Idiopathic Neuralgia Research Articles

The impact of needle location on clinical outcome of radiofrequency rhizotomy for trigeminal neuralgia.

Radiofrequency thermocoagulation trigeminal rhizotomy (RT-TR) through the foramen ovale is a minimally invasive treatment for trigeminal neuralgia. Navigation of magnetic resonance imaging (MRI) and CT fusion imaging is a well-established method for cannulation of the Gasserian ganglion. In this study, we use the inline measurements from fusion image to analyze the anatomical parameters between the actual and simulation trajectories and compare the short- and intermediate-term outcomes according to determinable factors. The study included thirty-six idiopathic neuralgia patients who had undergone RT-TR with MRI and CT fusion image as a primary modality or repeated procedures. Among thirty-six treated patients, the inline length of the trigeminal cistern was longer for the simulated trajectory (8.4 ± 2.4 versus 6.5 ± 2.8 mm; p < 0.05), and the predominant structure at risk extrapolated from the inline trajectory was the brainstem, which signified a more medially directed route, in contrast with the equal weighting of temporal lobe and brainstem for the actual trajectory. The preoperative visual analogue scale (VAS) was 9.3 ± 1.0, which decreased to 2.5 ± 2.6 and 2.9 ± 3.1 at first (mean, 3 months) and second (mean, 14 months) postoperative follow-up, respectively. The postoperative VAS scores at the two follow-ups were not statistically significant without a covariate analysis. After adjustment for covariate risk factors, the second follow-up sustained therapeutic benefit was evident in patients with no prior history of related treatment, an ablation temperature greater than 70 °C, and needle location within or adjacent to the trigeminal cistern. This preliminary study demonstrated that the needle location between cistern and ganglion also plays a significant role in better intermediate-term results.

Хроническая нейропатическая лицевая боль при поражении черепных нервов: клиника, диагностика, лечение

The purpose — to study of the features of chronic neuropathic facial pain associated with cranial nerve damage. Material and methods. We studied the modern works on the features of the clinic, diagnosis and treatment of chronic orofacial pain caused the cranial nerves damage. Special attention was paid to the methods of diagnosing neuropathic facial pain of various etiologies, and identifying clinical variants of their course. Results. The best known and most common variant of neuropathic orofacial pain is trigeminal neuralgia. There are classic trigeminal neuralgia that occurs as a result of vaso-neural conflict, secondary trigeminal neuralgia (in multiple sclerosis, voluminous brain neoplasm, etc.), and idiopathic trigeminal neuralgia. Patients have short-term (from fractions of a second to 2 minutes) unilateral paroxysmal facial pain in classic trigeminal neuralgia. In case of secondary trigeminal neuralgia, mainly bilateral neuropathic pain is detected. Painful trigeminal neuropathy (trigeminal neuropathic pain other than trigeminal neuralgia) is caused by trauma and herpes zoster with acute neuropathic pain. After 3 months, painful manifestations after the herpes zoster are qualified as trigeminal postherpetic neuralgia. Post-traumatic neuropathic trigeminal pain is the result of external trauma or iatrogenic damage resulting from dental treatment or neuroablation procedures. Both classical and secondary, idiopathic neuralgia of the glossopharyngeal nerve is characterized by unilateral short-term stabbing pain in the ear, base of the tongue, tonsil region, posterior part of the pharynx; it is less common, in contrast to trigeminal neuralgia. Intermediate nerve neuralgia was first described in 1907 by Hunt; it is rare, manifests itself as unilateral, shooting, paroxysmal pain in the ear canal and temporal areas. Painful neuropathy of the intermediate nerve (Ramsey — Hunt syndrome) with herpes zoster is characterized by dull, persistent pain that occurs inside the ear canal, auricle or mastoid. Rarely, tumors of the face can be the cause of Ramsey — Hunt syndrome. Conclusion. Thus, chronic neuropathic facial pain associated with facial nerves damage has a varied etiology, which requires careful differential diagnosis and selection of adequate treatment tactics.

