Treatment Of Neuralgia Research Articles

Efficacy and safety of subcutaneous injection of botulinum toxin in the treatment of Chinese postherpetic neuralgia compared to analgesics: a systematic review of randomized controlled trials and meta-analysis

Efficacy and safety of subcutaneous injection of botulinum toxin in the treatment of Chinese postherpetic neuralgia compared to analgesics: a systematic review of randomized controlled trials and meta-analysis

Relieving postherpetic neuralgia pain via gabapentin-loaded bigels as an auspicious topical drug delivery system.

Over the past decades, a substantial portion of the population worldwide has been infected with varicella zoster and most cases developed shingles. Unfortunately, shingles is usually accompanied by postherpetic neuralgia, which may persist for months to years after the resolution of the viral infection. Gabapentin is an orallygamma-aminobutyric acid analogue approved by the Food and Drug Administration to manage shingles postherpetic neuralgia. However, gabapentin shows nonlinear pharmacokinetics, with variable absorption and bioavailability along with its short half-life and long side effects that may include dizziness and somnolence, which calls for an appropriate topical dosage form. Bigels are unique semisolid dosage forms with boosted penetrability and satisfactory hydrophilic texture. The current work pointed to formulating gabapentin-loaded bigels for the treatment of postherpetic neuralgia, where the analysis and optimization of design were performed via Design-Expert®. The selected bigel (F5), incorporating 400mg Span 60, 1000mg Tween 80, and 1000mg Transcutol, displayed spherical nanosized particles with acceptable viscosity and spreadability. Subsequent topical application of the selected bigel on the skin of Wistar rats, F5, demonstrated a boosted accumulation of gabapentin in the skin similar to PLO gel but superior to the drug solution. Furthermore, a histopathological study demonstrated the biosafety of the selected bigel when applied topically. Accordingly, gabapentin-loaded bigel would be considered a potentially topical dosage form for the delivery of gabapentin for the management of postherpetic neuralgia.

ID: 325457 Combined Occipital Nerve and Cervical Spinal Stimulators for Treatment of Post-Lyme Occipital and Trigeminal Neuralgias

ID: 325457 Combined Occipital Nerve and Cervical Spinal Stimulators for Treatment of Post-Lyme Occipital and Trigeminal Neuralgias

Letter to the Editor Regarding “Benchtop and In Vitro Experiments of Novel Transform Stents for Trigeminal Neuralgia Treatment”

Letter to the Editor Regarding “Benchtop and In Vitro Experiments of Novel Transform Stents for Trigeminal Neuralgia Treatment”

Long-term effects of conventional radiofrequency in cases of trigeminal neuralgia

Objective: Trigeminal neuralgia (TN) is defined as severe, episodic pain occurring in one or more branches of the trigeminal nerve. Due to its long-term effect, radiofrequency thermocoagulation (RFT) is used as a first-line treatment. The first choice in the treatment of classical trigeminal neuralgia patients is medical treatment. Additionally, pregabalin and gabapentin are frequently used drugs. Surgical treatment is an option for Trigeminal Neuralgia that cannot be treated with medication, but there is no single method for this. Various surgical methods, such as Trigeminal Radiofrequency (RF) rhizotomy may be effective in treatment. Material and metods: The procedure is performed under operating room conditions and radiological imaging guidance. The patient is placed in the supine position, an IV line is established, and monitoring is initiated. After local field cleaning and sterile draping, optimal imaging is achieved using C-arm fluoroscopy with an ipsilateral 15° oblique and 30° caudal angle. A 22-gauge, 100 mm RF needle with a 5 mm active tip is directed towards the foramen ovale, and the tunnel view is checked. Results: In our study, the minimum age was 41 and the maximum age was 68. Additionally, 9 of the patients were female, and 2 were male. In our series, 9 patients had mandibular nerve involvement, and 2 had maxillary nerve involvement. In our series, 6 patients were using carbamazepine, 4 were using pregabalin, and 1 was using gabapentin. Medication treatment was discontinued in all patients after the procedure. As shown in Table 1, the VAS score decreased to 0 in 6 patients on the 15th day, to 2 in 4 patients, and to 1 in 1 patient. The VAS score exceeded 5 in 1 patient in the 2nd year and in 5 patients in the 4th year, and conventional RFT was repeated for these patients. The VAS score decreased to 0 in 6 patients on the 15th day, to 2 in 4 patients, and to 1 in 1 patient. The VAS score exceeded 5 in 1 patient in the 2nd year and in 5 patients in the 4th year, and conventional RFT was repeated for these patients. Pregabalin 75 mg was started for all patients between the recurrence of pain and the interventional procedure, and it was discontinued once the pain decreased after the procedure. No side effects were observed in the patients. Conclusion: The treatment of trigeminal neuralgia includes medical, surgical, and percutaneous interventional options. Conventional RF thermocoagulation is the first choice among other percutaneous interventional and surgical treatment options in TN treatment due to its selective lesion formation, minimally invasive nature, high success rate, low complication rate, and low cost.

