Trigeminal Neuralgia Research Articles

Pure Endoscopic Microvascular Decompression for Trigeminal Neuralgia and Hemifacial Spasm

The panoramic view offered by endoscopy has been used to observe neurovascular compression in endoscope-assisted microsurgery to compensate for the blind spots in microvascular decompression(MVD)for trigeminal neuralgia and hemifacial spasm. In recent years, purely endoscopic MVD has been performed as a minimally invasive surgery and has become a new surgical technique for MVD. Endoscopic MVD has gained acceptance, and further developments are expected. Here, we present endoscopic MVD, including the setup, equipment, surgical procedures, and decompression techniques by transposition, as well as representative cases, and discuss the future prospects and possibilities of endoscopic MVD.

Pulp Sensitivity Testing in Multiple Sclerosis: Disease Duration and Sensory/Motor Associations-A Cross-Sectional Study.

Introduction: This study explores a relatively unexplored aspect of multiple sclerosis (MS) by examining the sensitivity threshold of dental pulp as a potential indicator of neuropathy in MS patients. Building upon earlier research that focused on assessing the response to electrical pulp testing in MS patients who did not have a history of trigeminal neuralgia, this survey is aimed at delving into the relationship between MS duration and the threshold for stimulation in response to pulp sensitivity tests. Materials and Methods: This study encompassed a total of 124 maxillary central incisors from patients diagnosed with relapsing-remitting multiple sclerosis (RRMS). The participants were uniform in terms of age, falling within the 18-50 years range, and all had RRMS with no history of trigeminal neuralgia. The electric pulp sensitivity test was conducted on all samples, and the results of the electric pulp testing (EPT) were recorded according to the grade of the pulp tester that elicited a response. The threshold was considered reached when the patient first experienced a burning sensation after EPT application and the use of 1,1,1,2-tetrafluoroethane spray. Data analysis employed paired t-tests, Fisher's exact test, and Spearman correlation, with a significance level set at p < 0.05. Results: Based on the study's findings, the average response value to EPT was 2.69 ± 1.17, while the response time to the cold test was 2.61 ± 1.03 s. There was no statistically significant difference in the response to the cold test based on age (p = 0.45). However, it was observed that the mean response time to the cold test was significantly longer among male participants (p = 0.001). No significant differences were identified in the pulpal response to EPT or the cold test between patients with and without sensory-motor involvement (p > 0.05). Furthermore, Spearman's analysis revealed a noteworthy positive correlation between the electrical pulp threshold and the time taken to respond to the cold test (p = 0.025, r = 0.2). Conclusions: The utilization of the pulpal sensitivity test in MS patients holds promise for practical clinical use. Notably, individuals with a more extended duration of the disease exhibited a notably elevated threshold for both the EPT and the cold test conducted on their maxillary central incisors.

Personalized analysis of pain-weather associations: a pilot study.

<p style="text-align: justify;">It is a wellknown belief that weather can influence human health, including pain sensation. However, the current data are controversial, which might be due to the wide range of interindividual differences. The present study aimed to characterize the individual pain&ndash;weather associations during chronic pain by utilizing several data analytical methods.</p>. <p style="text-align: justify;">The study included 3-3 patients with (P1, P3, and P4) or without (P2, P5, P6) diabetes mellitus and signs of trigeminal neuralgia or low back pain. Subjective pain scores (0&ndash;10) and 12 weather parameters (terrestrial, geomagnetic, and solar) were recorded for one month repeated three times&nbsp;daily. Nonparametric Spearman&rsquo;s correlation&nbsp;(Sp), multiple regression (Mx), and principal&nbsp;component (PCA) analyses were performed&nbsp;to evaluate associations between pain and&nbsp;meteorological factors obtained at the day&nbsp;of recorded pain value, 2 days before and&nbsp;2 days after the recorded pain, and the&nbsp;changes in these parameters (5 &times; 12 parameters). Complex scores were calculated&nbsp;based on the results of these analyses.</p>. <p style="text-align: justify;">While the temperature had the&nbsp;highest effects on the pain levels in most&nbsp;of the participants, huge interindividual&nbsp;dif&shy;ferences in the degree and the direction of the associations between pain and&nbsp;weather parameters could be obtained.&nbsp;The analytic methods also revealed subjectspecific results, and the synthesis of different&nbsp;statistical methods as total scores provided a personalized map for each patient, which&nbsp;showed disparate patterns across the study&nbsp;participants. Thus, Participants 2 and 5 had&nbsp;higher scores for Mx compared to Sp; furthermore, certain factors showed opposite&nbsp;direction in their associations with the pain&nbsp;level depending on the type of analysis (Sp vs&nbsp;Mx). In contrast, P3 had a lower score for Mx&nbsp;compared to Sp, which might suggest a low&nbsp;level of weather sensitivity on the association&nbsp;between the different weather parameters&nbsp;in this subject. Furthermore, participants&nbsp;P4 and P6 had a very high level of weather&nbsp;sensitivity, while P1 had an opposite pattern.&nbsp;Regarding the time point-related effects on&nbsp;the pain level, most patients were sensitive&nbsp;to parameters obtained at the same day or&nbsp;two days before, except the P1 subject, who&nbsp;had the highest sensitivity to weather parameters detected two days after.</p>. <p style="text-align: justify;">The present study highlights&nbsp;the importance of integrating different&nbsp;data analysis approaches to elucidate the&nbsp;individual connections between pain and&nbsp;most of the weather parameters. In conclusion, complex personalized profiling should&nbsp;be considered for the characterization of&nbsp;pain&ndash;weather associations by applying different data analytical approaches, which may&nbsp;provide feedback to physicians and patients.&nbsp;</p>.

