Primary Trigeminal Neuralgia Patients Research Articles

Evaluation of the correlation between trigeminal nerve atrophy and trigeminal neuralgia using multimodal image fusion: A single-center retrospective study

Background3D-Slicer is an open-source medical image processing and visualization software. In the surgical treatment of trigeminal neuralgia, it is commonly used to predict the responsible vessels. However, there are few reports on the use of 3D-Slicer software to quantitatively measure the bilateral trigeminal nerve volume in patients with primary trigeminal neuralgia (PTN) based on the three-dimensional images. Therefore, this study aims to explore the role of three-dimensional fused images processed by 3D-Slicer in the evaluation of trigeminal nerve atrophy, providing an objective basis for the diagnosis of PTN. Methods57 PTN patients who underwent microvascular decompression (MVD) or percutaneous balloon compression (PBC) surgery in Hebei general hospital between January 2020 and April 2023 were included. Additionally, 30 patients with facial spasms(HFS) were included as a control group. All patients underwent 3D-TOF-MRA and 3D-FIESTA sequence examinations. Comparisons of bilateral trigeminal nerve volumes within and between groups were conducted by performing image fusion using 3D-slicer. ResultsThe volume of the affected trigeminal nerve in the MVD group (33.96 mm³±12.61 mm³) and PBC group (23.05 mm³±7.71 mm³) was smaller than that of the unaffected trigeminal nerve in the MVD group (39.61 mm³±12.83 mm³) and PBC group (26.14 mm³±6.42 mm³), as well as the average volume of the trigeminal nerve in the control group (40.27 mm³±10.25 mm³) (P<0.05). The differences in bilateral trigeminal ganglion volume (∆V) was significant between the MVD group (∆V=23.59 %±14.32 %) and the control group (∆V=14.64 %±10.00 %) (P<0.05). There was no statistical difference in the trigeminal nerve volume difference between the MVD group (∆V=23.59 %±14.32 %) and the PBC group (∆V=26.52 %±15.00 %) (P>0.05). ConclusionTrigeminal nerve atrophy is correlated with primary trigeminal neuralgia. 3D-slicer software can quantitatively measure trigeminal nerve volume and assist in the diagnosis of primary trigeminal neuralgia based on the difference in bilateral trigeminal nerve volumes. However, trigeminal nerve atrophy is not associated with postoperative pain recurrence in patients.

Establishment of a Clinical Prediction Model Based on the Study of Risk Factors for Pain Recurrence after Percutaneous Radiofrequency Thermocoagulation in Patients with Primary Trigeminal Neuralgia

Objectives: This study aimed to investigate the follow-up outcomes and risk factors associated with pain recurrence after percutaneous radiofrequency thermocoagulation (PRT) among patients with primary trigeminal neuralgia (PTN) and to establish a clinical prediction model based on these risk factors. Methods: The data of PTN patients who underwent PRT were collected in our study. All subjects were randomly divided at a 7:3 ratio into a training group (T Group) and a test group (C Group) to select risk factors. According to the follow-up results, the patients were divided into a recurrence group (F Group) and a nonrecurrence group (NF Group). Predictive factors were selected through LASSO regression analysis based on T Group. The identified variables were subjected to multivariate logistic regression analysis to construct a nomogram. Receiver operating characteristic (ROC) curves and calibration curves were uesd to evaluate discrimination and calibration ability separately. Results: A total of 884 patients were initially included, 857 patients achieved satisfactory results, and the pain relief rate at discharge was 96.95%. A total of 529 subjects were included after screening, and the recurrence rate was 27.22% after 1 year. Six non-zero variables were selected through LASSO regression analysis: the disease course, atypical pain, previous surgery, facial numbness before PRT, neurovascular contact (NVC), and operation duration. Six variables were included in the multivariate logistic regression analysis, and the results showed that they were independent risk factors (P&lt;0.05). The predictive model is represented by a nomogram. The area under the curves (AUC) of the ROC curves were 0.868 (0.826~0.909) and 0.874 (0.802~0.950) for T Group and C Group, respectively. The prediction curves for T Group (P=0.784) and C Group (P=0.293) fit the ideal prediction curve, and the Brier scores were 0.120 and 0.099 for T Group and C Group, which indicates that the probability predicted by the model is consistent with the actual occurrence. Conclusion: The Pain relief rate at discharge was 96.95% for PTN patients after PRT, and the recurrence rate was 27.22% after 1 year. The disease course, atypical pain, previous surgery, facial numbness before PRT, NVC, and operation duration are independent risk factors for the recurrence of pain. A nomogram model for pain recurrence was established, which has good predictive ability.