Evaluation of the efficacy of ultrasound-guided maxillary and mandibular nerve pulsed radiofrequency treatment for trigeminal neuralgia and factors associated with successful response: a retrospective study.

This study aimed to investigate the treatment efficacy and clinical and demographic characteristics affecting treatment success in patients who underwent ultrasound (US)-guided pulsed radiofrequency (PRF) to the maxillary and/or mandibular nerves for trigeminal neuralgia. The data of patients with trigeminal neuralgia who underwent US-guided maxillary and/or mandibular nerve PRF between September 2022 and December 2023 were reviewed and the study was retrospectively designed. Good analgesia was defined as ≥ 50% reduction in pain score at 3 months after the procedure, and the demographic and clinical characteristics of the patients were assessed. Among the 72 included patients, 39 (54.2%) and 33 (45.8%) were classified as responders and non-responders, respectively. The age, pre- and post-procedural Numerical Rating Scale (NRS) scores, pain duration, and presence of constant pain were significantly lower in the responders. Logistic regression analysis revealed that older age (OR = 0.899, p < 0.001), high pre-procedural NRS scores (OR = 0.177, p = 0.009) and non-idiopathic (secondary or classic) etiology (OR = 0.062, p = 0.048) were significantly associated with an unsuccessful response to maxillary/mandibular PRF treatment. This study is the first clinical trial to evaluate the efficacy of PRF therapy of the maxillary and mandibular nerves in the treatment of trigeminal neuralgia and demonstrated a significant reduction in pain scores at 3 months. Older age, high pre-procedural NRS scores, and non-idiopathic (secondary or classical) etiology are independent predictors of poor response to ultrasound-guided maxillary/mandibular nerve pulse radiofrequency treatment.

Case Series and Literature Review of Up-to-date Surgical Management of Occipital Neuralgia

AbstractNerve decompression is an emerging surgical treatment option for patients with occipital neuralgia. However, limited research is available on the efficacy of this treatment in South Korea. This retrospective study evaluates the efficacy of nerve decompression surgery in patients with chronic migraines, specifically focusing on occipital neuralgia, in South Korea. Between January 2019 and December 2022, six patients diagnosed with occipital neuralgia, who had not responded to conservative treatments, underwent nerve decompression surgery. This procedure, performed under local anesthesia, involved decompression of the greater and/or lesser occipital nerves. Patient data were analyzed for headache frequency and intensity (using the Numeric Rating Scale [NRS]) and the decrease in oral medications needed postsurgery. Results showed significant improvement in headache symptoms postsurgery, with the average preoperative NRS score of 7.9 dropping to 3.7 postoperatively. Additionally, the average number of medications used decreased from 3.2 to 1.3. No significant surgical complications were reported. The study highlights the potential of nerve decompression as an effective treatment for occipital neuralgia, particularly in cases resistant to traditional medical management.

Comparison of treatment results between microvascular decompression and gamma knife radiosurgery in primary trigeminal neuralgia.

