Trigeminal Neuralgia Research Articles

Acupuncture and moxibustion treatment of a child with primary trigeminal neuralgia: A case report

Primary Trigeminal Neuralgia (PTN) is a paroxysmal severe pain that occurs in the distribution area of the trigeminal nerve in the head, face, and oral cavity, which is more common in middle-aged and elderly people. Acupuncture is a traditional Chinese medical practice in which "treating internal diseases externally" is employed, and it refers to the use of both acupuncture and moxibustion. It has been reported in many literatures that acupuncture is effective in treating primary trigeminal neuralgia with few adverse reactions. This article reports on the case of a 9-year-old child with primary trigeminal neuralgia who, after experiencing some effectiveness but significant adverse reactions while using carbamazepine, was treated with acupuncture and moxibustion, resulting in a complete cure.

Dual-Target Radiosurgery for Concomitant Continuous Pain Presentation of Trigeminal Neuralgia: Radiomodulation Effect and Dose.

Patients with trigeminal neuralgia (TN) experience concomitant continuous pain (CCP) that can be difficult to treat. A dual-target approach delivering a high dose of radiation to the nerve and the contralateral thalamus can develop a fast radiomodulation effect on lowering pain. We sought to determine if this effect was dose dependent. We retrospectively reviewed 21 patients treated with radiosurgery in CCP and severe TN pain, with a visual analog scale (VAS) score of nine out of 10 at the time of treatment. Ten patients were treated with a high dose (>120 Gy) in the thalamus 90 Gy to the nerve, and the rest with a low dose (<120 Gy) to the thalamus and >90 Gy to the nerve. Of those who received the high dose to the thalamus, six patients (60%) received 140 Gy, and four (40%) received 120 Gy, with a median dose to the trigeminal nerve of 90 and 85 Gy, respectively. The high thalamus dose showed a radiomodulation effect from day 1. The low thalamus dose did not produce radiomodulation on any of the first four days. The percentage of VAS scorereduction one month after treatment was higher in the high-thalamus dose group than in the low-thalamus dose group. At three months, VAS score was 2 in the high-dose group and 4 in the low-dose group. The radiomodulation effect in pain and dual-target radiosurgery is dose dependent in CCP in TN; a high dose can provide a more consistent clinical result than a lower dose.

Efficacy of Gasserian Ganglion High‐Voltage, Long‐Duration Pulsed Radiofrequency Combined With Block on Acute/Subacute Zoster‐Related Trigeminal Neuralgia

Background: Trigeminal postherpetic neuralgia (TPHN) is a severe chronic pain that can lead to various socioeconomic consequences. Therefore, it is necessary to explore optimal treatment options for acute/subacute herpes zoster (HZ)–related trigeminal neuralgia and prevent the further development of TPHN. High‐voltage, long‐duration pulsed radiofrequency (HL‐PRF) of the Gasserian ganglion is a new surgical intervention used to treat PHN. A ganglion block has been reported to possess anti‐inflammatory effects and potential analgesic benefits.Methods: We included 83 patients with HZ‐related acute/subacute trigeminal neuralgia admitted from January 1, 2021, to June 1, 2023, and received Gasserian ganglion HL‐PRF combined with block. A 6‐month follow‐up was conducted, including Numerical Rating Scale (NRS) scores, Pittsburgh Sleep Quality Index (PSQI), the incidence of TPHN, the dosage of anticonvulsants and analgesics, efficacy, and adverse events.Results: All patients showed a significant decrease in postoperative NRS scores (p &lt; 0.05). The NRS scores of the acute HZ group were consistently lower than those of the subacute HZ group at different time points (p &lt; 0.01). The overall incidence of TPHN from the onset of HZ to 12 weeks is 21.68%. The incidence of TPHN in the acute phase group was 12.77%, significantly lower than the 33.33% in the subacute phase group (p = 0.024). The effective rate was 74.7% in all patients, at 3 months after the treatment. The effective rate was 82.98% in the acute phase group and 63.89% in the subacute phase group, showing a statistically significant difference (p = 0.047). The PSQI score of the acute group was consistently lower than that of the subacute group (p &lt; 0.01). The dosage of analgesics and anticonvulsants used in the acute HZ group was lower than that in the subacute group (p &lt; 0.01). All patients did not experience serious adverse reactions.Conclusions: Gasserian ganglion HL‐PRF combined with block can be an effective and safe technique to relieve the pain of acute/subacute zoster‐related trigeminal neuralgia and prevent the incidence of TPHN.