Comparison of initial percutaneous balloon compression versus radiofrequency thermocoagulation followed by percutaneous balloon compression in the treatment of trigeminal neuralgia.

There are a variety of minimally invasive interventional treatments for trigeminal neuralgia, and the efficacy evaluation is different. The preferred treatment scheme is still controversial. This study aims to investigate the differences in treatment effects between patients with primary trigeminal neuralgia (PTN) treated with percutaneous balloon compression (PBC) for the first intervention and patients with pain recurrence after radiofrequency thermocoagulation (RT) who then received PBC for PTN, and to offer clinicians and patients more scientifically grounded and precise treatment alternatives. We retrospectively analyzed 103 patients with PTN admitted to the Department of Pain Management of the Second Affiliated Hospital of Guangxi Medical University from January 2020 to December 2021, including 49 patients who received PBC for the first time (PBC group) and 54 patients who received PBC for pain recurrence after RT (RT+PBC group). General information, preoperative pain score, intraoperative oval foramen morphology, oval foramen area, balloon volume, duration of compression, and postoperative pain scores and pain recurrence at each time point on day 1 (T1), day 7 (T2), day 14 (T3), 1 month (T4), 3 months (T5), and 1 year (T6) were collected and recorded for both groups. The differences in treatment effect, complications and recurrence between the 2 groups were compared, and the related influencing factors were analyzed. The differences of general information, preoperative pain scores, foramen ovale morphology, foramen ovale area, T1 to T3 pain scores between the 2 groups were not statistically different (all P>0.05). The balloon filling volume in the PBC group was smaller than that in the RT+PBC group, the pain scores at T4 to T6 and pain recurrence were better than those in the RT+PBC group (all P<0.05). Pain recurrence was positively correlated with pain scores of T2 to T6 (r=0.306, 0.482, 0.831, 0.876, 0.887, respectively; all P<0.01). The choice of PBC for the first intervention in PTN patients is superior to the choice of PBC after pain recurrence after RT treatment in terms of treatment outcome and pain recurrence.

The efficacy of acupuncture for trigeminal neuralgia: an overview of systematic reviews.

Many systematic reviews (SRs) and meta-analysis (MAs) have reported the efficacy of acupuncture treatment for primary trigeminal neuralgia (PTN), but the quality of evidence is unknown and therefore needs to be evaluated comprehensively. Eight electronic databases were searched from their inception until January 5, 2024. The methodological quality, reporting quality, and risk of bias of the included SRs were assessed by the assessment of multiple systematic reviews 2 (AMSTAR-2), the Risk of Bias in Systematic Reviews (ROBIS) tool, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The quality of evidence for outcome measures was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). We identified 13 SRs/MAs met inclusion criteria. According to the results of the AMSTAR-2, six were rated as critically low quality and seven as low quality. According to ROBIS assessment, 8 SRs/MAs were classified as low risk, and 5 SRs/MAs were found to be high risk. The PRISMA report still has some reporting deficiencies in aspects such as protocol and registration, search strategy, risk of bias, additional analyzes and funding. According to the GRADE system, no high-quality evidence was found, 1 was of moderate quality, 4 were of low quality, and 8 were of critical low quality. Based on the evidence collected, acupuncture shows promise as a treatment for PTN patients. However, it is important to note that the included SRs/MAs generally have low methodological quality and evidence quality. Therefore, caution must be exercised when interpreting this conclusion. To enhance future research in this area, it is recommended to adequately report methodological details and adhere to guidelines for conducting SRs/MAs.Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024499280.

How Far Has Radiofrequency Thermocoagulation Come Along as a Treatment Procedure in Treating Trigeminal Neuralgia Patients?