This study aims to analyze and evaluate the comparative clinical outcomes associated with microvascular decompression (MVD) and gamma knife radiosurgery (GKRS), focusing on pain relief, pain recurrence, and complications encountered in the treatment of trigeminal neuralgia (TN). Among 155 surgical procedures performed for TN (90 GKRS, and 65 MVD) between March 1997 and December 2020, the exclusion criteria encompassed prior surgical interventions, the presence of other pathological conditions such as tumors, vascular diseases, and multiple sclerosis, as well as patients who were lost to follow-up. Ultimately, 101 patients received their initial treatment for primary TN (47 GKRS, and 54 MVD) and were followed up for more than 1 year. The MVD procedures utilized the suboccipital retrosigmoid sinus approach, whereas GKRS was conducted with MR imaging guidance, employing a single 4mm isocenter, with median GKRS doses of 80 Gy. We retrospectively analyzed patient characteristics, including sites of divisions, distributions of pain, and clinical outcomes. The assessment of outcomes was performed utilizing the Barrow Neurological Institute Pain Intensity Score and the Visual Analog Scale (VAS), with evaluations taking place preoperatively and after 1, 3, 6 and 12 months. Postoperative VAS scores for patients undergoing either MVD or GKRS demonstrated a significant improvement when compared with their preoperative counterparts. The reduction in postoperative VAS scores within the MVD group was significantly more substantial than that observed in patients who underwent GKRS at the initial postoperative evaluations (P = .037). The maintenance of pain relief after MVD proved significantly superior to that following GKRS (P < .01). Both MVD and GKRS present as safe and efficacious therapeutic options for individuals diagnosed with primary TN, though MVD displayed superior initial outcomes in terms of pain relief and its maintenance. However, for older patients or those with medical contraindications to invasive procedures, GKRS emerges as a viable and less invasive alternative for initial treatment in cases of primary TN.

Percutaneous Balloon Compression Guided by a Compression-Time Effect in Trigeminal Nerve Branches.

Percutaneous balloon compression (PBC) is an important treatment for trigeminal neuralgia (TN). Establishing the duration of balloon compression involves a tradeoff between outcome and postoperative complications. We aimed to explore the effect of the duration of balloon compression on the numbness response in areas innervated by the branches of the trigeminal nerve. Thirty-three patients with TN were included as an exploratory cohort, and the response area and compression time to the onset of facial numbness were recorded intraoperatively. Seventy-six patients with TN were then randomly divided into experimental (EG) and control groups (CG) for validation. The EG was treated with balloon compression times adjusted to reflect the compression-time effect observed in the initial investigation, whereas the CG was treated with a standardized compression time of 180 s. Patients were followed up postoperatively for pain relief and facials to verify the reliability of the effect. We found that the mean compression time to numbness in the region innervated by the ophthalmic meridian (V1) was 89.09 ± 8.99 s; by V1 and the maxillary nerve (V2), 123.52 ± 7.97 s; and by V1, V2, and the mandibular nerve (V3), 181.33 ± 10.29 s. All 76 patients used to verify the effect had complete relief of pain, and the EG had significantly less numbness than the CG. In PBC, with the extension of balloon compression time, the numbness response of each branch of the trigeminal nerve appears in a certain order. This effect can guide PBC in mitigating complications while ensuring efficacy.

Clinical presentation and treatment of herpes zoster and postherpetic neuralgia

Herpes zoster (HZ) is acommon disease caused by reactivation of varicella zoster virus. Diagnosis is usually based on the typical clinical presentation. Standard treatment includes antiviral, topical and analgesic therapies. As acomplication, postherpetic neuralgia (PHN) can result from acute HZ infection, particularly in older and/or immunocompromised people. This can seriously impair the quality of life of those affected and requires adequate analgesia. In addition to the genesis, clinical presentation and treatment recommendations for HZ and PHN, this article also deals in particular with the vaccination prophylaxis recommended by the standing vaccination commission of the Robert Koch Institute (STIKO).