Unusual Presentation of Trigeminal Neuralgia and its Surgical Management

Trigeminal neuralgia (TN) is a debilitating neuropathic condition characterized by excruciating, lancinating pain attacks. The standard first-line treatment of TN is carbamazepine medication, but some patients do not experience relief from this drug. For cases that do not respond to medication, surgical procedures that cut or remove portions of the peripheral nerves, such as the inferior alveolar and mental nerves, can be attempted. However, these neurectomysurgeries often have high rates of severe facial pain recurring over time. A 40-year-old man suffered from chronic, debilitating trigeminal neuralgia. He underwent multiple tooth extractions and took carbamazepine, but neither provided improvement in his agonizing facial pain. He then had surgical neurectomies of the mental and inferior alveolar nerves, which provided only partial pain relief. The patient was not relieved, so he underwent a surgical neurectomy of the lingual nerve. This third procedure successfully provided a significant reduction in his trigeminal neuralgia pain. Lingual neurectomy emerges as a potentially definitive treatment modality for trigeminal neuralgia refractory to medication or alternative neurectomy procedures. This minimally invasive surgical approach offers a valuable option for patients seeking sustained pain relief, particularly those who are not suitable candidates for or desire to avoid, more extensive or resource-intensive interventions.

Safety and efficacy of carbamazepine in the treatment of trigeminal neuralgia: A metanalysis in biomedicine.

Trigeminal neuralgia is a debilitating condition characterized by severe facial pain. Carbamazepine has been widely used as a first-line treatment option for trigeminal neuralgia, but there is a need to evaluate its safety and efficacy based on existing evidence. This meta-analysis aims to systematically assess the available literature and provide a comprehensive evaluation of the safety and efficacy of carbamazepine in the treatment of trigeminal neuralgia. A thorough search of electronic databases yielded a total of 15 relevant studies that met the inclusion criteria. The pooled analysis of these studies revealed that carbamazepine demonstrated significant efficacy in reducing pain intensity and frequency in patients with trigeminal neuralgia. Moreover, the drug was generally well-tolerated, with the most common adverse events being mild and transient. Subgroup analyses based on different dosages and treatment durations further supported the overall findings. However, caution should be exercised in patients with certain comorbidities or specific populations, as some rare but severe adverse events were reported. In conclusion, this meta-analysis provides strong evidence supporting the safety and efficacy of carbamazepine as a valuable therapeutic option for the management of trigeminal neuralgia. These results can guide clinicians in making informed decisions regarding the use of carbamazepine and contribute to optimizing treatment strategies for patients with trigeminal neuralgia. Further research is warranted to explore long-term safety and efficacy outcomes, as well as to compare carbamazepine with alternative treatment modalities.

Personalized 3D Printed Tooth-Supported Template as a Novel Strategy for Radiofrequency Thermocoagulation for Trigeminal Neuralgia After the Failure of CT-Guided Puncture.

Trigeminal neuralgia (TN) is a common form of craniofacial pain, and Radiofrequency thermocoagulation (RFT) has become a commonly utilized treatment modality for TN. However, the complex anatomical configuration of the maxillofacial region and the difficulties inherent in positioning the neck in a hyperextended manner can present challenges for CT-guided punctures. The objective of this study is to assess the effectiveness and safety of 3D printed tooth-supported template(3D-PTST) guided RFT in patients who have previously undergone unsuccessful CT-guided puncture. Patients with TN undergoing RFT at the Department of Pain Medicine, PLA General Hospital, from January 2018 to January 2023, were assessed. 3D-PTST guided RFT was employed as an alternative when percutaneous puncture failed. Clinical, demographic, and follow-up data were collected. The duration of the procedure was determined by subtracting the time of anesthesia administration from the time of surgical drape removal. Pain intensity was assessed using the Numerical Rating Scale-11 scale. Treatment effects were evaluated utilizing the Barrow Neurological Institute scale. Incidences of complications related to RFA were documented. Six TN patients underwent 3D-PTST guided RFT. With tooth-supported template guidance, five patients achieved therapeutic target puncture in one attempt with one CT scan. One patient required two attempts with two CT scans. Operation duration ranged from 18 to 46 mins (mean 30 mins). All completed 3D-PTST-guided RFT without difficulty, significantly improving pain symptoms. Four patients had no pain recurrence at 12, 18, 36 and 37 months follow-up, respectively. Recurrence occurred in two patients (at 1 and 13 months). No serious treatment-related complications were observed. 3D-PTST guided RFT is an effective, repeatable, safe, and minimally invasive treatment method for patients with TN who have failed due to difficulty in puncture.

