Treatment Of Trigeminal Neuralgia Research Articles

Uso da Toxina Botulínica Tipo A em pacientes com Neuralgia Trigeminal

This article provides a systematic review of the efficacy of Botulinum Toxin Type A (TBA) in treating trigeminal neuralgia (TN), a painful disorder affecting the trigeminal nerve. TN is described in the literature as a facial pain of acute nature, often unilateral, characterized by episodes of intense and transient pain, comparable to electric shocks. The diagnosis is made through a detailed evaluation that includes anamnesis, characterization of symptoms, and imaging tests to exclude similar pathologies. Conventional therapy for TN involves the use of carbamazepine; however, in cases of pharmacological resistance or ineffectiveness of standard treatments, TBA emerges as a viable therapeutic alternative. The efficacy of TBA, as demonstrated in retrospective and prospective studies, is due to its ability to inhibit the release of neurotransmitters responsible for pain transmission and inflammatory processes. Various studies corroborate the efficacy of TBA, especially in patients over 50 years old, observing substantial improvement in symptoms with minimal adverse effects. The administration of TBA is carried out directly in the trigger zones, where it has proven to be well-tolerated, providing significant improvement in the quality of life of the affected patients. Despite promising results, the literature suggests the need for additional studies to optimize the dosage protocols and application of TBA, aiming to ensure its efficacy and safety in the long term. In conclusion, this article reiterates that TBA represents an effective and minimally invasive therapeutic alternative for the treatment of TN. However, it is essential to develop individualized therapeutic protocols and conduct more comprehensive studies to consolidate its use as the treatment of choice.

Unlocking relief: the revolutionizing potential of spinal cord stimulation in the treatment of refractory trigeminal neuralgia

Unlocking relief: the revolutionizing potential of spinal cord stimulation in the treatment of refractory trigeminal neuralgia

Protocol for a systematic mapping review of surgical and pharmacological interventions for the treatment of trigeminal neuralgia.

Trigeminal neuralgia is a painful neuropathic disorder characterized by sudden electric shock-like pain that significantly impacts patients' quality of life. Multiple treatment alternatives are available, including medical and surgical options but establishing the optimal course of action can be challenging. To enhance clinical decision-making for trigeminal neuralgia treatment, it is imperative to organize, describe and map the available systematic reviews and randomized trials. This will help identify the best treatment alternatives supported by evidence and acknowledge potential knowledge gaps where future research is needed. This systematic mapping review aims to provide up-to-date evidence on the different surgical and pharmacological treatment alternatives used for trigeminal neuralgia. A search will be systematically conducted on the Epistemonikos database to identify potentially eligible systematic reviews. Additionally, a search will be made in PubMed, CENTRAL, and EBSCO to identify randomized controlled trials assessing pharmacological and surgical treatment interventions for trigeminal neuralgia. Two independent reviewers will screen and select the studies. Data on the different treatment alternatives and reported outcomes in the included studies will be extracted using standardized forms. Following extraction, descriptive statistical methods will be used to analyze the data. The final output of this study will include an evidence map that will illustrate the connections between different treatments and their respective outcomes, providing a clear depiction of the evidence landscape. This study expects to map, describe and assess the methodological quality of the available systematic reviews and trials on pharmacological interventions and neurosurgical procedures for treating trigeminal neuralgia. It will present the results in an evidence map that organizes the available evidence based on their different interventions and outcomes. This evidence map will serve as a visual tool to assist healthcare professionals and patients to understand evidence-based treatment options and their implications for managing this medical condition. La neuralgia del trigémino es un trastorno neuropático doloroso caracterizado por un dolor súbito y agudo, similar a una descarga eléctrica, que impacta significativamente en la calidad de vida. Dada la variedad de tratamientos disponibles, médicos y quirúrgicos, es crucial organizar y mapear la evidencia proveniente de revisiones sistemáticas y ensayos clínicos para orientar las decisiones clínicas. Esto permite identificar tratamientos respaldados por evidencia y señalar áreas de investigación futura. El propósito de esta revisión sistemática de mapeo es proporcionar una visión actualizada de la evidencia existente en relación con las diversas opciones de tratamiento quirúrgico y farmacológico empleadas en el manejo de la neuralgia del trigémino. Se realizará una búsqueda sistemática en la base de datos Epistemonikos para identificar potenciales revisiones sistemáticas. Adicionalmente, se buscará en PubMed, CENTRAL y EBSCO ensayos clínicos aleatorizados que evalúen intervenciones de tratamiento farmacológico y quirúrgico para la neuralgia del trigémino. Dos revisores independientes cribarán y seleccionarán los estudios. Se extraerán datos sobre las diferentes alternativas de tratamiento y los resultados reportados en los estudios incluidos utilizando formularios estandarizados. Tras la extracción, se utilizarán métodos estadísticos descriptivos para analizar los datos. El producto final de este estudio incluirá un mapa de evidencia que ilustrará las conexiones entre los diferentes tratamientos y sus respectivos resultados, proporcionando una representación clara del panorama de la evidencia. Los resultados que se extraerán de este mapeo sistemático incluyen identificar y describir las diferentes alternativas, tanto farmacológicas como quirúrgicas, que existen para el tratamiento de la neuralgia del trigémino. Además, se planea presentar un mapa de evidencia que se basará en los ensayos clínicos aleatorizados y revisiones sistemáticas, el cual mostrará la evidencia de manera organizada entre las diferentes intervenciones y sus desenlaces. Este mapa de evidencia servirá como una herramienta visual que ayudará a los profesionales de la salud y los pacientes a comprender mejor las opciones de tratamiento respaldadas por la evidencia y sus consecuencias en el manejo de esta condición médica.