Pharmacological Treatment of Trigeminal Neuralgia

Although carbamazepine is the first-line treatment option for trigeminal neuralgia, it may not be sustained long-term. The benefits of carbamazepine are offset by adverse effects that lead to its withdrawal. The alternatives to carbamazepine include gabapentin, pregabalin, and microgabalin. Although used off-label in Japan, baclofen, lamotrigine, intravenous lidocaine, and botulinum toxin type A are also effective. Clinical experience has shown that alternative treatments are less effective than carbamazepine. Therefore, they can be used instead of or in addition to carbamazepine. The adverse effects of drugs include drowsiness, dizziness, rash, bone marrow suppression, and liver dysfunction. Carbamazepine and lamotrigine are particularly likely to cause severe drug eruptions such as Stevens-Johnson syndrome and toxic epidermal necrolysis. Low-dose titration is important to avoid the development of rashes and adverse effects.

Slow-Chronic Progressive Hydrocephalus as Complication of Microvascular Decompression for Trigeminal Neuralgia: A Case Report

Microvascular decompression (MVD) is one of the well-established treatment options for trigeminal neuralgia that may include posterior fossa surgery. However, Several complications were noted as being part of posterior fossa surgery and hydrocephalus is very rare to occur, especially the slow-chronic onset type. The pathophysiology is still unclear, but surgeons and patients must be warned about this possible surgical adverse event. Here we report a case of slow-chronic hydrocephalus in a 66-years old male who has a history of MVD procedure due to left trigeminal neuralgia. A shunt procedure was performed, in which after the surgery the patient’s complaints were resolved, and discharged without any morbidity.

Unusual presentation of trigeminal post-herpetic neuralgia as Hemicrania Continua: A case study

Introduction: Cranial post-herpetic neuralgia sometime becomes refractory to medications. Before increasing the medications detailed history of headache phenotype is very important. Case report: A 41-year-old male developed a herpes infection in the right side first division of the trigeminal nerve two years back before presenting to us. He complained of continuous background dull aching headache (VAS 3 to 4) in the right orbito-fronto-temporal region. Besides this he used to experience sharp shooting severe pain (VAS 8 to 9) for one to two hours, occurring two to three times a day every five to six days for the last two years in same distribution. Episodes of exacerbation were associated with cranial autonomic symptoms (CAS), including right-side eye redness, lacrimation, and nasal congestion. His examination revealed nothing additional than allodynia in the same distribution. His MRI brain revealed no significant abnormality. Different medications were tried but in vain. He was started on Indomethacin to which he responded dramatically. Discussion: Non responsive cases of PHN form a refractory group and might be subjected to unnecessary medications or interventions. Secondary hemicrania continua have been reported due to different causes other than herpes. So, after ruling out secondary causes indomethacin challenge should be the next step in the diagnostic workup.