Pelvic Floor Physical Therapy is Self-Reported as a Minimally Effective, and Sometimes Harmful, Treatment for Pudendal Neuralgia: A Cross-Sectional Study

Objectives: Pudendal neuralgia (PN) is a sexual pain disorder characterized as pain of the genital and/or perineal regions, and despite the lack of clinical evidence supporting its use, pelvic floor physical therapy (PFPT) is a recommended treatment for PN. Methods: An online anonymous cross-sectional survey was administered to participants through convenience sampling conducted on May 19 to September 19, 2023 to understand the self-reported efficacy of PFPT as a treatment for PN. Participants’ measures included sociodemographics, Patient Global Impression of Change (PGIC), and satisfaction scores. Results: The average self-reported PGIC score among participants was 4.6 ± 1.3 (n = 144), indicating no to minimal improvement in symptoms. Most participants (66%) scored 4 or 5, suggesting no change to minimal improvement. Twelve percent of participants scored 3 or lower, indicating worsening of symptoms, and only 22% scored 6 or 7, indicating much or very much improvement of symptoms. Participants who only participated in PFPT (n = 24) had a lower PGIC score of 4.4 ± 1.3. For self-reported satisfaction with PFPT as a treatment for PN, participants self-reported a score of 4.9 ± 3.0, indicating slight dissatisfaction. For those who experienced symptom improvement, the median number of sessions before noticing improvement was five sessions. Conclusion: Based on self-reported results, PFPT is a minimally effective, and sometimes harmful, treatment for PN. Patients should receive greater transparency regarding the lack of efficacy of PFPT and its potential harm.

Standard operating procedure and surgical technique innovation in fully endoscopic microvascular decompression for trigeminal neuralgia: technical note on 189 patients.

Microvascular decompression (MVD) is a well-established and effective treatment for primary trigeminal neuralgia (TN). Endoscopy has been implemented to provide a comprehensive view of neurovascular conflict and minimizes the damages of brain retraction during MVD. To preliminarily evaluate the surgical safety and efficacy of fully endoscopic microvascular decompression (EMVD) for primary TN with surgeon performing two-hand manipulation and assistant holding endoscope. Retrospective clinical analysis of 189 patients with primary TN underwent EMVD between June 2019 and August 2022 was performed. By analyzing the intraoperative situation, the outcomes of postoperative symptoms and the main complications, we evaluated the reliability and effectivity of the operative technique in the treatment of primary TN. We summarized the standard operating procedure of EMVD for primary TN with surgeon performing two-hand manipulation and assistant holding endoscope. In addition, acicular bipolar electrocoagulation technique was developed to handle venous compression. During the follow-up period, good pain relief was achieved in 178 patients (94.2%) and recurrence of pain was observed in 4 patients (2.1%). Postoperative temporary complications included trigeminal dysesthesias (7 patients, 4.8%), cerebrospinal fluid leak (2 patients, 1.1%), hearing difficulty (3 patient, 1.6%), facial paresis (2 patients, 1.1%) and vertigo (5 patients, 2.7%). There were no cases of intracranial hemorrhage, cerebellar swelling and death. This EMVD technique is reliable and effective, and can be used as a routine surgical procedure for primary TN.

Application of the semidiving technique in fully endoscopic microvascular decompression.

Microvascular decompression (MVD) is the preferred treatment for hemifacial spasm (HFS) and trigeminal neuralgia (TN), and fully endoscopic microvascular decompression (E-MVD) has been widely discussed in recent years. Considering the endoscopic diving technique used in endoscopic transsphenoidal pituitary adenoma resection, we developed the endoscopic semidiving technique. This technique involves preserving some cerebrospinal fluid (CSF) and positioning the endoscope at an appropriate distance from it; the potential advantages include reducing cerebellar retraction, accurately identifying the responsible vessels and minimizing mechanical damage. This study aimed to preliminarily evaluate the safety and feasibility of the semidiving technique in E-MVD. A total of 359 patients with HFS and TN scheduled to undergo E-MVD were included in the study. Patients with each disease were divided into a nonsemidiving technique group and a semidiving technique group. Surgical data, postoperative outcomes, complications, and recurrence rates were compared between the groups. In patients with HFS, the effective rate was 95.6% (nonsemidiving)and 92.9% (semidiving) respectively, with no statistically significant difference. The semidiving technique group had a lower incidence of postoperative permanent hearing loss compared with the nonsemidiving technique group (0% vs. 5.9%). In TN patients, no significant differences in effectiveness or postoperative complications were observed. The application of the semidiving technique in E-MVD for HFS not only ensures surgical quality and postoperative efficacy but also reduces the incidence of postoperative hearing loss, shortens the surgical duration and reduces the number of postoperative hospitalization days, aligning with the concept of enhanced recovery after surgery (ERAS).