COMPLETE AND INCOMPLETE BONY BRIDGES NEAR FORAMEN OVALE WITH POTENTIAL SURGICAL AND CLINICAL IMPLICATIONS

Objectives: Pterygospinous or Pterygoalar ligaments may pose mandibular nerve compression by when present near foramen ovale. The presence of ossified pterygospinous or pterygoalar ligaments might cause trouble to surgeons in performing percutaneous rhizotomy for trigeminal neuralgia, electroencephalographic procedures, or taking biopsy from cavernous sinus tumors. The present study aims to find the incidence and specific morphological variations related to the ossification of pterygospinous and pterygoalar ligaments. Methods: The study was conducted on 200 dried adult human cadaveric skull of unknown age and sex in the department of Anatomy, Mahatma Gandhi Medical College and Hospital, Jaipur. Skulls were obtained from different medical colleges of the Rajasthan region. The study included fully dried, intact, adult human skull bones with no structural defects. Damaged, fractured, skull with the developmental anomaly, injured or pathologically malformed skull especially at or near the foramen ovale on either side were excluded from the study. Ossification of pterygospinous and pterygoalar bar was studied on both sides. Statistical analyses were performed using SPSS Version 26 software. Results: Ossified ligaments were studied in 400 sides of 200 skulls. The ossification of pterygospinous bar was observed in 53 cases (13.25%). The pterygospinous bar was complete in twelve (3%) cases and incomplete in 41 cases (10.25%). The ossified pterygoalar ligament was observed in 62 cases (15.5%). Ossification was complete in 15 cases (3.75%) and incomplete in 47 cases (11.75%). Conclusion: Ossification of pterygospinous and pterygoalar bars was observed in skulls obtained from medical colleges in the Rajasthan region. Knowledge of such morphological variations of the skull base will improve the therapeutic outcomes in the treatment of trigeminal neuralgia.

The Efficiency of Established Diagnostic and Therapeutic Approaches in the Treatment of Trigeminal Neuralgia

The Efficiency of Established Diagnostic and Therapeutic Approaches in the Treatment of Trigeminal Neuralgia

Chiari type 1.5 malformation as a cause of secondary trigeminal neuralgia: case report and literature discussion

BackgroundChiari syndrome is a very rare cause of secondary trigeminal neuralgia (TN). There are a few cases of TN associated with Chiari syndrome in the literature, and all of these cases were reported as Chiari type 1. In this report, we present a case of secondary trigeminal neuralgia caused by Chiari type 1.5 for the first time unlike the literature.Case presentationA 38-year-old male patient, who had frequent and severe attacks of pain under the orbit, at the chin and rim of the mouth, was evaluated with craniocervical Magnetic Resonance Imaging (MRI) and revealed Chiari type 1.5 malformation and syringomyelia.ConclusionsThe mechanism of TN associated with Chiari malformation is unclear. However, the main concepts emphasized in cases presented in the literature are compression and stretching. The rapid relief of pain after decompression surgery in these cases also supports this situation. It can be predicted that compression and tension forces will become more pronounced in Chiari type 1.5 malformation, in which the brainstem elongation and ventral pressure are more prominent. Decompression of the foramen magnum provides rapid and effective pain control in the treatment of TN accompanying Chiari 1.5 syndrome that does not respond to medical treatment.