Clinical and Radiological Profile of Trigeminal Neuralgia- A Retrospective Study

Introduction: Trigeminal neuralgia is described as severe, stabbing unilateral pain along the distribution of trigeminal nerve branches. The three subtypes include- Classical, secondary and idiopathic. Aim: To study the clinical profile, presentation and radiological imaging features in trigeminal neuralgia patients. Materials and Methods: This cross-sectional study included outpatient medical records of 60 trigeminal neuralgia patients between June 2015 to June 2020 (five years) in a Tertiary care Medical College Hospital. Various parameters studied were: (a) Age; (b) Gender; (c) Dental treatment; (d) Pain severity; (e) Trigger factors; (f) Side and branch involved; (g) Sensory abnormalities; (h) MRI. Data was entered in Microsoft excel and analysed using SPSS statistical software 20.0. Chi-square test was used for categorical variables. Results: Among the 60 patients studied, the common demographic and clinical features were as follows: 34 were females (56.7%); 36 with right side presentation (60%); 25 had maxillary nerve division distribution (41.7%); 57 patients experienced shock/lancinating pain (95%); and 40 had numeric pain severity scale of 4-6 (66.7%). Classical Trigeminal Neuralgia was the most common subtype seen in 31 patients (51.7%). Involvement of dual divisions (maxillary and mandibular), absence of trigger factors and presence of hypoesthesia were more suggestive of Secondary Trigeminal Neuralgia (p&lt;0.05). Based on MRI imaging, 31 (51.7%) showed neurovascular compression with atrophy or displacement of trigeminal nerve root. Only 5 (8.4%) had secondary causes (schwannoma, meningioma, demyelination, infarct). Conclusion: The key clinical features of trigeminal neuralgia include female preponderance, right side presentation, maxillary nerve division distribution, shock/lancinating pain with touch and breeze as common trigger factors. As some of them had a previous dental treatment or procedure, dentists need to be aware of this entity. Certain clinical features would help to differentiate the secondary from classic and idiopathic neuralgia subtype.

Sonographically Guided Cryoneurolysis

Chronic peripheral nerve pain is a common problem that can arise from numerous causes, for which neurolysis is a therapeutic option. It is postulated that cryotherapy will have less adverse events than other methods of nerve ablation. A retrospective case series review was performed in patients who had undergone sonographically guided cryoneurolysis for Morton neuromas, postsurgical and posttraumatic neuromas, and idiopathic neuralgia. Fifteen of 20 patients had a positive response to cryoneurolysis, as did 2 of 4 patients with borderline symptoms for chronic regional pain syndrome. In view of our positive results, we believe that cryoneurolysis should be considered a reasonable option in performing neurolytic therapy.

Occlusion of maxillary artery in treatment of trigeminal neuralgia

This paper deals with a treating method of trigeminal neuralgia classified so far as idiopathic neuralgias and treated conservatively. The study was aimed at proving the compression of peripheral branches of N. trigeminus in those patients by vascular elements of A. maxillaris within the bone-ligament space of the scull and the face base. The study sample consisted of 76 patients having trigeminal neuralgia. The compression was proved by clinical examination, by angiography and electrophysiological investigations. Endovascular occlusion of A. maxillaris is the original method and it was carried out in selected patients. This method was applied in 76 patients. Embolisation was done in 71 patients by using occlusion spiral and gelfoan was used in 3 patients. Externa carotid artery ligation was done in 2 cases. The effect of absolute improvement has been achieved and verified by electrophysiological method and subjective assessment of the patients.

Sectioning the Sensory Auricular Branch of the Facial Nerve to Treat Recalcitrant Otalgia

To present a new surgical approach to treat idiopathic neuralgia of the sensory auricular branch of the facial nerve. : Three patients with chronic ear pain resistant to medical therapy. Sectioning of the sensory auricular branch of the facial nerve along its course at the posterior wall of the external auditory canal by a retroauricular mastoidectomy approach. Resolution of otalgia. All the patients were relieved of their pain at their first follow-up visit, and they have remained symptom-free. The patients were followed at least for 1 year. The surgical treatment of idiopathic otalgia should be reserved for patients in whom medical treatment has failed. Finding the exact location of the ear pain is of utmost importance for a favorable outcome after surgery. If the origin of the otalgia is found to be the sensory auricular branch of the facial nerve, the section of this nerve offers favorable outcomes with no morbidity.