Investigation of a novel 2.5 MV sintered diamond target beam for intracranial linac-based stereotactic treatments.

This work investigates the small-field dosimetric characteristics of a 2.5 MV sintered diamond target beam and its feasibility for use in linac-based intracranial stereotactic treatments. Due to the increased proportion of low energy photons in the low-Z beam, it was hypothesized that this novel beam would provide sharper dose fall-off compared to the 6 MV beam owing to the reduced energy, and therefore range, of secondary electrons. Stereotactic treatments of ocular melanoma and trigeminal neuralgia were simulated for 2.5 MV low-Z and 6 MV beams using Monte Carlo to calculate dose in a voxelized anatomical phantom. Two collimation methods were investigated, including a 5x3 mm2 HDMLC field and a 4 mm cone to demonstrate isolated and combined effects of geometric and radiological contributions to the penumbral width. The measured 2.5 MV low-Z dosimetric profiles demonstrated reduced penumbra by 0.5 mm in both the inline and crossline directions across all depths for both collimation methods, compared to 6 MV. In both treatment cases, the 2.5 MV low-Z beam collimated with the 4 mm cone produced the sharpest dose fall off in profiles captured through isocenter. This improved fall-off resulted in a 59% decrease to the maximum brainstem dose in the trigeminal neuralgia case for the 2.5 MV low-Z MLC collimated beam compared to 6 MV. Reductions to the maximum and mean doses to ipsilateral and contralateral OARs in the ocular melanoma case were observed for the 2.5 MV low-Z beam compared to 6 MV with both collimation methods. While the low dose rate of this novel beam prohibits immediate clinical translation, the results of this study support the further development of this prototype beam to decrease toxicity in intracranial SRS treatments.&#xD.

Step-by-Step Description of Percutaneous Full-Endoscopic C2 Ganglionectomy: An Anatomic Feasibility Study in Human Cadavers.

The percutaneous full-endoscopic C2 ganglionectomy (PEC2G), an innovative procedure developed for the surgical treatment of intractable occipital neuralgia, was firstly reported by us in 2021. However, a universally accepted and well-articulated protocol modality remains elusive. The primary objective of this anatomic investigation was to meticulously elucidate the standard procedural steps of PEC2G and assess the anatomic features supporting the safe implementation of PEC2G. Eighteen fresh adult cadavers were incorporated into this study. From this sample, 3 cadavers were subjected to bilateral PEC2G. Each procedure was documented and assessed, leading to the formulation of standard procedure criteria for PEC2G. Subsequently, 10 sets of anatomic parameters pertinent to this procedure were identified, quantified, and analyzed in 15 cadavers after complete bilateral endoscopic exposure of the C2 ganglion. An assessment of the technical feasibility and potential constraints associated with PEC2G was conducted, providing invaluable insights into the procedure's anatomic considerations. All 3 cadavers successfully underwent the PEC2G without any observed complications, such as dura tears or vertebral artery injuries. The C2 inferior articular process emerged as the optimal bony target for puncture, with the C2 pedicle serving as the standard guiding landmark en route to the C2 ganglion. In the 15 cadavers subjected to the planned procedure, 10 sets of anatomic parameters were quantified, establishing a foundational understanding of the anatomy in the context of PEC2G procedure. The results demonstrated that the characteristic of anatomic data pertinent to surgical site supported the safe implementation of PEC2G. This study contributes the standard surgical steps and crucial anatomic parameters relevant to PEC2G. The characteristic of anatomic data bolsters the safety credentials of this technique, which offers a reliable approach to achieve C2 ganglionectomy. These insights undeniably establish a robust foundation for the ongoing refinement and broader adoption of PEC2G.