Efficacy and safety of Dyna CT-assisted percutaneous balloon compression in the treatment of tumor-related trigeminal neuralgia: A single-center retrospective analysis

BackgroundPercutaneous balloon compression (PBC) has been widely used in the treatment of trigeminal neuralgia (TN). Patients with tumor-related TN are typically treated by tumor resection. However, when craniotomy is not feasible, PBC may serve as a simple and effective method for pain relief. Currently, there is limited literature on the use of this technique in treating patients with tumor-related TN. In this study, we aim to evaluate the efficacy and safety of Dyna CT-assisted PBC in the treatment of tumor-related TN. MethodsFrom January 2018 to December 2023, a total of 19 patients with tumor-related TN underwent Dyna CT-assisted PBC at our institution. The modified Barrow Neurological Institute Pain Intensity Grading Scale and sensory reduction scores were employed to assess treatment outcomes. A retrospective analysis was conducted on the clinical characteristics, surgical efficacy, postoperative complications, and follow-up results of all patients. ResultsImmediate and complete pain relief was observed in 18 patients following PBC, with one patient experiencing delayed recovery. Follow-up periods ranged from 4 to 62 months, revealing only 4 patients with pain recurrence at the last follow-up, and tumor-related TN patients with involvement of Meckel's cave were more prone to recurrence. No severe complications occurred throughout the follow-up period. Although facial numbness was reported in all 15 patients, jaw weakness in 8 patients, and postoperative headache in 7 patients, these symptoms resolved within a short period. There were no statistically significant differences in postoperative facial numbness and jaw weakness between tumor-related TN patients with or without Meckel's cave involvement. However, patients with Meckel's cave involvement were more likely to experience postoperative headaches. Patient satisfaction scores indicated a significant improvement in postoperative quality of life. ConclusionFor patients with tumor-related TN, when craniotomy is not feasible, Dyna CT-assisted PBC proves to be a safe and effective alternative treatment. Additionally, we observed varying postoperative clinical outcomes based on the different sites of tumor compression on the trigeminal nerve. Patients with tumor-related TN not involving Meckel's cave exhibited more enduring clinical efficacy compared to those with Meckel's cave involvement.

Trigeminal neuralgia: drug therapy : The new German guideline

Trigeminal neuralgia is characterized by severe, lightning-like attacks of pain, which are mandatory for the diagnosis. The pain typically occurs on one side and is often triggered by simply touching the face, chewing or talking. In acute exacerbations, this can also hinder food and fluid intake, resulting in alife-threatening clinical picture. Adistinction is made between classical, secondary and idiopathic trigeminal neuralgia. For the diagnosis of trigeminal neuralgia, the medical history and imaging procedures are key for classification. The only active substances approved for the treatment of trigeminal neuralgia in Germany are carbamazepine and phenytoin, which is why off-label drugs often need to be used if there is no or insufficient effect or inacceptable side effects. Cooperation between research and clinical practice to improve the care of affected patients is therefore essential.

Orthokinetic splint as treatment of trigeminal neuralgia associated with temporomandibular dysfunction

Orthokinetic splint as treatment of trigeminal neuralgia associated with temporomandibular dysfunction

Clinical Efficacy of Percutaneous Balloon Compression Combined with Carbamazepine in the Treatment of Trigeminal Neuralgia: A Retrospective Study.