Trigeminal neuralgia: therapeutic strategies to restore quality of life

Trigeminal neuralgia (TN) usually affects the maxillary and mandibular branches of the fifth cranial nerve. Although the condition is primarily unilateral, few cases of bilateral manifestation have been reported. TN is uncommon; however, it significantly affects patients’ quality of life because the neuropathic pain worsens over time. Paroxysmal pain is triggered by mechanical stimuli or environmental factors. Diagnosis is usually based on clinical findings, including pain triggered by palpation of distinct areas; nevertheless, imaging studies, such as magnetic resonance imaging, are always used to rule out a secondary cause. TN can be caused by several factors, such as trauma and neurovascular compression, or could be idiopathic, which complicates its treatment. Although several studies focused on TN have been reported, a treatment modality with 100% efficacy is lacking. The first-line treatment is pharmacological; however, surgery may be required if symptoms persist.

Frame navigation guided percutaneous balloon compression for intractable trigeminal neuralgia secondary to multiple sclerosis

BackgroundPatients with multiple sclerosis (MS) are more likely to develop trigeminal neuralgia (TN) compared to the regular population, due to scarring of the nerve and development of a demyelination plaque. Despite treatment, approximately 10% of MS patients treated for TN experience symptom recurrence, including the development of MS-like symptoms such as optic neuritis and bilateral facial pain. MethodsA computed tomography (CT) scan was performed preoperatively on two patients diagnosed with multiple sclerosis (MS) who experienced secondary trigeminal neuralgia (TN). A precise reference frame was strapped firmly to the patient's forehead during the intraoperative procedure. Preliminary CT images were registered using the navigation system and the bony landmarks were set. Case descriptionTwo patients diagnosed with multiple sclerosis (MS) who experienced refractory trigeminal neuralgia (TN) underwent percutaneous balloon compression. Initial conservative treatment and one dosage of Gamma Knife Radiosurgery (GKR) resulted in symptom control for a few weeks. Both patients had an acute recurrence of pain; thus, percutaneous retrogasserian balloon compression was performed. During follow-up, the patients reported a 70% decrease in pain after the procedure, with minimal recurrence of shooting episodes. ConclusionManagement of trigeminal neuralgia secondary to drug-resistant multiple sclerosis presents a persistent challenge. The percutaneous technique for retrogasserian balloon compression may offer a solution for some patients, but it presents unique challenges for neurosurgeons. Given the complexity of the pathogenesis, target identification, and the potential absence of neurovascular conflict, microvascular decompression remains a debated approach for this patient population. While stereotactic radiosurgery may be a promising alternative.

Sphenopalatine Ganglion Block Using Intranasal Lignocaine Spray for Trigeminal Neuralgia: A Case Series

Abstract Various interventions have been tried for the management of trigeminal neuralgia which is a sharp, shooting recurrent neuropathic pain. The use of the sphenopalatine ganglion (SPG) block has been established as a fast, safe, and effective means of pain relief for these patients. Recently, 10% lignocaine spray has been described as a less invasive alternative for this block. We report seven patients of idiopathic trigeminal neuralgia with acute unilateral severe pain managed by SPG blocks using 10% intranasal lignocaine spray. Seven patients with unilateral trigeminal neuralgia were included in the study. Two puffs of 10% lignocaine were sprayed into the nostril of the affected side in a slightly medial and inferior direction. Before the procedure and 30 min later, Visual Analog Scale (VAS) scoring was done. The procedure was repeated in case of no pain relief after 1 h of nasal spray (VAS 4 or 5). All patients were observed for 2 h and oral medication was prescribed if required after assessment at 24 h. Four patients reported complete relief (VAS 0 or 1) and two of them reported pain (VAS 4 and 5) after 24 h. The procedure had to be repeated in two patients with no pain relief (VAS 4 and 5) after 1 h. There was no relief in one patient even after repeated administration (VAS 5). The findings suggest a role for intranasal lignocaine spray for SPG block in trigeminal neuralgia for alleviating acute exacerbations of pain and obtaining quick relief.

