 2023. After undergoing PBC therapy, all patients were promptly assessed for treatment efficacy based on the modified Barrow Neurological Institute (BNI) pain intensity grading scale. All 37 patients with BTN experienced significant pain relief (BNI I-IIIb) immediately following unilateral PBC treatment. Among these patients, 25 reported relief from pain on the non-operative side, which was effectively managed with medication. Out of the 12 patients who did not experience improvement in contralateral symptoms, 11 received contralateral PBC. Out of the 48 treated sides, 47 sides (97.9%) achieved excellent pain control following a single PBC procedure. The follow-up times ranged from 2 to 62months. At the 1-year follow-up, 94.6% of the patients maintained excellent therapeutic outcomes.Three recurrent patients underwent repeated unilateral PBC, and all of them maintained excellent pain control postoperatively. At the last follow-up, satisfaction was at 91.7% (measured using the Likert scale), with no severe complications occurring. The results indicate that PBC is an effective and relatively safe method for treating BTN, offering a valuable option for pain control in these rare cases of TN.

Assessment of hemilateral pain and possible trigeminal neuralgia

Objective: To report a case of trigeminal neuralgia observed in a 52-year-old patient who had pre-diabetes and hypertension, fibromyalgia as previous comorbidities, and a surgical history of carpal tunnel syndrome correction. Case details: On September 30, 2022, the patient reported intense right-sided unilateral headache. The patient was on Metformin, Hydrochlorothiazide (HCTZ), and Losartan. For the treatment of possible trigeminal neuralgia, Carbamazepine was initially prescribed at a dose of 200 mg every 12 hours and later adjusted to 200 mg every 8 hours. It was found that the dose of 600 mg per day of Carbamazepine was more effective in relieving the intensity of the pain and improving the patient's mood. Additionally, the patient underwent a magnetic resonance imaging which revealed the presence of vascular branches near the cisternal portion of the bilateral trigeminal nerve, more evident on the right side, without compression. Finally, it is worth noting that adjustments were made to the anti-hypertensive medications. Final Considerations: Trigeminal neuralgia presents a significant pain component for the patient, with a compromise to their quality of life. Therefore, early diagnosis coupled with the introduction of medication in an adjusted dose becomes essential.

The first treatment option for secondary trigeminal neuralgia: open surgery versus stereotactic radiosurgery

Trigeminal neuralgia (TN) is a condition involving oro-facial pain that causes patients to suffer and significantly impacts their quality of life. TN can generally be classified into three categories: classical, secondary, and idiopathic. Among these, secondary TN, which accounts for approximately 15% of cases, is attributed to identifiable neurologic diseases such as tumors and multiple sclerosis. Although the clinical features of classical and secondary TN are similar, secondary TN should be treated individually based on its underlying pathology. This paper presents a case of secondary TN induced by meningioma. The patient underwent Gamma Knife radiosurgery twice but showed no improvement in symptoms, ultimately leading to surgical removal of the tumor. The diagnosis-to-surgery time was 2 years. This case report discusses the first-line treatment options for secondary TN, with a focus on symptom relief.

The Correlation between Trigeminal Neuralgia and Local Anesthetics Neurotoxicity Associated with Acute Inflammation: A Cross-sectional Study