Neurotrophins play an important role in the perineural invasion and distant metastasis of malignant tumor

Neurotrophins (NTs) family was first discovered in nervous system and it regulates the proliferation and differentiation of many neural cell types in the peripheral and central nervous system. Due to their perineural invasive characters, certain part of malignant tumor cases was first diagnosed because of nerve paralysis or idiopathic neuralgia caused by perineural invasion. For this reason, the study on the association between NTs and perineural invasion of malignant tumor aroused the attention of many researchers. Increasing evidence indicates that NTs and their receptors, Trks, play important roles in malignant cells, especially the exhibiting perineural invasive phenotype. It was suggested that NTs produced by neural tissue can act as a chemotactic factor, and tumor cells in which the overexpression of Trks' exists seem to be selected to invade the perineural space. Except for contributing to perineural invasion of malignant tumor, accumulated evidence proved NTs now also significantly associated with the metastasis of malignant tumor. Overexpression of NTs or Trks often correlated with the tumorigenesis, angiogenesis and anoikis resistance in these malignancies, contributing significantly to the metastasis and poor prognosis. In summary, besides its role in development and function of nervous system, NTs also play an important role in the perineural invasion and metastasis of malignant tumor. Considering the role that NTs played in malignant tumor, we believe that further studies between NTs and malignant tumor are necessary. Research on the role of NTs pathway might allow advancements in this field.

Verbesserung der Diagnostik und Therapie der Glossopharyngeusneuralgie

Differential diagnosis of neuralgias affecting the cranial nerves and of facial pain is often difficult. Glossopharyngeal neuralgia is much less common than trigeminal neuralgia and is not well known. Idiopathic neuralgia of the glossopharyngeal nerve sometimes occurs in association with neurovascular compression syndrome of the vagus and trigeminal nerves. High-resolution MRI of the brain stem with three-dimensional visualization allows a secure diagnosis of neurovascular compression and is useful in the planning of appropriate microsurgical decompression (Jannetta's operation).

Atlantoaxial Joint Syndrome Misconceived as an Idiopathic Neuralgia -A case report-

Although the atlantoaxial joint is the most common site of rheumatoid arthritis, our patient had no symptoms or signs suggestive of rheumatoid arthritis. The atlantoaxial joint is frequently involved in degenerative osteoarthritis, especially in elderly patients. An 81-year old man presented with severe intermittent electric shock like, lancinating pain from the occipital to the temporal and parietofrontal areas. He also had neck pain and a limited range of motion. After many examinations and laboratory tests, at the department of neurology and neurosurgery, he was diagnosed with idiopathic neuralgia. The diagnosis of atlantoaxial joint syndrome was confirmed, and treated successfully with atlantoaxial joint block.

Long-term results of surgical treatment of idiopathic neuralgias of the glossopharyngeal and vagal nerves.

Physicians disagree about the best surgical treatment for patients with idiopathic neuralgias of the glossopharyngeal and vagal nerves after medical treatment has failed. Some favor percutaneous thermal rhizotomy, and other prefer extracranial section of the glossopharyngeal or branches of the vagal nerve, intracranial section of the glossopharyngeal and upper vagal rootlets, or microvascular decompression. However, the results of these procedures are limited to series with follow-up periods of less than 5 years or to series with longer follow-ups that were performed before the microneurosurgical era. We reviewed the long-term results of 14 patients with vagoglossopharyngeal neuralgia treated surgically at our center between 1976 and 1987 to determine the best treatment. Sixteen procedures were performed: 2 percutaneous thermal rhizotomies; 2 extracranial sections of the superior laryngeal nerve; and 12 intracranial glossopharyngeal and upper vagal rhizotomies, 4 with and 8 without microvascular decompression. The follow-ups ranged from 4 to 17 years (mean, 10 yr). All 14 patients who underwent percutaneous or intracranial rhizotomies were pain free. Two patients who underwent percutaneous rhizotomies developed persistent dysphagia and hoarseness. Both patients who underwent extracranial nerve section experienced pain recurrence 2 and 4 years later. Of 12 patients who underwent intracranial section of the glossopharyngeal and upper vagal rootlets, 2 developed dysphagia, which resolved completely in 1 patient and persisted mildly in the other; 1 had transient hoarseness; and 2 developed frequent coughing episodes, which persisted in 1 patient and resolved completely in the other. Side effects due to motor vagal deficits may be eliminated by intraoperative monitoring.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term Results of Surgical Treatment of Idiopathic Neuralgias of the Glossopharyngeal and Vagal Nerves