Clinical observation of perioperative negative emotional changes in patients with percutaneous balloon compression for primary trigeminal neuralgia: A prospective cohort study

ObjectiveTo investigate the prevalence of negative emotions in trigeminal neuralgia (TN) patients, to identify risk factors associated with anxiety and depression, and further to explore the impact of percutaneous balloon compression (PBC) on anxiety and depression in TN patients during the perioperative period. Methods400 patients with primary TN treated with PBC at our institution from November 2021 to April 2023 were included. We analyzed visual analogue scale (VAS) and the Hospital Anxiety and Depression Scale (HADS) scores. The patients’ clinical data and short-term clinical outcomes were gathered and subjected to statistical analysis. ResultsThis study included a total of 400 patients diagnosed with primary TN. Patients who had high pain intensity (OR 1.20, 95 % CI 1.02–1.41; p = 0.025) or a history of multiple previous TN procedures (OR 1.49, 95 % CI 1.03–2.16; p = 0.036), were more prone to anxiety. Patients who were female (OR 1.59, 95 % CI 1.03–2.44; p = 0.036), had high pain intensity (OR 1.28, 95 % CI 1.08–1.52; p = 0.004) or had a history of multiple previous TN procedures (OR 1.48, 95 % CI 1.11–1.98; p = 0.008), were more likely to have depression. Significant improvements in anxiety and depressive symptoms were observed in patients who experienced pain relief after PBC (p < 0.001). ConclusionsFemale gender, high pain intensity, and a history of multiple prior TN procedures are associated risk factors for anxiety and depression in TN patients. PBC can provide patients with a high pain relief rate and significantly improve their anxiety and depression symptoms during the perioperative period.

Safety and Efficacy of Radiofrequency Ablation of Gasserian Ganglion in Trigeminal Neuralgia

Background: Trigeminal neuralgia (TN) is characterized by intractable pain in one or more division of trigeminal nerve. Pharmacologic management is first line treatment for TN, when it fails interventional treatment options are considered like percutaneous procedures or micro vascular decompression. Radio frequency thermoscoagulation is an effective option for medically refractory cases to control pain.Objective: To evaluate the safety and efficacy of Radiofrequency thermocoagulation of the gasserian ganglion for the treatment of trigeminal neuralgia.Methods: Total 44 patients were included in this prospective obsarvational study who were already diagnosed with trigeminal neuralgia and refractory to medical management. All patients were treated by radiofrequency thermocoagulation after confirming the position of needle tip by sensory and motor stimuli. Three lesions were created at 60-70oC for 90 second each. Patients were assessed for pain relief, corneal reflex, numbness and masticatory muscle weakness at immediate post procedural stage, 1 week, 1 month and at 6 months.Results: Twenty eight patients had pain over both mandibular (V3) and maxillary (V2) division, 12 patients had mandibular (V3) and 4 patients had only maxillary (V2) division involvement. Excellent pain relief was archived in 38 (86.36%) patients, 4 patients (9.09%) have good pain control and 2 (4.54%) patient developed poor pain control with development of Anesthesia dolorosa in 1 patient. None of them develop complete facial numbness, 41 patients developed tolerable numbness and 2 patients develop somewhat bothersome, Facial numbness. Three patients developed unilateral masseter muscle weakness however no patients developed corneal ulcers, blindness or other complications.Conclusion: Temperature controlled thermocoagulation is a safe and effective treatment options for trigeminal neuralgia.

Trigeminal Neuralgia: Anticonvulsants and Antidepressants

Orofacial neuropathic pain happens due to somatosensory nervous system injury or disease in the orofacial region. Multiple types of orofacial neuropathic pain have been identified, including nonodontogenic neuropathic orofacial pain, postherpetic neuralgia, atypical odontalgia, glossopharyngeal neuralgia and trigeminal neuralgia. Currently, pharmacological intervention is well known as the foundation for managing neuropathic pain. Drugs from different classifications, including anticonvulsants, antidepressants, opioids, and nonsteroidal anti-inflammatory drugs, are generally used to treat these events. However, these drugs are not yet broadly accepted for these treatments. This review will explore recent clinical findings and fragments of evidence regarding anticonvulsants and antidepressants in the management of trigeminal neuralgia.

Review of craniofacial pain syndromes involving the greater occipital nerve: relevant anatomy, clinical findings, and interventional management.