Background: Trigeminal neuralgia (TN) represents a subject of importance in oral medicine due to the large number of patients complaining of TN who are aware that the orofacial pain has a dental origin and therefore seek initial care from the dentist. The reasons for the majority of TN cases remain controversial, but nearly 10% of patients have an obvious pathological condition, such as intracranial pathology. Aim: This study aimed to assess the correlation between idiopathic trigeminal neuralgia and local anesthetic overdose and/or repeated injections caused by dental malpractice. Patients and Methods: An adequate sample of thirty-four patients was selected from the teaching clinic of oral medicine in the College of Dentistry, the University of Karbala, Iraq. All patients were fit for the inclusion criteria and subjected to a thorough oral examination to exclude any organic diseases that cause orofacial pain. Also, they were subjected to a medical examination by multiple neurologists using magnetic resonance imaging and other medical investigations to ensure that all patients did not suffer from intracranial pathology. Results: The patients were statistically distributed by their ages into two sub-groups. The first group (25-48 years old) represented 52.94% of all patients, and the second group (49-72 years old) included 47.06%. The percentage of disease according to sex was 79.4% in males and 20.6% in females. 3-6 dental carpules containing lidocaine (2%) with epinephrine were given to patients. The data of the studied sample were analyzed by using the statistical package of social sciences (SPSS) version 25. The chi-square test was used to test the effect of the type of dental procedure before pain in the two age groups and the two sex groups. For the age group, the difference was significant (p-value < 0.05), which indicated an increased incidence of nerve damage caused by local anesthesia in older patients. For the sex group, the chi-square test exhibited a value of 2.45, with no significant difference (p-value > 0.05). The main theory suggested for the occurrence of local neuropathies and the initiation of TN was the demyelination of nerve, which may be due to the neurotoxic effects of local anesthesia administered at high concentrations and for prolonged exposure times (repeated injections at the site of the dental infection after failure of LA) that may activate the intrinsic pathway of apoptosis through cytochrome C release. The local anesthetic-related neurotoxicity has thus been found to have harmful effects on the nerve tissue, including demyelination and axonal degeneration. Conclusion: The malpractice of local anesthesia in dentistry may lead to dysesthesia, allodynia, and trigeminal neuralgia with different degrees and severity due to the neurotoxicity of the peripheral nerve fiber. The nerve damage may occur in many forms, such as demyelination, apoptosis, axonal degeneration, and hypoxia due to thrombosis. So, dentists should recognize the risk of repeated injections or high dose solution (4%) of LA in the inflamed tissues when inducing analgesia for their dental operations that might initiate the primary trigeminal neuralgia.

A Systematic Review of the Role of Magnetic Resonance Imaging in the Diagnosis and Detection of Neurovascular Conflict in Patients With Trigeminal Neuralgia.

Trigeminal neuralgia (TN) is a debilitating disorder causing severe, episodic, unilateral stabbing facial pain disturbing enough to disrupt the activities of daily life. Classic TN is caused due to compression injury of the trigeminal nerve at the cistern segment caused by either an artery or a vein, referred to as neurovascular contact or conflict (NVC). Magnetic resonance imaging (MRI) has been the standard tool for the diagnosis of NVC. This study aimed to determine the incidence of NVC in TN, as identified by MRI, assess the various MRI grading patterns among patients with TN, and identify the vessels primarily involved in NVC. A systematic search of studies that used MRI for the diagnosis of TN in reference to NVC was conducted on DOAJ and PubMed/PubMed Central. Data were extracted and entered into a Microsoft Excel spreadsheet. The outcomes measured were the incidence of NVC as shown in MRI, vessels involved in NVC, and MRI grading patterns. We identified and selected 20 studies that fulfilled inclusion/exclusion criteria. In total, 1,436 patients were enrolled in all included studies. The type of MRI used was 1.5 T or 3 T MRI. The mean age of the patients varied from 49 to 63 years, with an equivalent male-to-female ratio. NVC was seen in 1,276 cases out of 1,436 cases (88.85%) of TN on the ipsilateral side, as shown by MRI. The vessels involved were arteries in 80-90% of the cases, followed by veins. Among the arteries, the superior cerebellar artery was the most common artery (80-90% of cases). The grades of NVC as assessed by MRI included grades I, II, and III with varied proportions in different studies. NVC is a common problem in TN, wherein there is compression at the nerve root entry zone, and it shows a strong predilection for the elderly population. MRI seems to be a novel imaging diagnostic investigation to identify NVC associated with TN. Moreover, NVC grading must be done with MRI so that it may help the surgeon in stratifying the patient's treatment.