To investigate the effect of percutaneous balloon compression combined with carbamazepine on patients with Trigeminal Neuralgia (TN). The clinical data of 126 patients with TN admitted to our hospital from January, 2021 to January, 2022 were retrospectively analyzed. All patients underwent percutaneous balloon compression in our hospital. The patients were divided into a control group and an observation group, according to whether they continued to take carbamazepine after surgery. The general demographic data of patients, such as gender, age, family income, education level, pain site, diseased nerve, course of disease, and duration of pain were collected. Propensity score matching was used to balance the baseline data of the two groups, and the quality of life, treatment effect, and complications of the two groups were compared after matching. After treatment, the total effective rate of the observation group (95.00%) was higher than that of the control group (70.00%) (p < 0.05). Before treatment, there were no significant differences in the scores for quality of life dimensions between the two groups (p > 0.05). After treatment, the scores for each quality of life dimension in the observation group were higher than those in the control group. After treatment, the incidence of complications in the observation group (7.50%) was lower than that in the control group (30.00%) (p < 0.05). Percutaneous balloon compression combined with carbamazepine can effectively enhance the treatment of patients by improving their quality of life and reducing the occurrence of complications. These results can improve the clinical management of TN.

Evaluation of the Effectiveness of Using Pulse Dose Radiofrequency for Treatment of Trigeminal Neuralgia

Trigeminal neuralgia has an incidence of 4-13 per 100000 people per year. The incidence of this disease increases in the elderly, and it is known to cause severe shock-like pain. Pharmacological therapy is the first-line treatment of trigeminal neuralgia. If pharmacological therapy fails, then different procedures are available. Pulse-dose radiofrequency is one such procedure. In this study, we evaluated Pulse dose radiofrequency's efficacy as a method in which pulse amplitude and width are considered essential variables. This research was conducted as a cross-sectional study on trigeminal neuralgia patients referred to the pain clinic of Amir A’lam Hospital in 2020. Conservative therapy has failed; therefore, the clinician decided to use pulse dose radiofrequency to reduce their pain. Among the 29 patients registered during this period, 15 (51.8%) were women and 14 (48.3%) were men. The mean (±SD) age of the patient was 57.07(±14.26) years. The tow route was interrupted in 7 (24.1%) patients. A significant difference was observed between the pain scores before and after the operation (P&lt;0.001). Pulse-dose radiofrequency is a safe and effective therapy for treating trigeminal neuralgia and can be considered a new way to develop the pulse radiofrequency method.

Gamma Knife radiosurgery for the treatment of trigeminal neuralgia: A single center-experience

Introduction and objectivesWe aimed to assess the outcomes of patients with trigeminal neuralgia (TGN) who underwent Gamma Knife radiosurgery (GKRS). Materials and methodsFifty-three patients with typical TGN underwent GKRS from May 2012 until December 2022. Among these patients, 45 patients who were follow-up for at least 12 months were included in the study. A mean dose of 87.5 Gy (range, 80–90) was administered to the trigeminal nerve. Postoperatively, outcome was considered excellent if the patient was pain- and medication-free. ResultsThe mean symtpom duration was 9.53 years, and the mean patient age was 59.8 years (range, 34–85). The mean follow-up period was 46.8 months (range, 12–127 months). 46.7% of patients had a history of previous surgical interventions. A single nerve division was affected in 14 patients (31.1%), and multiple divisions were affected in 31 patients (68.9%). The rate of initial pain relief was 80%. Hypoesthesia in the area of trigeminal nerve developed in 30 (66.7%). Twenty patients (44.4%) exhibited excellent results within 72.4 months. Recurrence occurred in 11 patients (24.4%) with 27.6 months. ConclusionsOur results suggest that GKRS is a safe and effective procedure. Thus, it is an attractive first- and second-line treatment choice for TGN.

Endoscopically Assisted Exoscopic Surgery for Microvascular Decompression of the Trigeminal Nerve with Intraoperative Use of Indocyanine Green

Trigeminal neuralgia (TN) is a chronic condition that is typically caused by a blood vessel exerting pressure on the V cranial nerve at the root entry zone. The gold standard for TN treatment is microvascular decompression (MVD). This illustrative case shows an advanced surgical technique that combines the use of an exoscope and endoscope to treat TN with an innovative addition of intraoperative indocyanine green (ICG) control that can improve arterial and venous compression identification. The use of exoscopes and endoscopes, offering 360° root assessment, represents a significant evolution in surgical approaches. Enhanced visualization with ICG aided in identifying complex neurovascular conflicts, improving decompression accuracy. The use of both exoscope and endoscope, offering a 360° root assessment, represents a significant evolution in the microsurgical approach of TN. The additional use of ICG monitoring in a dynamic mode may be useful in identifying the complex arteriovenous form of neurovascular conflict. The endoscopically assisted exoscopic surgery with the intraoperative use of ICG for MVD of the trigeminal nerve can improve the identification of complex impingements underlining its effectiveness and potential in neurosurgical practice.