Autonomic features of craniofacial neuralgias: a systematic review with meta-analysis

The aim of the study is to describe the severity, temporal characteristics, and types of autonomic features as they relate to the characteristics of pain of the neuralgias. Also, to describe, based on literature, how these autonomic features can affect the treatment outcomes of patients with craniofacial neuralgias. We carried out a literature search using five databases, PubMed, Embase, OVID, Scopus and Web of Science. The search was executed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The protocol for this systematic review and meta-analysis was registered on PROSPERO CRD42021235319. 40% of all patients with craniofacial neuralgias had at least one autonomic feature. Out of the craniofacial neuralgias, trigeminal neuralgia was the most reported, with lacrimation being the most prevalent concomitant autonomic feature. There was also differences in the occurrence of the autonomic features dependent on which branch of a nerve such as the trigeminal nerve, was afflicted. When trigeminal neuralgia is excluded, the rest of the craniofacial neuralgias had reported autonomic features 28% of the pain events. (95% Confidence Interval: 2–90%). Contrary to the conventional belief, we found certain autonomic features to be more predominant than others, in specific craniofacial neuralgias. The prevalence of the autonomic features for all craniofacial neuralgias in the descending order is as follows, lacrimation, conjunctival injection, nasal congestion, rhinorrhea, flushing, edema/swelling, salivation, ptosis and sweating. With trigeminal neuralgia, the most common autonomic feature was lacrimation, and the least common was nasal congestion.

History of Trigeminal Neuralgia:Before the Era of Modern Treatment

Descriptions of what appears to be trigeminal neuralgia(TN)appear in medical literature from around the 2nd century AD. Aretaeus of Cappadocia is believed to be the first person in history to have specifically described TN. TN or TN-like facial pain was once known as Fothergill's disease, following a detailed description of the symptoms by Fothergill in the 18th century. For a long time, no effective oral therapy for TN was available, and only surgical treatments were used, such as severing of the trigeminal nerve or resection of the Gasserian ganglion. In the 19th and 20th centuries, Hartley, Krauss, Cushing, Spiller and Frazier developed techniques for approaching the Gasserian ganglion through the middle cranial fossa, and Dandy pioneered trigeminal nerve transection through the posterior fossa. Also at this time, Harris introduced nerve block using alcohol. Later, various oral medications, such as phenytoin(1942)and carbamazepine(1962), were introduced and these became effective treatments. Modern surgical treatment began in the mid-20th century, when Taarnhøj, Gardner and Jannetta introduced nerve decompression.

An accurately supervised motion-aware deep network for non-contact pain assessment of trigeminal neuralgia mouse model

Pain assessment in trigeminal neuralgia (TN) mouse models is essential for exploring its pathophysiology and developing effective analgesics. However, pain assessment methods for TN mouse models have not been widely studied, resulting in a critical gap in our understanding of TN. With the rapid advancement of deep learning, numerous pain assessment methods based on deep learning have emerged. Nonetheless, these methods have some limitations: (1) insufficiently objective supervision signals for training, (2) failure to account for the dynamic behavioral characteristics of mouse models in the constructed models and (3) inadequate generalization ability of the models. In this study, we initially constructed an objective pain grading dataset as the ground truth for model training, which remedy the limitations of prior studies that relied on subjective evaluation as supervisory signals. Then we proposed a novel deep neural network, named trigeminal neuralgia pain assessment network (TNPAN), which fuses the static texture characteristics and dynamic behavioral characteristics of mouse facial expressions. The promising experimental results demonstrate that TNPAN exhibits exceptional accuracy and generalization capability in pain assessment.

Trigeminal Neuralgia and Hemifacial Spasm: What to Do If It Does Not Cure?