Craniofacial pain syndromes exhibit a high prevalence in the general population, with a subset of patients developing chronic pain that significantly impacts their quality of life and results in substantial disabilities. Anatomical and functional assessments of the greater occipital nerve (GON) have unveiled its implication in numerous craniofacial pain syndromes, notably through the trigeminal-cervical convergence complex. The pathophysiological involvement of the greater occipital nerve in craniofacial pain syndromes, coupled with its accessibility, designates it as the primary target for various interventional procedures in managing craniofacial pain syndromes. This educational review aims to describe multiple craniofacial pain syndromes, elucidate the role of GON in their pathophysiology, detail the relevant anatomy of the greater occipital nerve (including specific intervention sites), highlight the role of imaging in diagnosing craniofacial pain syndromes, and discuss various interventional procedures such as nerve infiltration, ablation, neuromodulation techniques, and surgeries. Imaging is essential in managing these patients, whether for diagnostic or therapeutic purposes. The utilization of image guidance has demonstrated an enhancement in reproducibility, as well as technical and clinical outcomes of interventional procedures. Studies have shown that interventional management of craniofacial pain is effective in treating occipital neuralgia, cervicogenic headaches, cluster headaches, trigeminal neuralgia, and chronic migraines, with a reported efficacy of 60-90% over a duration of 1-9months. Repeated infiltrations, neuromodulation, or ablation may prove effective in selected cases. Therefore, reassessment of treatment response and efficacy during follow-up is imperative to guide further management and explore alternative treatment options. Optimal utilization of imaging, interventional techniques, and a multidisciplinary team, including radiologists, will ensure maximum benefit for these patients.

Exploring biomarkers in trigeminal neuralgia patients operated with microvascular decompression: A comparison with multiple sclerosis patients and non-neurological controls.

Trigeminal neuralgia (TN) is a severe facial pain condition often associated with a neurovascular conflict. However, neuroinflammation has also been implicated in TN, as it frequently co-occurs with multiple sclerosis (MS). We analysed protein expression levels of TN patients compared to MS patients and controls. Proximity Extension Assay technology was used to analyse the levels of 92 proteins with the Multiplex Neuro-Exploratory panel provided by SciLifeLab, Uppsala, Sweden. Serum and CSF samples were collected from TN patients before (n = 33 and n = 27, respectively) and after (n = 28 and n = 8, respectively) microvascular decompression surgery. Additionally, we included samples from MS patients (n = 20) and controls (n = 20) for comparison. In both serum and CSF, several proteins were found increased in TN patients compared to either MS patients, controls, or both, including EIF4B, PTPN1, EREG, TBCB, PMVK, FKBP5, CD63, CRADD, BST2, CD302, CRIP2, CCL27, PPP3R1, WWP2, KLB, PLA2G10, TDGF1, SMOC1, RBKS, LTBP3, CLSTN1, NXPH1, SFRP1, HMOX2, and GGT5. The overall expression of the 92 proteins in postoperative TN samples seems to shift towards the levels of MS patients and controls in both serum and CSF, as compared to preoperative samples. Interestingly, there was no difference in protein levels between MS patients and controls. We conclude that TN patients showed increased serum and CSF levels of specific proteins and that successful surgery normalizes these protein levels, highlighting its potential as an effective treatment. However, the similarity between MS and controls challenges the idea of shared pathophysiology with TN, suggesting distinct underlying mechanisms in these conditions. This study advances our understanding of trigeminal neuralgia (TN) and its association with multiple sclerosis (MS). By analysing 92 protein biomarkers, we identified distinctive molecular profiles in TN patients, shedding light on potential pathophysiological mechanisms. The observation that successful surgery normalizes many protein levels suggests a promising avenue for TN treatment. Furthermore, the contrasting protein patterns between TN and MS challenge prevailing assumptions of similarity between the two conditions and point to distinct pathophysiological mechanisms.

Isolated trigeminal neuralgia as the presenting symptom of cerebellopontine infarction: a case report

Isolated trigeminal neuralgia as the presenting symptom of cerebellopontine infarction: a case report

Dosimetric impact of rotational errors in trigeminal neuralgia radiosurgery using CyberKnife.