Clinical Efficacy of Oxcarbazepine compared with Carbamazepine in terms of Pain Relief in the Management of Trigeminal Neuralgia

Background: Despite various pharmacological drugs used for the treatment of Trigeminal Neuralgia (TN), the clinical efficacy of carbamazepine with oxcarbazepine in terms of pain relief particularly in Pakistani population is poorly studied. This study aimed to compare the efficacy of carbamazepine with oxcarbazepine for treating Trigeminal Neuralgia. Objective: To compare oxcarbazepine with carbamazepine in the management of trigeminal neuralgia in terms of mean pain. Study Design: Quasi-Experimental study. Settings: Fauji Foundation Hospital, Rawalpindi Pakistan. Duration: 06 months i.e. 30th Apr 2018 to 30th Oct 2018. Methods: This single-centre, prospective clinical study was conducted on 70 patients diagnosed with TN. Patients were divided into two groups; Group A: Control group (n = 35), in which patients were given Carbamazepine 200mg twice a day upto1800mg and Group B: an Experimental group (n = 35), in which the patients receive Oxcarbazepine (300mg BD daily up-to 1800mg). The clinical parameters were evaluated by a self-reported questionnaire. Pain level was assessed at 1st and 2nd month follow-up using a Visual Analog Scale. Results: The mean postoperative pain was measured for both groups. Although the mean pain score at 1st follow-up month was similar for Group A (5.2±1.0) and B (4.9±1.1), p=0.328, higher clinical efficacy was observed in 2nd follow-up month for Group B– Oxcarbazepine (3.1±0.8) when compared with Group A– Carbamazepine (5.14±0.8) in terms of mean pain score that was statistically significant p&lt;0.001. Conclusion: This study concludes that in term of pain relief, Oxcarbazepine appears to be a more effective as compared to Carbamazepine in the treatment of TN.

Benchtop and in Vitro Experiments of Novel Transform Stents for Trigeminal Neuralgia Treatment

Trigeminal neuralgia (TN) is a debilitating condition characterized by sudden, excruciating facial pain due to neurovascular compression of the trigeminal nerve. Stent deployment can change the course of the superior cerebellar artery upwards, possibly releasing the root entry zone of the trigeminal nerve. We developed a novel stent, the Transform stent, for TN treatment, and evaluated its mechanical properties using benchtop and in vitro hemocompatibility tests. We compared the performance of Transform and Enterprise stents in treating TN because they share similar self-expanding closed-cell features in the manufacturing process, are derived from nitinol tubes, and are fabricated through a laser-cutting process, but also because only the safety of Enterprise stents deployed in intracranial arteries has been reported clinically. All benchtop measurements, including radial force, trackability, bending stiffness, and conformability, were performed thrice for each stent model, and their average values are presented. Transform stents showed higher radial forces in vessels of diameters ranging from 1.0 mm than Enterprise stents. The trackability of the Transform stent was better than that of the Enterprise stent in a neurovascular model. Bending stiffness was stronger in the Transform stent whereas conformability was superior in the Enterprise stent. No significant thrombogenic issues were observed in the in vitro hemocompatibility tests. This study demonstrated the Transform stent as a potential option and paved the way for innovative endovascular approaches for the future TN treatment. Namely, the study confirmed that the characteristics of Transform stents at benchtop and in vitro evaluations may be used as a first step for studies such as in vivo pre- and clinical studies.