Trigeminal neuralgia (TN)refers to sudden shooting pain in areas innervated by trigeminal nerves originating from the Gasserian ganglion. Physicians initially manage it by prescribing drugs, such as carbamazepine. Surgical intervention is the next best option if patients do not respond to drug treatments. These procedures include microvascular decompression, rhizotomy, balloon compression, and gamma knife surgery. However, less optimal patient outcomes, recurrences, adverse effects, and high costs have necessitated alternative surgical interventions to treat such patients. Radiofrequency thermocoagulation (RFT) has emerged as a minimally invasive, safer, and effective surgical option in treating TN patients. Despite research showing RFT's safety and effectiveness, neurosurgical healthcare providers do not frequently use it to treat TN patients. Lack of universal standardized protocol, and minimal awareness of its efficacy in specific cohorts, such as geriatric patients, may lead to RFT underutilization.Hence, this review highlights RFT's advancement as a robust alternative to traditional surgical approaches in treating TN patients. In addition, it identifies RFT's areas of improvement and its safety and effectiveness in treating elderly TN patients. We followed the Systematic Reviews and Meta-Analysesguidelines for systematic reviews and conducted a literature search between July 2022 and March 2023.Our findings indicate that RFT has evolved significantly over the last decade and a half as a minimally invasive and effective treatment procedure for TN patients. It is more effective as a combined continuous and pulsed RFT than its other subtypes in treating primary TN patients. Moreover, RFT via a transverse puncture through the supraorbital foramen results in lesser inter- and post-procedural complications. Further, there is a slightly lesser incidence of post-procedural adverse effects and complications with RFT through the foramen rotundum. Besides, RFT, performed at a lower temperature of 65 degrees Celsius and a voltage between 64.51 and 79.29 volts, effectively provides pain relief and long-term patient satisfaction. RFT is safe and effective in patients over 60 with primary TN. Interestingly, it is also safe and effective in treating patients over 70 with poor fitness standards of Class II or higher.Despite these remarkable findings, there is still a substantial gap in the literature, specifically concerning the standardized protocol for temperature, voltage, and puncture methods of RFT. Despite the sufficient evidence of combined continuous and pulsed RFT's superiority in efficacy and safety, most researchers still utilize either pulsed or continuous RFT. Studies vary in not only these aspects but also the patient cohorts. For instance, most researchers focus solely on evaluating RFT's efficacy and safety in patients with primary TN, excluding a critical patient population suffering from secondary TN. Nevertheless, sufficient clinical evidence shows that RFT has come of age in treating primary TN patients. However, more extensive studies with large sample sizes of patients with primary and secondary TN with multiple trigeminal nerve affectation will significantly help standardize RFT protocol and its inclusion in the standard clinical practice in treating TN patients.

Predictive value of foramen ovale size on pain recurrence after percutaneous balloon compression.