Guasha-fangsha therapy combined with electroacupuncture in treatment of greater occipital neuralgia: a randomized controlled trial

To observe the clinical effect of guasha-fangsha (scrapping and bleeding) therapy combined with electroacupuncture (EA) on greater occipital neuralgia. Ninety patients with greater occipital neuralgia were randomly divided into an observation group (45 cases) and a control group (45 cases, 2 cases dropped out). In the control group, EA was delivered at Fengfu (GV 16) and bilateral Tianzhu (BL 10), Fengchi (GB 20), Wangu (GB 12), Yuzhen (BL 9) and Houxi (SI 3), with disperse-dense wave, at 2 Hz/100 Hz in frequency and 2 mA to 6 mA in intensity, for 30 min in each intervention, once every other days, 3 times a week. In the observation group, on the basis of the intervention as the control group, guasha-fangsha therapy was used along the distribution of the bladder meridian of foot-taiyang on the occipital region and that of the gallbladder meridian of foot-shaoyang on the lateral side of the head, once weekly. The duration of treatment was 3 weeks in the two groups. In the two groups, before treatment, after 1, 2 and 3 weeks of treatment and in follow-up visit after 3 weeks of treatment completion, the score of visual analogue scale (VAS) was observed; before and after treatment, as well as in follow-up visit after 3 weeks of treatment completion, the scores of self-rating anxiety scale (SAS), self-rating depression scale (SDS) and 36-item short-form health survey (SF-36) were observed; after treatment and in follow-up visit after 3 weeks of treatment completion, the clinical efficacy was evaluated. After one week of treatment, the VAS score in the observation group decreased when compared with that before treatment (P<0.05), while the scores in 2 and 3 weeks of treatment and in follow-up visit after 3 weeks of treatment completion were lower than those before treatment in the two groups (P<0.05) separately. At each time point after treatment, the VAS scores in the observation group were lower than those in the control group (P<0.05). After treatment and during the follow-up visit, the scores of SAS and SDS decreased when compared with those before treatment in the two groups (P<0.05), and the scores in the observation group were lower than those in the control group (P<0.05); the scores of each item in SF-36 were elevated in comparison with those before treatment in the two groups (P<0.05), and the scores in the observation group were higher than those in the control group (P<0.05). After treatment, the total effective rate of the observation group was 91.1% (41/45), higher than that (76.7%, 33/43) of the control group (P<0.05). In follow-up visit, the total effective rate of the observation group was 91.1% (41/45), which was higher than 72.1% (31/43) of the control group (P<0.05). Guasha-fangsha therapy combined with electroacupuncture can effectively relieve greater occipital neuralgia, alleviate pain severity, ameliorate anxiety and depression and improve the quality of life in the patients.

Meta-analysis and sequential analysis of acupuncture compared to carbamazepine in the treatment of trigeminal neuralgia.

In this randomized controlled trial (RCT) comparing current acupuncture with carbamazepine for trigeminal neuralgia, meta- and sequential analyses were utilized. To guide clinical decision making regarding the treatment of trigeminal neuralgia with carbamazepine. The RCT literature on needle comparison was searched in various Chinese biomedical databases including Chinese Biomedical Literature Database, Wanfang Data, VIP Database, as well as international databases such as Excerpt Medica Database, Cochrane Library, PubMed, and Web of Science, along with related clinical registration platforms such as World Health Organization International Clinical Trial Registry Platform, ChiCTR, and Clinical Trials up to 1 April 2020. Risk of bias was evaluated using the Cochrane Collaborative Risk Bias tool, primary outcome measures (pain reduction) were analyzed using STATA meta-analysis, outcome measures were analyzed using trial sequential analysis 0.9.5.10 Beta sequential analysis, GRADE was used to assess the evidence, and adverse reactions were documented. This study analyzed 16 RCTs with a total of 1231 participants. The meta-analysis revealed a statistically significant difference in pain reduction between acupuncture and carbamazepine [standardized mean difference (SMD) = 1.47; 95% confidence interval (CI): 0.99-1.95], although the quality of evidence was deemed to be of extremely low quality. Cumulative meta-analysis based on the year of publication indicated that carbamazepine treatment first demonstrated a statistically significant difference in pain reduction in 2014 and remained relatively stable over time [SMD = 1.84; 95%CI: 0.22-3.47]. Additionally, the number of adverse events associated with acupuncture was significantly lower compared to carbamazepine. Acupuncture for trigeminal neuralgia is better than analgesia and safer than carbamazepine; however, firm conclusions still require a high-quality, multicenter, large-sample RCT to confirm these findings.