Percutaneous balloon compression for trigeminal neuralgia due to the primitive trigeminal artery: A case report and review of the literature

Trigeminal neuralgia (TN) is often caused by vascular compression of the trigeminal nerve cisternal segment. TN due to the primitive trigeminal artery formed by developmental variants of cerebral vessels is rare. We report here a 59-year-old male with TN whose preoperative MRI showed a primitive trigeminal artery that compressed the trigeminal nerve, and microvascular decompression (MVD) was performed to separate the vessel from the trigeminal nerve cisternal segment. The pain was relieved after MVD, but it recurred two months later. MRI reexamination showed that although MVD relieved the vascular compression of the trigeminal nerve cisternal segment, the nerve in the Meckel’s cave was still compressed by PTA, which was thought to be the cause of TN recurrence. Due to the limitations of the surgical microscope view, completing the vascular decompression at the Meckel’s cave is challenging. So percutaneous balloon compression was performed. After the procedure, the TN subsided. The patient remained pain free at one year follow-up. To our knowledge, this is the first case of primitive trigeminal artery-associated TN treated by percutaneous balloon compression. This case suggests that percutaneous balloon compression may be considered for TN caused by compression of the primitive trigeminal artery when MVD is difficult to perform.

Questionnaire for Dental Practitioners to Screen for Trigeminal Neuralgia.

Objective Trigeminal neuralgia (TN) is a neurological disorder that often presents as severe toothache. The majority of TN patients visit dental clinics first, so TN represents a potential pitfall for dental practitioners. This report describes the development of a trigeminal neuralgia questionnaire (TNQ), assessing 10 characteristics of TN, to assist dentists in screening for TN in dental clinics, and evaluates the effectiveness of TNQ. Materials and Methods Fifty-three patients who visited the TN outpatient department in our institute and completed the TNQ were included in this study. All patients were examined by two neurosurgeons and neuroimaging was performed. Statistical Analysis Patients were classified into a TN group and a non-TN group. TNQ score was retrospectively compared between groups. Furthermore, history and characteristics of TN were investigated in the TN group to clarify the status of the reference situation. Results Thirty-seven cases were assigned to the TN group, and 16 cases to the non-TN group. Mean TNQ score was 8.3 in the TN group and 6.6 in the non-TN group. Setting a TNQ cutoff score of 7 offered 91% sensitivity and 56% specificity for TN. Investigation of the history of the present illness indicated that 39.2% of TN cases were improperly triaged and referred from initial dental clinics, and interdisciplinary practice was insufficient. Conclusion TNQ offers a reliable, convenient method to triage TN patients, and may assist dentists in screening for TN. Multidisciplinary practice is necessary for total management of TN and the TNQ is expected to connect dentists and TN specialists.

Stereotactic Radiosurgery for Medically Refractory Trigeminal Neuralgia Secondary to Stroke: A Systematic Review and Clinical Case Presentation

Trigeminal neuralgia (TN) is a paroxysmal, unilateral, brief, shock-like pain in ≥1 divisions of the trigeminal nerve. It can result from multiple causes; however, TN secondary to stroke is very rare. We present the case of TN secondary to pontine infarction treated with incremental doses of neuropathic pain medication for >5 years before conservative management failed. He was then treated with stereotactic radiosurgery (SRS). Additionally, we conducted a systematic review using standard PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines for all the cases of TN with brainstem stroke from 1976 to2022. Our patient was an 82-year-old man. Magnetic resonance imaging demonstrated a pontine lesion consistent with stroke. The Barrow Neurological Institute (BNI) score at presentation was 5. He received a marginal dose of 60 Gy to the 80% isodose line in a single fraction to a volume of 0.05 cm3. The immediate post-treatment BNI score was 0 and remained at 0 for 3 months, when he experienced recurrence. The recurrence was treated with oxcarbazepine. His pain remained well controlled with a lower dose of oxcarbazepine, and he had no adverse effects at 1 year of follow-up with a BNI score of 3. The systemic review identified 21 case reports with a combined cohort of 25 patients with TN secondary to stroke. Only 3 patients were treated with SRS, 2 of whom reported symptom improvement at 6 months and 8 months of follow-up with no adverse events. Our case and literature review demonstrate durable and effective treatment with SRS, which can be considered a safe and effective treatment option for patients with stroke-associated TN.