Trigeminal neuralgia (TN) can be treated on the CyberKnife system using two different treatment delivery paths: the general-purpose full path corrects small rotations, while the dedicated trigeminal path improves dose fall-off but does not allow rotational corrections. The study evaluates the impact of uncorrected rotations on brainstem dose and the length of CN5 (denoted as Leff) covered by the prescription dose. A proposed model estimates the delivered dose considering translational and rotational delivery errors for TN treatments on the CyberKnife system. The model is validated using radiochromic film measurements with and without rotational setup error for both paths. Leff and the brainstem dose is retrospectively assessed for 24 cases planned using the trigeminal path. For 15 cases, plans generated using both paths are compared for the target coverage and toxicity to the brainstem. In experimental validations, measured and estimated doses agree at 1%/1mm level. For 24 cases, the treated Leff is 5.3±1.7mm, reduced from 5.9±1.8mm in the planned dose. Constraints for the brainstem are met in 23 cases for the treated dose but require frequent treatment interruption to maintain rotational corrections<0.5° using the trigeminal path. The treated length of CN5, and plan quality metrics are similar for the two paths, favoring the full path where rotations are corrected. We validated an analytical model that can provide patient-specific tolerances on rotations to meet plan objectives. Treatment using the full path can reduce treatment time and allow for rotational corrections.

New Meningoencephalocele and Skull Base Changes Revealed by Trigeminal Neuralgia 14 Years After Diagnosis of Idiopathic Intracranial Hypertension.

New Meningoencephalocele and Skull Base Changes Revealed by Trigeminal Neuralgia 14 Years After Diagnosis of Idiopathic Intracranial Hypertension.

PERPLEXING IMPACTED THIRD MOLARS IN A CASE OF TRIGEMINAL NEURALGIA AND ARACHNOID CYST (CASE REPORT)

Introduction: Trigeminal neuralgia (TN) is the most frequent form of craniofacial neuropathic pain, with a wide range of severity. Trigeminal neuralgia classically has been associated with neurovascular compression in the prepontine cistern at the nerve root entry zone or in Meckel’s cave due to an abnormal vessel, tumor, or cyst. Arachnoid cysts of the posterior cranial fossa are still less commonly compared to those superior to the constituent part of the posterior cranial fossa meninges. However, the arachnoid cyst in conjunction with the impacted third molar may cause compression of the trigeminal ganglion with similar clinical symptoms. The aim of this report is to explain the management of the first division of trigeminal neuralgia with an arachnoid cyst perplexed by impacted third molars. Case report: A case of a 27-year-old female with throbbing pain on top of her head, forehead, temple, and eyes several times. Extensive clinical and radiologic examinations were performed and revealed an arachnoid cyst and impacted third molars. Impacted third molars were removed. The patient declined the surgery for the arachnoid cyst and was treated symptomatically with amitriptyline 25 mg once daily until recently. The definitive diagnosis was the first division of trigeminal neuralgia and an arachnoid cyst. Conclusions A fundamental aspect of the diagnosis of trigeminal neuralgia is to examine and exclude all possible underlying etiologies and structural pathologies, which can refer the pain to a location remote from the stimulus.

Features of trigeminal nerve exit on the base of the brain: neurovascular conflict

The trigeminal nerve is a complex anatomical formation that performs very important tasks in terms of functionality. This article focuses on the study of the exit of the trigeminal nerve and its syntopy with arteries. It is the study of the location of nearby vessels relative to the nerve and their neurovascular conflict that determines the relevance of this work. The prevalence of trigeminal neuralgia (TN) is quite high and amounts to 40–60 patients per 100,000 population, and the incidence according to the World Health Organization is within 2–4 people per 10,000 population. The maximum risk of neurovascular conflict is observed in the age group of people from 45 to 60 years. It is also known that women suffer from neuralgia significantly more often than men. Not only the exact diagnosis, but also the selection of the most appropriate treatment tactics will depend on the result of studies of the individual anatomical features of the pons area. The authors of the article studied 17 preparations of the base of the brain of middle-aged individuals, fixed in a 7 % formalin solution. Of the 17 preparations studied, neurovascular relationships were noted in 14, which is 82.4 % of the total. As a result of morphometric measurements, the data on the length and width of the pons, the thickness of the trigeminal nerve roots, and the middle cerebellar peduncles were obtained. Statistical data processing and photographic documentation were carried out. The clinical manifestations of the disease, diagnostic options, and various methods of treatment were considered. The most effective method of treating neurovascular conflict is surgery, the first mention of which dates back to 1934.