Primary trigeminal neuralgia (PTN) is a common cranial nerve disease in neurosurgery, which seriously endangers the physical and mental health of patients. Percutaneous balloon compression (PBC) has become an effective procedure for the treatment of PTN by blocking pain conduction through minimally invasive puncture. However, the recurrence of facial pain after PBC is still a major problem for PTN patients. Intraoperative balloon shape, pressure and compression time can affect the prognosis of patients with PBC after surgery. The foramen ovale size has an effect on the balloon pressure in Meckel's lumen. This study aims to analyse the predictive value of foramen ovale size for postoperative pain recurrence of PBC by exploring the relationship between foramen ovale size and postoperative pain recurrence of PBC. A retrospectively analysis was conducted on the clinical data of 60 patients with PTN who were treated with PBC in Department of Neurosurgery, Affiliated Hospital of Chengde Medical College from November 2018 to December 2021. We followed-up and recorded the Barrow Neurological Institute (BNI) pain score at 1, 3, 6 and 12 months after operation. According to the BNI pain score at 12 months after surgery, the patients were divided into a cure group (BNI pain score I to Ⅱ) and a recurrence group (BNI pain score Ⅲ to Ⅴ). The long diameter, transverse diameter and area of foramen ovale on the affected side and the healthy side of the 2 groups were measured. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used for analysis the relationship between the recurrence of pain and the long diameter, transverse diameter, area of foramen ovale on the affected side, and aspect ratio, transverse diameter ratio, area ratio of foramen ovale on the affected side to healthy side in the 2 groups. At the end of 12 months of follow-up, 50 (83.3%) patients had pain relief (the cured group), 10 (16.7%) patients had different degrees of pain recurrence (the recurrence group), and the total effective rate was 83.3%. There were no significant differences in preoperative baseline data between the 2 groups (all P>0.05). The long diameter of foramen ovale on the affected side, the long diameter ratio and area ratio of foramen ovale on the affected/healthy side in the cured group were significantly higher than those in the recurrence group (all P<0.05), and there were no significant differences in the transverse diameter and area of foramen ovale on the affected side and the transverse diameter ratio of foramen ovale on the affected/healthy side between the 2 groups (all P>0.05). The ROC curve analysis showed that the AUC of the long diameter of foramen ovale on the affected side was 0.290 (95% CI 0.131 to 0.449, P=0.073), and the AUC of aspect ratio of foramen ovale on the affected side to healthy side was 0.792 (95% CI 0.628 to 0.956, P=0.004). The AUC of area ratio of foramen ovale on the affected side to healthy side was 0.766 (95% CI 0.591 to 0.941, P=0.008), indicating that aspect ratio and area ratio of foramen ovale on the affected side to healthy side had a good predictive effect on postoperative pain recurrence of PBC. When aspect ratio of foramen ovale on the affected side to healthy side was less than 0.886 3 or area ratio of foramen ovale on the affected side to healthy side was less than 0.869 4, postoperative pain recurrence was common. Accurate evaluation of the foramen ovale size of skull base before operation is of great significance in predicting pain recurrence after PBC.

Microvascular decompression for young onset primary trigeminal neuralgia: a single-center experience

This study aims to explore the causes of primary young onset trigeminal neuralgia (TN) and the clinical outcomes of these patients. From May 2015 to December 2020, 19 primary TN patients with onset age under 30years underwent microvascular decompression (MVD) in Nanjing Drum Tower Hospital. In this study, the clinical characteristics, surgical outcomes, and postoperative complications of these patients were analyzed retrospectively. Of the 19 patients, 5 were males and 14 were females, and the pain was located on the right side in 10 cases (52.6%). Vascular compression was observed in 17 patients, including 14 cases of superior cerebellar artery (SCA) alone, 2 cases of superior petrosal vein (SPV) alone, and 1 case of SCA and SPV combined. Two patients had no neurovascular conflict, and nerve combing was performed. After surgery, 18 patients got immediate pain relief; 1 patient improved but still had occasional pain. With a mean follow-up of 42.7 ± 22.3months, one patient was found to have a relapse 45months after MVD. Surgical complications including mild facial numbness in two patients and hearing impairment in one patient. Neurovascular compression is the main cause of young onset primary TN, and the most commonly encountered vascular was SCA. MVD is a safe and effective treatment for these patients.

Risk factors of herpes simplex virus reactivation after surgery for primary trigeminal neuralgia

The objective of this study is to investigate the risk factors of oral or facial herpes simplex virus (HSV-1) infection after primary trigeminal neuralgia (PTN). The clinical data of 33 PTN patients admitted by the same surgeon in the neurosurgery were retrospectively analyzed. Among the 33 patients, 26 patients underwent microvascular decompression (MVD), 6 patients who have not been found the clear offending vessels during the operation underwent partial sensory rhizotomy (PSR), and only one underwent adhesive band separation. Thirteen patients with postoperative oral and facial HSV-1 infection were selected as the herpes group, and the remaining 20 patients without postoperative oral and facial HSV-1 infection were selected as the non-herpes group. The differences between the two groups were compared by statistical analysis of factors such as gender, age, operation mode, operation time, and serum HSV-1 antibody titer value before surgery. Compared with the non-herpes group, there were no statistically significant differences in sex ratio (P = 0.930), age composition (P = 0.261), or disease profile (P = 0.226). Twenty-six patients underwent MVD operation, eight of whom were infected, and the difference between the two groups was statistically significant (P = 0.029). The operation time of the herpes group was 10-30min, which was significantly longer than that of the non-herpes group. The difference in operation time between the two groups was statistically significant (P = 0.023). Serum HSV-1-IgM was negative (< 0.9 COI) in all patients before surgery, but the positive rate of HSV-1-IgG (≥ 1.1 COI) was 97%, and the titer was greater than four times in 97% (32/33) of patients. The titer of IgG antibody in the herpes group was significantly lower than that in the non-herpes group, and the difference between the two groups was statistically significant (P = 0.017). The serum HSV-1-IgG in most of the PTN patients was positive. Latent HSV-1 in the trigeminal ganglion may be reactivate after PTN surgery to produce ipsilateral oral and facial herpes infection. The infection of HSV-1 reactivation after PTN surgery was positively correlated with the operation time but negatively correlated with the titer of HSV-1-IgG antibody before PTN surgery. The incidence of HSV-1 infection after PTN operation is related to different surgical procedures.