Riveting technique in percutaneous balloon compression for trigeminal neuralgia remedy

BackgroundThe percutaneous balloon compression (PBC) is a safe and simple treatment for trigeminal neuralgia. It works by compressing the Gasserian ganglion to block pain signals from the trigeminal nerve. To ensure effectiveness, it is important to focus the compression on the lower part of the balloon. ObjectiveTo validate the efficacy of a riveting technique, specifically pulling an inflated balloon, in order to apply enhanced compression on the ganglion. MethodsTo compare this novel technique with the conventional approach, a retrospective investigation was conducted on consecutive PBCs performed in our department between 2019 and 2022. For postoperative outcome assessment, efficacy was defined as achieving a VAS score of 0 or an improvement exceeding 5 points. Postoperative numbness was graded as none, mild, or severe based on its impact on daily life and tolerance level. ResultsExcluding cases with missed follow-up, a total of 179 participants were included in the study, and their follow-up period ranged up to 40 months. Postoperatively, symptomatic remission was achieved by 98.1% (52/53) of patients in the riveting technique group compared to 87.3% (110/126) in the conventional group (P<0.05). At the last follow-up period, with recurrence observed over time, the long-term efficacy of riveting and conventional groups were 94.3% and 74.6%, respectively (P<0.05). The majority of cases in both groups experienced ipsilateral facial numbness immediately following PBC, which appeared to diminish after 3 months in both groups without significant difference between them (P>0.05).

Cannabidiol and it fluorinate analog PECS-101 reduces hyperalgesia and allodynia in trigeminal neuralgia via TRPV1 receptors

Trigeminal neuralgia (TN) is an intense and debilitating orofacial pain. The gold standard treatment for TN is carbamazepine. This antiepileptic drug provides pain relief with limited efficacy and side effects. To study the antinociceptive potential of cannabidiol (CBD) and its fluorinated analog PECS-101 (former HUF-101), we induced unilateral chronic constriction injury of the infraorbital nerve (IoN-CCI) in male Wistar rats. Seven days of treatment with CBD (30 mg/kg), PECS-101 (3, 10, and 30 mg/kg), or carbamazepine (10 and 30 mg/kg) reduced allodynia and hyperalgesia responses. Unlike carbamazepine, CBD and PECS-101 did not impair motor activity. The relief of the hypersensitive reactions has been associated with transient receptor potential vanilloid type 1 (TRPV1) modulation in the trigeminal spinal nucleus. CBD (30 mg/kg) and PECS-101 (10 and 30 mg/kg) reversed the increased expression of TRPV1 induced by IoN-CCI in this nucleus. Using a pharmacological strategy, the combination of the selective TRPV1 antagonist (capsazepine-CPZ – 5 mg/kg) with sub-effective doses of CBD (3 and 10 mg/kg) is also able to reverse the IoN-CCI-induced allodynia and hyperalgesia responses. This effect was accompanied by reduced TRPV1 protein expression in the trigeminal spinal nucleus. Our results suggest that CBD and PECS-101 may benefit trigeminal neuralgia without motor coordination impairments. PECS-101 is more potent against the hypernociceptive and motor impairment induced by TN compared to CBD and carbamazepine. The antinociceptive effect of these cannabinoids is partially mediated by TRPV1 receptors in the caudal part of the trigeminal spinal nucleus, the first central station of orofacial pain processing.

Morbid Obesity and Diabetes Increase the Risk of Reoperation following Microvascular Decompression: A National Surgical Quality Improvement Program Analysis of 1,303 Patients

Abstract Background Microvascular decompression (MVD) is the preferred treatment for refractory trigeminal neuralgia (TN) and hemifacial spasm (HFS). MVD provides long-lasting results for these conditions with a relatively low risk of postoperative complications. However, reoperation rates are reported up to 11%, an unacceptably high rate for an elective procedure. We determined what factors may increase the risk of reoperation among patients undergoing MVD for TN or HFS. Methods Patient data from 2015 to 2020 were obtained from the American College of Surgeons–National Surgical Quality Improvement Program database and were included in this study if they had a procedure corresponding to an MVD with the current procedural terminology code 61458. Patient demographics, comorbidities, and outcomes were analyzed. Patients were subsequently categorized based on body mass index (BMI) and a logistic regression analysis was used to model the association of comorbidities with reoperation and its indication. Results The overall rate of reoperation in the cohort is 3.2 and 7.2% for patients with morbid obesity (BMI ≥ 40; p = 0.006). Patients with morbid obesity were more likely to present at a younger age (50.1 vs. 57.4; p &lt; 0.0001), have comorbidities such as hypertension (60.9 vs. 33.5%; p &lt; 0.0001) and diabetes (16.3 vs. 7.7%; p = 0.0002), and increased procedure duration (179 vs. 164 minutes; p = 0.02). Indications for reoperation include cerebrospinal fluid (CSF) leak (31%), wound complications (19%), refractory pain (11.9), intracranial hemorrhage (4.8%), and other/unknown (33.3%). Patients with either morbid obesity or diabetes have a 2-fold increase in risk of reoperation, while having both is associated with a 5-fold risk of reoperation. Conclusions We demonstrate morbid obesity leads to increased procedure duration and increased risk of reoperation due to wound complications and CSF leak. In these patients, alternative treatment strategies or preoperative optimization may be reasonable to reduce the risk of surgical complications and reoperation.