Although microvascular decompression(MVD)is a highly effective treatment, there is little pathological evidence and some aspects of its mechanism remain unclear. Therefore, when symptoms appear after surgery, it is difficult to determine the pathological condition and select the treatment method. Therefore, we recommend dividing these factors into three categories. The first is "prolonged cure." Compressed nerves may take time to regenerate; therefore, it is necessary to wait at least one year to see if they recover naturally, especially in facial spasms. The second is "uncured." Intraoperative video and postoperative imaging findings should be reviewed. If a compressed blood vessel is overlooked or inappropriately decompressed, additional surgery should be performed. The third is "true recurrence," which is the loss of fixation of compressed blood vessels and granulomatization of the Teflon. Nerve bending that occurs again due to the retraction of the trigeminal nerve is corrected by reoperation. The therapeutic effects of reoperation are particularly strong in trigeminal neuralgia. Owing to the risk of nerve damage due to adhesion dissection, it is important to carefully consider and establish good communication with patients before surgery.

The outcomes of microvascular decompression for primary trigeminal neuralgia: insights from a single-center experience and technical advancements.

Microvascular decompression (MVD) remains the primary surgical treatment for trigeminal neuralgia due to its positive postoperative results. This study aims to evaluate the outcomes of patients with primary trigeminal neuralgia who underwent MVD. Additionally, the paper offers a detailed explanation of the surgical methodology of MVD employed at the neurosurgical hospital in Kazakhstan. The study involved 165 medical records of patients with trigeminal neuralgia who underwent MVD between 2018 and 2020. Out of these 165 patients, 90 (54.55%) were included in the final analysis and were further evaluated using the Barrow Neurological Institute pain intensity score. Various variables were analyzed, including age, sex, affected side, dermatomes, offending vessel, and surgical intervention type. Moreover, the surgical technique employed at the hospital was described. The average follow-up period after the MVD procedure was 32.78 ± 9.91 months. The results indicated that out of the 90 patients, 80 (88.89%) achieved a good outcome as evidenced by BNI scores I and II. It was observed that patients with affected maxillary dermatomas and those with affected ophthalmic + maxillary dermatomas were more likely to experience fair + poor postsurgery BNI scores. On the other hand, patients with neurovascular conflicts involving the maxillary + mandibular dermatomas demonstrated good BNI scores (p = 0.01). The outcomes of MVD in patients with primary trigeminal neuralgia showed good BNI scores within this study population. The outcome depended on the affected dermatome of the trigeminal nerve with the vessel. Additionally, patient positioning, intraoperative management including small skin incisions, minimal craniotomy, and precise closure of the dura, as well as intraoperative neurolysis, may contribute to achieving good clinical and satisfactory post-surgery aesthetic outcomes.

Prevalences of Trigeminal Neuralgia and Hemifacial Spasm

Neurosurgeons must have knowledge about the epidemiology of trigeminal neuralgia and facial spasm. The annual incidence of trigeminal neuralgia is 4.3-28.9 per 100,000 persons, with a prevalence of 76.8 per 100,000 persons, increasing with age. It is more common in women and on the right side, with SCA being the most common causative vessel. The long-term efficacy of MVD for trigeminal neuralgia is 80% with complete resolution of pain and 5.2% with complications, which is safe and highly effective when performed by an expert surgeon. Hemifacial spasm has an annual incidence of 0.78/100,000 with a prevalence of approximately 10 per 100,000, increasing with age. It is more common in women and on the left side. AICA alone is the most common causative vessel. The long-term efficacy of MVD for facial spasms is 87.1% with complete resolution of facial spasms and 3.0% with complications. As with trigeminal neuralgia, safe and highly effective treatment can be expected when treated by an expert surgeon.

Quality of life in patients suffering from trigeminal neuralgia – clinical case series

Quality of life in patients suffering from trigeminal neuralgia – clinical case series

Image Diagnosis of Trigeminal Neuralgia

Classic trigeminal neuralgia is mainly caused by arterial compression; most cases involve the superior cerebellar artery, followed by the anterior cerebellar, basilar, and vertebral arteries. The detection of neurovascular conflicts in trigeminal neuralgia requires special magnetic resonance imaging(MRI)modalities, including high-resolution three-dimensional(3D)-T2 sequence, 3D-time of flight angiography, 3D-T1 sequencing with gadolinium injection, and merged images of these sequences. The conflicting sites are not necessarily restricted to the root entry zone of the trigeminal nerve root and can be located more distally, proximal to the Meckel's cavum. Arterial compression and its severity, including displacement, angulation, distortion, and atrophy of the trigeminal root, are good predictors of the long-term efficacy of decompression surgery. Veins, primarily the transverse pontine vein, comprise 10%-20% of all causative vessels in trigeminal neuralgia. Gadolinium-enhanced 3D-T1 MRI and high-resolution 3D-T2 MRI merged with computed tomographic angiography are useful for detecting venous compression.