Acupuncture Methods for Primary Trigeminal Neuralgia: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

Background Primary trigeminal neuralgia (PTN) is a clinical refractory disorder characterized by excruciating pain that severely impacts the quality of life. Several studies have shown that acupuncture can improve PTN pain. However, the comparative efficacy and safety of acupuncture are unknown. Herein, a systematic review was conducted to compare the efficacy and safety of various acupuncture methods for PTN treatment. Methods Relevant randomized controlled trials (RCTs) published up to 1 August 2021 were obtained from PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, CQVIP Database, Wanfang Database, Allied and Alternative Medicine Database, and related registration platforms. Two authors independently selected the studies and obtained data. Cochrane Handbook was used to assess the methodological quality. We put the pain relief as the primary outcome and the response rate and adverse events as the secondary outcomes. Review Manager v5.3, ADDIS v1.16.8, and STATA v15.0 software were used for data analysis. The intraclass correlation coefficient was used to assess the consistency of the two investigators. Results A total of 58 RCTs with 4,126 participants were obtained. The meta-analysis indicated that five acupuncture methods were superior to conventional medicine (carbamazepine) in pain reduction intensity and response rate. Meanwhile, electronic acupuncture plus manual acupuncture was the most effective therapy since it reduced pain intensity in 11 methods and improved the response rate in 10 interventions. Moreover, six interventions had acceptable adverse events, and none of the included studies reported severe adverse events. However, most pieces of evidence were ranked as critically low. Conclusion These findings show that acupuncture methods can be effective and safe for PTN. Moreover, electronic acupuncture plus manual acupuncture maybe the best acupuncture treatment for PTN and should be administered to PTN patients. However, additional well-designed and high-quality RCTs should be conducted to verify the above findings in the future. The systematic review is registered with CRD42020221456.

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.

Cryoneurotomy in the management of intractable trigeminal neuralgia.

In this paper we describe the effects of peripheral cryoneurotomy on a consecutive series of patients with intractable trigeminal neuralgia (TN) who had been treated by a single surgeon over a ten-year period. The results of 55 patients who underwent a total of 102 cryoneurotomies were documented. The age at first cryofreeze was 64 (30-92) years with 24 males and 31 females. Thirty-five had primary TN and 20 secondary TN. The first cryofreeze resulted in 28.2 (5-144) pain free months. Twenty-nine had a second freeze which lasted 34 (2-100) pain-free months and 13 had a third cryofreeze which lasted 26 (1-108) pain free months. Two patients had further freezes. Thirty-four of the primary TN patients had prolonged freedom from pain with one dying perioperatively. The 20 patients with secondary TN had shorter period of pain relief (p<0.05) and one committed suicide. The procedure of peripheral cryoneurotomy is recommended for older, unwell patients with primary TN that is refractory to medical or neurosurgical treatments. It is less effective for dysaesthesia secondary to traumatic nerve injuries.