Independent association of the Meckel’s cave with trigeminal neuralgia and development of a screening tool

PurposeTo 1) investigate the association of the properties of the Meckel’s cave (MC) with TN occurrence (i.e., affected vs. unaffected nerves) and whether such association was independent of neurovascular contact (NVC); and 2) develop an objective screening tool for TN. Materials and methodsTwo hundred and nineteen trigeminal nerves were included. (The severity of) NVC was identified for individual nerve, and a set of 107 radiomic features were extracted to characterize various properties of each MC. Both procedures were primarily based on magnetic resonance imaging sequences. A radiomic score (Rad-score) was constructed for each MC to integrate the features associated with TN occurrence. Independent t-test and logistic regression were conducted to assess the association and develop the screening tool mentioned above. ResultsTwelve features were selected to build the Rad-score, with the Inverse Difference Moment Normalized (IDMN) having the greatest weight. The Rad-score was significantly (p ≤ 0.05) higher in the affected compared to the unaffected nerves, irrespective of NVC. The Rad-score and NVC were incorporated in the regression model/screening tool, which demonstrated an acceptable discriminating ability (C-statistic = 0.84). ConclusionThis study has identified a potential association of the properties/features of the MC with TN occurrence, probably involving the demyelination and axonal injury of the trigeminal ganglion within the MC as suggested by the IDMN. Such association may be independent of NVC. This finding may provide new insight into the etiology and/or pathophysiology of TN. The screening tool, which demonstrated an acceptable discriminating ability, may contribute to an improvement in its diagnosis.

Transplantation of olfactory ensheathing cells can alleviate neuroinflammatory responses in rats with trigeminal neuralgia

Trigeminal neuralgia (TN) is a common form of facial pain, which primarily manifests as severe pain similar to facial acupuncture and electric shock. Olfactory ensheathing cells (OECs) are glial cells with high bioactivity; these cells are essential for the periodic regeneration of the olfactory nerve and have been utilized for the repair of nerve injuries. A member of the P2X receptor family, P2X7R, is an ion channel type receptor that has been confirmed to participate in various pain response processes. In this study, we transplanted OECs into trigeminal nerve–model rats with distal infraorbital nerve ligation to observe the therapeutic effect of transplanted OECs in rats. Additionally, we utilized the P2X7R-specific inhibitor brilliant blue G (BBG) to study the therapeutic mechanisms of cell transplantation. The facial mechanical pain threshold of these rats significantly increased following cell transplantation. The immunohistochemistry, immunoblotting, and RT-qPCR results demonstrated that the levels of P2X7R, (NOD)-like receptor protein-3 (NLRP3), nuclear factor-κB (NF-κB), interleukin (IL)-1β, and IL-18 in the trigeminal ganglion of rats treated with OEC transplantation or BBG treatment were significantly lower than those in the injured group without treatment. Overall, our results demonstrate that OEC transplantation can alleviate TN in rats, and it can reduce the expression of P2X7R related inflammatory factors in TN rats, reducing neuroinflammatory response in TG.

Trigeminal neuralgia and cerebrovascular malformations. Two cases presentation

Two rare cases of combined pathology, representing trigeminal neuralgia caused by cerebrovascular malformations (cavernous malformation, arteriovenous malformation), are detailed and analyzed. The study involved two patients, a 39-year-old woman and a 63-year-old man, with pain syndrome along the V2‒V3 branches of the left trigeminal nerve that was resistant to medical therapy. Neurological status otherwise unchanged. After thorough examination, neurosurgical treatment was performed in the form of microsurgical decompression of the trigeminal neuralgia via a retrosigmoid approach to the cerebellopontine angle and removal/mobilization of the cerebrovascular malformation, significantly improving the patients' overall condition and providing long-term pain-free postoperative periods: 5 years in the first and 6 months in the second cases.Trigeminal neuralgia may be the initial or sole manifestation of existing cerebrovascular malformations. Standard evaluation of patients with trigeminal neuralgia includes MRI of the brain using 3D sequences, particularly T2-weighted 3D DRIVE mode, for better visualization of vascular-nerve structures to identify the provocative factor, although this mode does not always provide complete reliable information regarding the microstructural features of the cerebellopontine angle. Accordingly, the surgeon must always be prepared for both standard microvascular decompression surgery and work with pathological vascular formations without disrupting blood flow in this area of the brainstem. Decompression of the trigeminal nerve root with maximal possible removal or isolation of the compressive factor plays an important role in the treatment of pain syndrome and is effective when properly performed.

Effectiveness of gamma knife radiosurgery in the management of trigeminal neuralgia associated with multiple sclerosis: a systematic review and meta-analysis

Effectiveness of gamma knife radiosurgery in the management of trigeminal neuralgia associated with multiple sclerosis: a systematic review and meta-analysis