Factors associated with outcomes following microvascular decompression for the treatment of primary trigeminal neuralgia in adults: a systematic review and meta-analysis.

This study aimed to evaluate pain assessment strategies and factors associated with outcomes after microvascular decompression for the treatment of primary trigeminal neuralgia in adults. We conducted a systematic review and meta-analysis of English, Spanish, and French literature. We searched three databases, PubMed, Ovid, and EBSCO, from 2010 to 2022 and selected studies including patients with primary trigeminal neuralgia, clear pain assessment, and pain outcomes. Population means and standard deviations were calculated. Studies that included factors associated with postoperative outcomes were included in the meta-analysis. A total of 995 studies involving 5673 patients with primary trigeminal neuralgia following microvascular decompression were included. Patients with arteries compressing the trigeminal nerve demonstrated optimal outcomes following microvascular decompression (odds ratio [OR]= 0.39; 95% confidence interval [CI] = 0.19-0.80; X2 = 46.31; Dof = 15; I2 = 68%; P = < 0.0001). Conversely, when comparing arterial vs venous compression of the trigeminal nerve (OR = 2.72; 95% CI = 1.16-6.38; X2 = 23.23; Dof = 10; I2 = 57%; P = 0.01), venous compression demonstrated poor outcomes after microvascular decompression. Additionally, when comparing single-vessel vs multiple-vessel compression (OR = 2.72; 95% CI = 1.18-6.25; X2 = 21.17; Dof = 9; I2 = 57%; P = 0.01), patients demonstrated unfavorable outcomes after microvascular decompression. This systematic review and meta-analysis evaluated factors associated with outcomes following microvascular decompression (MVD) for primary trigeminal neuralgia (PTN). Although MVD is an optimal treatment strategy for PTN, a gap exists in interpreting the results when considering the lack of evidence for most pain assessment strategies.

Neuronavigation assisted percutaneous balloon compression of the gasserian ganglion for trigeminal neuralgia. How I do it

BackgroundSurgical treatment for trigeminal neuralgia includes percutaneous techniques, including balloon compression, first described in 1983 by Mullan and Lichtor (J Neurosurg 59(6):1007–1012, 6).MethodHere we present a safe and simple navigation-assisted percutaneous technique for balloon compression, which can also be used for glycerol injection.ConclusionThe navigation-assisted percutaneous technique for balloon compression for trigeminal neuralgia is a quick and safe treatment for patients not candidates for microvascular decompression.

Interdisciplinary strategies for diagnosis and treatment of trigeminal neuralgia.

Temporary, sudden, shooting and recurrent unilateral facial pain in the supply area of one or more trigeminal nerve branches characterises trigeminal neuralgia. Innocuous stimuli trigger the pain, e.g. chewing, speaking or brushing teeth. In some patients, paroxysms superimpose on continuous pain. In aetiological terms, idiopathic, classic (due to neurovascular compression) and secondary trigeminal neuralgia (e.g. due to multiple sclerosis, brainstem ischaemia and space-occupying lesions) are defined. Many drugs may be efficacious, with carbamazepine being first-choice therapy. However, non-pharmacological and invasive procedures may also help. To reach the correct diagnosis and determine the best therapeutic measures, adequate pain characterisation and interdisciplinary collaboration are essential. We hereby present our experience of an interdisciplinary approach for the diagnosis and treatment of trigeminal neuralgia.