Relationship Between Arterial Blood Pressure During Trigeminal Nerve Combing and Surgical Outcome in Patients with Trigeminal Neuralgia

Changes in blood pressure during trigeminal combing have been discussed in recent years. In this study, a retrospective analysis of patients with trigeminal neuralgia (TN) requiring microvascular decompression (MVD) with nerve combing was carried out to investigate fluctuation in arterial blood pressure during trigeminal nerve combing and its surgical effect and corresponding pathogenesis. A total of 70 cases of MVD with nerve combing performed during the treatment of primary TN patients were selected between January 2017 and January 2018 at Peking University People's Hospital. The degree of pain and prognosis of the patients were evaluated according to the visual analog scale. Postoperative facial numbness of the 2 groups were assessed by the Barrow Neurological Institute facial numbness score. Arterial blood pressure changes before and while combing the trigeminal nerve during MVD were dynamically monitored, and the patients were divided into responders and nonresponders. Total adrenaline (AD), norepinephrine (NE), and dopamine values were measured before and during trigeminal nerve combing. Increased arterial blood pressure during the combing of the trigeminal nerve in MVD had a significant correlation with the prognosis of patients, with patients with higher arterial blood pressure having a better prognosis (P < 0.05). In the increased arterial blood pressure patients, precombing total AD and NE means were dramatically improved (P < 0.05). This study shows that changes in arterial blood pressure during trigeminal nerve combing in MVD were correlated with the prognosis of patients. Further research is necessary to clarify the mechanism of increased arterial blood pressure.

Consistency of neurovascular relationship between multimodal image fusion 3D reconstruction and intraoperative findings of microvascular decompression for primary trigeminal neuralgia

Objective To explore the consistency of neurovascular relationships between multimodal image fusion 3D reconstruction and intraoperative findings in microvascular decompression (MVD) for primary trigeminal neuralgia (PTN). Methods A retrospective analysis was conducted on the clinical data of 50 PTN patients treated with MVD at Department of Neurosurgery, Qingdao University Hospital from January to November 2018. All subjects underwent three-dimensional time-flying magnetic resonance angiography (3D-TOF-MRA) and three-dimensional cyclic phase steady-state acquisition rapid imaging (3D-FIESTA) sequences. Then, the 3D-slicer software was used to reconstruct the multimodal fusion 3D image. Multimodal image fusion 3D reconstruction images and surgical video were analyzed to determine the offending vessels responsible for trigeminal neuralgia. At the same time, the direction of compression, compression site and compression degree of the trigeminal nerve were analyzed. Kappa consistency test method was used to judge the consistency of the two approaches above. Results With MVD set as the standard, the accuracies of multimodal image fusion 3D reconstruction images in determining the offending vessels, direction of compression, compression site and the degree of compression were 92.0% (46/50), 92.0% (46/50), 96.0% (48/50) and 58.0% (29/50), respectively. Multimodal image fusion 3D reconstruction images and MVD showed high consistency in judging offending vessels, compression direction and compression position (Kappa values: 0.729, 0.903 and 0.955 respectively, all P<0.001). However, the consistency was poor in judging the degree of compression of offending vessels to the trigeminal nerve (Kappa value=0.227, P=0.002). The degree of compression was higher in intraoperative findings of MVD than that revealed by multimodal image fusion three-dimensional reconstruction (mean values: 2.57 and 1.58 respectively, Z=-4.499, P<0.001). Conclusions Preoperative multi-modal image fusion 3D reconstruction could help accurately determine the offending vessel, compression direction and compression position of PTN, which seems highly consistent with intraoperative findings of MVD. Preliminary speculation could be used as one of the methods facilitating preoperative diagnosis. Key words: Trigeminal neuralgia; Multimodal image fusion; Microvascular decompression; Neurovascular relationship; Computer-aided diagnosis

Correlations between the trigeminal nerve microstructural changes and the trigeminal-pontine angle features.