Trigeminal Neuralgia Management with &lt;i&gt;Varmam&lt;/i&gt; Therapy and &lt;i&gt;Siddha&lt;/i&gt; Medicine – A Case Report

A 48 year old female staff nurse from Chennai consulted in the Varma Maruthuvam Outpatient Department of APH-NIS, Chennai presented with complaints of sudden and severe stabbing pain with burning sensation at the left half of the maxillary and mandibular region for one year. After her MRI scan was done, she was diagnosed with trigeminal neuralgia due to vascular compression. The patient had consulted an allopathic hospital and used carbamazepine for the long term. She experienced some temporary relief, but the episodes occurred for a short while, and she felt drowsy. For further improvement, she came for Varmam treatment. The present study is a case report of typical Trigeminal Neuralgia (TN) that was treated with Siddha Varmam therapy along with Amukkarachooranam, Arumugachenduram and Arakku thailam for two months. This case report showed a promising reduction in pain episodes and recurrence following treatment, as measured by the Visual Analogue Scale (VAS) score. This study sheds light on the fact that Varmam therapy with concomitant medicines has a promising effect in the management of trigeminal neuralgia.

Repeat Microvascular Decompression for Recurrent Trigeminal Neuralgia.

To review our experience with patients presenting with recurrent trigeminal neuralgia (TN) and who have undergone repeat microvascular decompression surgery (rMVD). This retrospective observational study was conducted at the Department of Neurosurgery at a university hospital. Patients who initially experienced complete pain relief after the first MVD but later had a recurrence of TN symptoms which required an rMVD were included in the study. Pain control outcomes were evaluated based on the Barrow Neurological Institute (BNI) scale score. Of the 375 patients who underwent MVD for TN over a 20-year period, 19 patients (6 females and 13 males) with a mean age of 57.68 ± 9.78 years developed symptom recurrence which necessitated an rMVD (5.06%). The average duration of the symptoms before the rMVD was 16.1 ± 19.36 months. The mean BNI score of the patients before the rMVD was 4.5 ± 0.5. Recurrence was primarily attributed to compression by a new offending vessel (n=9, 47.4%) or a Teflon granuloma (n=8, 42.1%). Two patients (10.5%) did not have any identifiable compression. During a follow-up period of 106.3 ± 58.3 months, excellent pain relief (BNI-I) was achieved in 10 patients (52.6%). Eight patients (42.1%) experienced a good outcome (BNI-III), and one patient (5.3%) experienced a poor outcome (BNI-IV). Recurrence of TN symptoms can occur even after an initially successful MVD. Subsequent MVDs should be considered as the primary treatment option for recurrent TN, as it significantly controls pain with low morbidity.

Intraoperative Monitoring During Microvascular Decompression

During microvascular decompression(MVD)for hemifacial spasm(HFS), trigeminal neuralgia(TN), and glossopharyngeal neuralgia(GPN), brainstem auditory-evoked potential monitoring is widely used to preserve hearing function. In MVD for HFS, abnormal muscle response monitoring is useful for identifying the offending vessels compressing the facial nerve and confirming the completion of decompression intraoperatively. The amplitude of facial motor-evoked potential by transcranial electrical stimulation in the orbicularis oculi muscle is reported to decrease after completing MVD. The Z-L response(ZLR)probably confirms the true offending vessels by stimulating the culprit vessels; then, the ZLR could disappear after decompressing the offending vessels away from the compression sites. Spontaneous electromyographic activities obtained from the mentalis muscles by injection of saline into the facial nerve reportedly decreased after MVD compared with those before MVD. In MVD for the GPN, glossopharyngeal motor-evoked potential by transcranial electrical stimulation is used to preserve swallowing function and not to assess the completion of MVD. Because MVD for both the TN and GPN can result in normalization of the hyperactivity of the sensory nerve, it may be difficult to develop any monitoring to confirm the completion of MVD during surgery.