Trigeminal Nerve Isolation Application in Microvascular Decompression for Treating Trigeminal Neuralgia: A Retrospective Study.

This study aimed to compare the outcomes of trigeminal nerve isolation (TNI) with conventional microvascular decompression (CMVD) in cases of trigeminal neuralgia (TN). We retrospectively reviewed 143 TN cases who underwent microvascular decompression from January 2017 to January 2020. The surgical management of TNI or CMVD in all patients was randomized. The cases were divided into two groups, one group underwent a TNI and the other one received CMVD. The general data, postoperative outcomes, and complications were reviewed retrospectively. Cases with a narrow cistern of cerebellopontine, short trigeminal nerve root, and arachnoid adhesion were defined as difficult cases. All of the cases were followed up for at least 1 year. Surgical outcomes were assessed and compared between the two groups. In results, we found no significant differences in the general data, duration of hospitalization and blood loss between the two procedures. However, of the 143 cases, 12 cases (17.1%) recurred after surgery in the CMVD group, and four cases (5.5%) recurred after TNI operation. The rates of pain relief were 69 (94.5%) in the CMVD group, and 58 (82.9%) for TNI ( P =0.027). In the TNI group, there was only one difficult case among four no pain-relief cases, while in the CMVD group, 10 difficult cases were found among the 12 no pain-relief cases ( P =0.008). In conclusion, the TNI technique is more effective than the CMVD procedure and could also be performed on patients with classical TN. Future double-blind and randomized controlled trials are necessary to confirm this result.

Transnasal Neuro-Prolozone for the Management of Trigeminal Neuralgia; Dramatic and Long-Term Relief of a Novel Technique

We report two cases of trigeminal neuralgia, dramatically relieved with transnasal neuro- prolozone infiltration of the sphenopalatine ganglion. To be mentioned, we are the first to describe this technique in the treatment of trigeminal neuralgia. The two cases had a history of trigeminal neuralgia for more than 2 years, refractory to pharmacological treatment. Case one is a 63 year-old female, with a 5-year history of trigeminal neuralgia. This patient reported a history of hypertension and atrial fibrillation. The second patient, a 33 year-old male, had a 2-year history of trigeminal neuralgia, and a reported history of type-1 diabetes and ischemic heart disease (IHD). No side effects were reported, along the 6-month follow- up period. The Penn Facial Pain Scale Revised (Penn-FPS-R) was conducted to assess pain interference with the quality of life in the included patients, 1-week before injection, 5 minutes, 15 minutes, one week, 4 weeks and 6 months after injection. The patients’ satisfaction and pain intensity were assessed using the 11-point numeric rating scale (NRS) at the pre-defined time points. The two cases reported long-term improvement, regarding pain intensity and quality of life. In conclusion, transnasal neuro-prolozone infiltration is emerging as an effective, long-term and immediate-acting treatment modality for mitigating the burden of trigeminal neuralgia.

Predictive value of preoperative magnetic resonance imaging structural and diffusion indices for the results of trigeminal neuralgia microvascular decompression surgery