Morphological and microstructural changes of the trigeminal nerve due to neurovascular compression (NVC) have been reported in primary trigeminal neuralgia (PTN) patients. This investigation was to examine the relationship between the trigeminal-pontine angle and nerve microstructural changes. Twenty-five patients underwent microvascular decompression (MVD) for trigeminal neuralgia, and 25 age- and sex-matched controls were studied. The two groups underwent high-resolution three-dimensional MRI and diffusion tensor imaging (DTI). Bilateral trigeminal-pontine angle, cross-sectional area of cerebellopontine angle (CPA) cistern, and the length of trigeminal nerve were evaluated. The mean values of fractional anisotropy and apparent diffusion coefficient at the site of NVC were also measured. Correlation analyses were performed for the trigeminal-pontine angle and the diffusion metrics (FA and ADC) in PTN patients. The mean trigeminal-pontine angle and FA value on the affected side was significantly smaller than the unaffected side and the control group (p < 0.001), while the mean ADC value was significantly increased (p < 0.01). When taking the conflicting vessel types into consideration, the angle affected by the superior cerebellar artery (SCA) was statistically sharper than when affected by other vessels (p < 0.01). However, there were no significant changes in the area of the CPA cistern or the length of the trigeminal nerve between the groups. Correlation analyses showed that the trigeminal-pontine angle was positively correlated with FA and negatively correlated with ADC. A sharp trigeminal-pontine angle may increase the chance of NVC and exacerbate nerve degeneration, which may be one of the supplementary factors that contribute to the pathogenesis of trigeminal neuralgia.

The Study of Calcium, Phosphonium, Magnesium, and Ferrum Concentration in Serum of Patients With Primary Trigeminal Neuralgia.

To measure the concentration of 4 essential elements (Ca, P, Mg, Fe) in serum of patients with primary trigeminal neuralgia. And evaluate the role of the 4 elements in serum on the pathogenesis of trigeminal neuralgia (TN), and the relevance of etiology. From June 2013 to June 2014, a number of 80 patients with primary trigeminal neuralgia were collected. We present a retrospective review of the concentration of 4 essential elements with those of control group of 80 patients without TN. The concentrations of 4 elements were measured with Olympus AU 400 automatic biochemistry analyzer. In primary TN patients, the concentration of Ca, P, Mg in serum is lower than the control group obviously (P <0.05), but the concentration of Fe in serum is higher than the control group obviously (P <0.05). Along with level of the VOS improved, the concentration of Ca, P, and Mg in serum becomes lower and lower. However, along with level of the VOS improved, the concentration of Fe in serum becomes higher and higher. Patients with primary TN, the change of 4 elements concentration in serum is connected with biochemical material change. The change of the microelement may play an important role in the development of Trigeminal neuralgia, possibly demyelinating lesions.

Clinical study of cerebrospinal fluid neuropeptides in patients with primary trigeminal neuralgia

ObjectivesTo investigate the expression levels of calcitonin gene-related peptide (CGRP), substance P (SP), vasoactive intestinal peptide (VIP), and β-endorphin in the cerebrospinal fluid (CSF) and peripheral blood of patients with primary trigeminal neuralgia (TN). Patients and methodsWe included 20 patients with primary TN who underwent percutaneous radiofrequency thermocoagulation and collected four types of samples from all of them: sample A: CSF samples; sample B: peripheral blood samples; sample C: peripheral blood samples collected one day before the operation; sample D: peripheral blood samples withdrawn one day after the operation. Another 20 CSF samples of patients with nervous system disease or gynecological disease were collected as a control (sample E). Samples A and B were obtained at the same time. We also evaluated the expression of CGRP, SP, β-endorphin, and VIP by visual analog scale (VAS) scores one day before and one day after the operation. In addition, heart rate (HR) at baseline and at the time of sample collection, mean arterial pressure (MAP), and all side effects of the procedure were recorded. ResultsSignificance were found concerning about CGRP, SP, β-endorphin, and VIP in TN patients and the controls (P<0.001). The expression of CGRP, SP, and VIP in sample A was higher than that in sample E. However, the β-endorphin level in sample A was lower than that in sample E. There was a positive correlation between sample A and B regarding the expression of CGRP, SP, β-endorphin, and VIP (P<0. 01). There was no relationship between the time of disease onset and the expression of CGRP, SP, β-endorphin, and VIP in sample A and sample B (P>0.05). No difference was detected between the neuropeptides levels in samples B and C (P>0.05). Notably, VAS in sample D was significantly lower than that in sample C (P<0.01). Finally, there was no difference between the intraoperative HR and MAP values in the studied samples. ConclusionIn primary TN patients, the blood levels of CGRP, SP, β-endorphin, and VIP were associated with those in CSF samples. There was a significant difference between the levels of the four neuropeptides in CSF and control samples. Our results also indicated that the levels of neuropeptides in blood samples can be tested for those in CSF. The disease onset and duration exerted insignificant effects on the production and release of CGRP, SP, β-endorphin, and VIP.