PHYSICIANS DISAGREE ABOUT the best surgical treatment for patients with idiopathic neuralgias of the glossopharyngeal and vagal nerves after medical treatment has failed. Some favor percutaneous thermal rhizotomy, and others prefer extracranial section of the glossopharyngeal or branches of the vagal nerve, intracranial section of the glossopharyngeal and upper vagal rootlets, or microvascular decompression. However, the results of these procedures are limited to series with follow-up periods of less than 5 years or to series with longer follow-ups that were performed before the microneurosurgical era. We reviewed the long-term results of 14 patients with vagoglossopharyngeal neuralgia treated surgically at our center between 1976 and 1987 to determine the best treatment. Sixteen procedures were performed: 2 percutaneous thermal rhizotomies; 2 extracranial sections of the superior laryngeal nerve; and 12 intracranial glossopharyngeal and upper vagal rhizotomies, 4 with and 8 without microvascular decompression. The follow-ups ranged from 4 to 17 years (mean, 10 yr). All 14 patients who underwent percutaneous or intracranial rhizotomies were pain free. Two patients who underwent percutaneous rhizotomies developed persistent dysphagia and hoarseness. Both patients who underwent extracranial nerve section experienced pain recurrence 2 and 4 years later. Of 12 patients who underwent intracranial section of the glossopharyngeal and upper vagal rootlets, 2 developed dysphagia, which resolved completely in 1 patient and persisted mildly in the other; 1 had transient hoarseness; and 2 developed frequent coughing episodes, which persisted in 1 patient and resolved completely in the other. Side effects due to motor vagal deficits may be eliminated by intraoperative monitoring. Of these 12 patients, 11 (92%) rated the procedure as excellent and 1 (8%) rated the procedure as good. We conclude that intracranial section of the glossopharyngeal and upper vagal rootlets is an effective and safe procedure in treating vagoglossopharyngeal neuralgia; microvascular decompression is a surgical adjunct for treating patients with significant compression of the lower vagal rootlets. Percutaneous thermal rhizotomy and extracranial section of the glossopharyngeal or vagal nerves should be restricted to those who cannot tolerate an open intracranial procedure.

Arnold's idiopathic neuralgia: Surgical treatment, exploration in the trigger point at the basis of the neck

Our purpose was to determine the effects on acute radiation sickness of interrupting afferent neural pathways that converge upon the medullary vomiting center but which bypass the emetic chemoreceptor trigger zone in the area postrema. A comparison was made of the vomiting response and other signs of sickness in three groups of chronic cats surgically prepared as follows: high spinal cord section of the dorsal columns, subdiaphragmatic vagotomy, and the combination of procedures. Every cat was exposed over the whole body to 45 Gy 60Co γ-radiation which was effective in evoking emesis in 11 of 12 normal cats. Neither cordotomy alone (8 cats) nor vagotomy alone (2 cats) reliably blocked the vomiting response but they separately delayed its onset. On the other hand, the cordotomy prevented the loss of appetite and behavioral malaise that was invariably caused by the irradiation in normal cats. Finally, the combination of cordotomy and vagotomy protected all of 3 cats against the entire radiation syndrome. These cats then vomited appropriately in response to the injection of deslanoside which induces emesis through an action on the area postrema. Histological examination of the lower medulla revealed no damage of the area postrema resulting from the cordotomies. We conclude that acute radiation sickness in the cat is signaled through afferent neural pathways originating in the abdomen and that the area postrema does not participate in the causation of this syndrome.

Surgical treatment of glossopharyngeal neuralgia and pain from cancer of the nasopharynx. A 20-year experience.

The outcome is summarized for 14 cases operated on for glossopharyngeal neuralgia, with both open and percutaneous rhizotomy techniques, between 1960 and 1984. Four patients, all with primary neuralgia, underwent open surgery. Pain disappeared, leaving only a ninth nerve deficit in all but one patient; in that patient, paroxysms of pain recurred after 3 years, mediated by the nervus intermedius. Five other patients with idiopathic neuralgia and five patients with pain secondary to carcinoma underwent percutaneous procedures. Seven patients who had retrogasserian percutaneous rhizotomy for associated trigeminal neuralgia were also pain-free. No mortality or morbidity resulted from either type of procedure.