PurposeTo explore the predictive value of preoperative magnetic resonance imaging structural and diffusion indices of the spinal trigeminal tract (SpTV) on the results of microvascular decompression (MVD) in patients with trigeminal neuralgia (TN).MethodsThis retrospective study included patients diagnosed with TN and treated with MVD in the Jining First People’s Hospital between January 2020 and January 2021. The patients were divided into good and poor results groups according to postoperative pain relief. Logistic regression analysis was performed to explore independent risk factors for poor results of MVD, and their predictive value was examined using receiver operating characteristic (ROC) curves.ResultsA total of 97 TN cases were included, 24 cases with a poor result and 73 with a good result. They were comparable in demographic characteristics. Fractional anisotropy (FA) was lower (P < 0.001), and radial diffusivity (RD) was higher (P < 0.001) in the poor result group compared to the good result group. Patients in the good result group showed a higher proportion of grade 3 neurovascular contact (NVC) (39.7% vs. 16.7%, P = 0.001) and a lower RD (P < 0.001). The multivariate analysis showed that the RD of SpTV (OR = 0.000016, 95% CI: 0.000–0.004, P < 0.001) and NVC (OR = 8.07, 95% CI: 1.67–38.93, P = 0.009) were independently associated with poor results. The area under the curve (AUC) of RD and NVC were 0.848 and 0.710, and their combination achieved an AUC of 0.880.ConclusionNVC and RD of SpTV are independent risk factors for poor results after MVD surgery, and combining the NVC and RD might achieve relatively high predictive value for poor results.

Hypnogenesis, Chronic Pain and Peircean Habit: Implications for Clinical Endeavors

This study’s objective is to discuss hypnogenesis parting from one of Erickson’s chronic pain cases, analyzing hypnogenesis involvement in iatrogenesis and in the therapeutic interventions. Hypnogenesis is a concept for how clinical relationships tend to reproduce the ideas and theories of the therapist in the subject’s subjectivity. In hypnotherapy, hypnogenesis is implicated in the relational nature of the hypnotic experience, addressing the difficulty in separation between fabricated and revealed realities. A case of trigeminal neuralgia is analyzed and discussed to illustrate the implications of hypnogenesis in iatrogenesis and its therapeutic potential for chronic patients. The study draws a theoretical possibility on how hypnogenesis highlights iatrogenesis by the neglect of the subject’s needs in clinical consultations. Then, the study demonstrates how Erickson uses hypnogenesis in the patient’s therapy, favoring her well-being. To approach hypnogenic communicational processes, Charles Peirce’s concept of habit and is utilized as a complex system of subjective processes.

A transformation of trigeminal neuralgia into SUNCT/SUNA: A case report and literature review

IntroductionTrigeminal neuralgia and Short-lasting Unilateral Neuralgiform Headache with Conjunctival injection and Tearing (SUNCT)/Short-lasting Unilateral Neuralgiform Headache Attacks with Cranial Autonomic Symptoms (SUNA) are characterized by similar clinical manifestations, which may lead to diagnostic confusion. However, the transformation of trigeminal neuralgia into SUNCT/SUNA is a rare phenomenon. This report describes a case of trigeminal neuralgia transformation into SUNCT/SUNA due to neurovascular compression and reviews all previously published cases of trigeminal neuralgia to SUNCT/SUNA transformation in the literature.Case presentationA 49-year-old Thai male patient presented with progressive right facial pain for a period of three months. One year prior, he developed trigeminal neuralgia along the maxillary branch of the trigeminal nerve, characterized by electrical shock-like pain in the right upper molar, exacerbated by eating. His symptoms were effectively managed with carbamazepine. Nine months later, he began experiencing recurrent electrical shock-like pain along the ophthalmic division of the right trigeminal nerve, accompanied by lacrimation, which failed to respond to continued treatment with carbamazepine. Three months prior to presentation, his symptoms evolved into SUNCT/SUNA, characterized by electrical shock-like pain in the right periorbital area and conjunctival injection, lacrimation. Neuroimaging revealed high-grade neurovascular compression of the right trigeminal nerve by the right superior cerebellar artery. The patient's symptoms resolved following microvascular decompression.ConclusionClinicians should be aware that patients with longer disease duration of trigeminal neuralgia who develop new neuralgic pain in the ophthalmic branch division with mild autonomic symptoms may be at risk for transformation into SUNCT/SUNA.