Intraoperative decisions and surgical efficacies of trigeminal neuralgia responsible vessels

To explore the types of primary trigeminal neuralgia (TN) responsible vessels and curative efficacies of microscopic vascular decompression (MVD). A total of 162 primary TN patients underwent MVD from August 2004 to the present at our hospital.Their clinical data were collected and analyzed. There were 69 males and 93 females with an age range of 22-88 years. The most common responsible vessels were superior cerebellar artery (n = 65, 40.12%), anteroinferior cerebellar artery (n = 45, 27.78%), multiple vessels (n = 26, 16.05%), posteroinferior cerebellar artery (n = 16, 9.88%), veins (n = 6, 3.70%) and vertebral artery (n = 4, 2.47%). And the pressure points were at the root of trigeminal nerve (n = 139, 85.80%), distal part (n = 16, 9.88%) and root and distal part (n = 7, 4.32%). Postoperatively pain disappeared in all patients (including one case on second surgery). Postoperative follow-ups were conducted for 132 cases.Two cases recurred over 8 years and the recurrence rate was 1.52%. MVD is preferred method for primary TN non-responsive to pharmacotherapy. Identification and treatment of responsible vessels remain a key. Venous and distal pressure points should be taken care.

Clinical effect of sphenopalatine ganglion needling in treating primary trigeminal neuralgia of liver-yang upsurge syndrome type

To observe the efficacy and safety of sphenopalatine ganglion needling in treating patients with primary trigeminal neuralgia (PTN) of Liver (Gan)-yang upsurge syndrome (LYUS) type. Sixty-five PTN patients of LYUS type were assigned by a random number table to two groups and treated by deep-needling (33 patients, DN group) and superficial-needling (32 patients, SN group), respectively. The main-acupoint used for both groups was Xiaguan (ST7) of affected side, on which needle was deeply inserted to reach spheno-palatine ganglion in the DN group, but was inserted conventionally in the SN group; the auxiliary acupoints used were the local points Cuanzhu (BL2), Sibai (ST2), Chengjiang (CV24) of affected side, as well as the remote points, bilateral Hegu (LI4) and Taichong (LR3). The needling was implemented every other day, with electric stimulation applied to all the punctured acupoints for 30 min, 10 days treatment as one therapeutic course. Each patient received 2 courses of needling with 1 week interval in between. The clinical efficacy, pain control and adverse reaction were evaluated and compared after the treatment. Rank-sum test showed that the efficacy in the DN group was significantly better than that in the SN group (Z =2.30, P=0.021); the pain was alleviated in both groups in frequency, intensity and sustained time (evaluated by visual analogue scale) significantly (P<0.01), but deep needling showed a superiority over superficial needling in reducing the frequency and intensity of episode (Z=9.55, Z=5.50, both P=0.00). No adverse reaction occurred during the treatment course of both groups. Spheno-palatine ganglion needling is highly effective, safe and reliable for the treatment of PTN.

Repeat Gamma Knife Radiosurgery for Trigeminal Neuralgia

Background: Although gamma knife radiosurgery (GKRS) has been shown to be safe and effective for the treatment of trigeminal neuralgia (TN), there are few studies that report the results of a second GKRS. Method: Between May 22, 1998 and April 1, 2003, we treated 335 primary TN patients with GKRS. All received a maximum dose of 75 Gy to the cisternal trigeminal nerve. 45 patients with recurrent or persistent TN were treated with a maximum dose of 40 Gy at a second GKRS and were available for at least 6 months of follow-up. Results: Final pain relief (mean of 15 months after second GKRS) was 50% or greater in 28 of the 45 patients (62.2%). Patients who had no neurosurgical procedure prior to their first GKRS were more likely to have pain relief of 50% or greater following the second GKRS (p = 0.042). Significant new dysesthesias (score greater than 5 on a scale of 0–10) developed in 2 patients (4.4%). Conclusion: Repeat GKRS has a good chance of relieving TN pain without complications and is more likely to relieve pain in those who did not have any procedure prior to their first GKRS.