Analyzing the Effect of Intraoperative Stimulation Voltage on Facial Numbness Following Radiofrequency Thermocoagulation in the Treatment of Idiopathic Trigeminal Neuralgia.

Radiofrequency thermocoagulation (RFT) effectively alleviates idiopathic trigeminal neuralgia (ITN); however, postoperative facial numbness poses a significant challenge. This issue arises due to the close proximity of high-temperature thermocoagulation, which not only ablates pain-related nociceptive fibers but also affects tactile fibers. Intraoperative sensory stimulation voltage (SV), which reflects the distance between the RFT cannula and the target nerve, potentially possesses the ability to prevent tactile fiber injury. This study aimed to investigate the influence of SV on postoperative facial numbness and provide valuable insights to mitigate its occurrence. A retrospective analysis was performed on 72 ITN patients with maxillary division (V2) pain who underwent RFT between 2020 and 2022. Among them, 13 patients with SV ≤ 0.2V constituted the low SV group. Subsequently, a matched-cohort analysis was conducted on the remaining 59 patients. The patients paired with the low SV patients were subsequently enrolled in the high SV group, adhering to a 1:1 match ratio. The primary outcome was the facial numbness scale assessment at 3days, 3months and 6months post-surgery. The pain intensity and medication burden served as the secondary outcomes. We successfully matched a cohort consisting of 12 patients in the low SV group and 12 patients in the high SV group. Each patient experienced various degrees of facial numbness at 3days post-RFT. Notably, the low SV group exhibited a higher incidence of moderate numbness (66.7% vs. 16.67%, P = 0.036), whereas the high SV group had more cases of mild numbness at the 6-month follow-up (25% vs. 83.3%, P = 0.012). Both groups demonstrated significant decreases in pain intensity and medication burden compared to before the operation. SV proved to be a reliable parameter for mitigating the degree of postoperative facial numbness in RFT treatment for ITN. A relatively high sensory SV ranging from 0.3 to 0.6V during the RFT procedure results in less facial numbness in the treatment of ITN.

Use Of Laser Phototherapy In The Treatment Of Trigeminal Neuralgia

Responsible for the sensory stimuli of the viscerocranium, the 5th pair of cranial nerves, called the trigeminal nerve due to its 3 branches, is a mixed-function nerve. The diagnosis of Trigeminal Neuralgia is directly related to the symptoms reported by the patient during the anamnesis. The right treatment depends on the correct diagnosis. The exact etiology of TN is still unknown. It affects around 4 to 13 individuals per 100,000 and although it seems to be a neuropathy with a low incidence, it is the most common among facial pain syndromes. A retrospective cross-sectional observational study was carried out. We used data on laser therapy treatment for Trigeminal Neuralgia, received and treated at the Laser Clinic of the Faculty of Dentistry of the Federal University of Bahia, from 2003 to 2022. A total of 119 patients with a diagnosis of Trigeminal Neuralgia were treated, most of them with unilateral pain (89%). After diagnosis, the initial irradiation protocol was determined individually. The laser frequency applied was 808 nm (infrared) due to its greater ability to penetrate and activate chromophores in nerve and bone structures. The amount of energy applied varies from case to case, usually starting with 2 or 3 J per point, which is indicated for cases of regeneration and analgesia. The final status of the treatment is based on the patient’s score according to the visual analog scale, where 10 is the highest pain threshold and 0 is no pain. 65% of the patients related no pain or ate at least under 3 grades before the first degree Laser phototherapy is an effective means of recovery, reducing pain symptoms and improving the quality of life of patients with Trigeminal Neuralgia, and the infrared wave spectrum is the most suitable for this treatment.