Treatment Of Idiopathic Trigeminal Neuralgia Research Articles

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.

Comparison of microvascular decompression, percutaneous radiofrequency rhizotomy, and stereotactic radiosurgery in the treatment of trigeminal neuralgia: A long term quasi-experimental study.

Microvascular decompression (MVD), radiofrequency rhizotomy (RFR), and stereotactic radiosurgery (SRS) are surgical techniques frequently used in the treatment of idiopathic trigeminal neuralgia (TN), although the results reported for each of these are diverse. This study aimed to compare long-term pain control obtained by MVD, SRS, and RFR in patients with idiopathic TN. To compare the results obtained by MVD, SRS, and RFR we chose a quasi-experimental, ambispective design with control groups but no pretest. A total of 52 participants (MVD n = 33, RFR n = 10, SRS n = 9) were included. Using standardized outcome measures, pain intensity, pain relief, quality of life, and satisfaction with treatment were assessed by an independent investigator. The TREND statement for reporting non-randomized evaluations was applied. Clinical outcomes were evaluated at the initial postoperative period and at 6 months, 1, 2, 3, 4, and 5 years postoperatively. MVD has shown better results in pain scales compared to ablative procedures. Significant differences between groups were found regarding pain intensity and pain relief at the initial postoperative period (p < 0.001) and 6 months (p = 0.022), 1 year (p < 0.001), 2 years (p = 0.002), and 3 years (p = 0.004) after the intervention. Those differences exceeded the thresholds of the minimal clinically important difference. A higher percentage of patients free of pain was observed in the group of patients treated by MVD, with significant differences at the initial postoperative period (p < 0.001) and 6 months (p = 0.02), 1 year (p = 0.001), and 2 years (p = 0.04) after the procedure. Also, a higher risk of pain recurrence was observed in the RFR and SRS groups (HR 3.15, 95% CI 1.33-7.46; p = 0.009; and HR 4.26, 95% CI 1.77-10.2; p = 0.001, respectively) compared to the MVD group. No significant differences were found in terms of quality of life and satisfaction with treatment. A higher incidence of complications was observed in the MVD group. Concerning pain control and risk of pain recurrence, MVD is superior to RFR and SRS, but not in terms of quality of life, satisfaction with treatment, and safety profile.

Frameless Linear Accelerator (LINAC) Based Radiosurgery (SRS) vs. Framed Gamma Knife SRS for Idiopathic Trigeminal Neuralgia (TN)

Stereotactic radiosurgery (SRS) is an effective treatment for idiopathic trigeminal neuralgia (TN). Conventional treatment is done through frame-based solution due to small target and high radiation dose. More recently, LINAC based frameless SRS technique has been established as a patient friendly alternative. Herein we compared our single institution experience of LINAC based frameless SRS vs frame-based gamma knife SRS for TN. The hypothesis is LINAC based frameless SRS can provide equivalent dosimetric and clinical outcome as compared frame-based gamma knife treatment. Patients with idiopathic TN who received SRS treatment (LINAC based frameless treatment or Gamma knife framed treatment) at our institution from 2015-2022 were included. A minimum follow up of 1 year was required. Patient data was extracted from electronic medical records and radiation treatment planning system. Pain intensity was evaluated utilizing a modified 0-4 Barrow Neurological Institute (BNI) pain intensity score, and then dichotomized where BNI score 0-2 represented response to treatment and BNI score 3-4 represented no response. Statistical analysis was conducted with a linear regression model accounting for race, gender, prior pain, pain distribution including laterality and branch involvement, medication regimen at time of treatment, previous radiation treatment, and prior procedures. Response was then compared between both modalities overall and within each sub-group with chi-square testing and linear regression. A total of 81 patients were identified, 14 patients were excluded due to lack of adequate follow-up, leaving 67 for analysis. 12 (17.9%) were male and, 55 (82.1%) were female. All patients were managed with medication prior to SRS treatment. 5 (7.5%) had rhizotomy and 13 (19.4) had microvascular decompression, and 8 (11.9%) had previous gamma-knife radiosurgery prior to SRS treatment at our institution. Of the 67 patients, 23 (34.3%) received frame-based gamma knife SRS, 44(65.7%) received frameless LINAC treatment. 58 (86.6%) radiation naïve patients received 90 Gy in 1 fraction, while out of the 9 who had previously had intracranial radiation treatment 7 (10.4%) received 70 Gy and 2 (3%) received 80 Gy all prescribed to 100% isodose line. All patients were treated with 4 mm cone. There was no significant difference in brainstem dose between these two techniques. Between LINAC-based or Gamma Knife modalities rate of pain control (77.3 % vs 82.6 %, respectively, p = 0.61) as well as toxicity in facial numbness (31.8% vs 21.7%, respectively, p = 0.38) showed no statistical difference. There was no statistically significant signal (p > 0.05) detected within the subgroups analyzed. The linear regression model also showed no significant difference. LINAC based frameless SRS provides comparable dosimetry and pain control for TN as compared to frame-based gamma knife treatment. It is a patient friendly solution for patients with TN.

Meckel’s cave compression with Teflon for the treatment of idiopathic trigeminal neuralgia: its possibility as a modified surgical technique

Objective: We analyzed the clinical outcomes of Meckel’s cave compression with Teflon (Rhee’s method) as a new modified and additional surgical technique for trigeminal neuralgia (TN).Methods: Between March 1996 and December 2014, out of 78 patients who were treated with microvascular decompression (MVD) or partial sensory root rhizotomy, 28 patients additionally underwent Meckel’s cave compression with Teflon. The mean age at initial treatment was 54.3 years (range: 40–69 years). The mean duration from onset to operation was 70.5 months (range: 5–360 months) and the mean follow-up period was 26 months (range: 1–77 months). Results: Fifteen patients (53.6%) had facial pain in the V2/V3 distribution. The offending or associating vessel was the superior cerebellar artery in four patients (14.3%), the superior petrosal vein in six (21.4%), the anterior inferior cerebellar artery in two (7.1%), multiple vessels in nine (32.1%), and miscellaneous arteries or veins in six (21.4%). One patient (3.6%) had no offending vessel, and seven patients were had no definite offending vessels that contacted the trigeminal root entry zone. Meckel’s cave compression with Teflon was applied to all patients: 10 (35.7%) in combination with MVD, one (3.6%) with partial rhizotomy, and 17 (60.7%) with both MVD and partial rhizotomy. TN was relieved in 26 patients (92.9%) and symptoms recurred in three patients (pain-free rate: 82.1%). The complication rate of this method appeared to be similar to other treatment procedures. Conclusion: Meckel’s cave compression with Teflon may be a safe and useful additional treatment procedure for TN.

Radiofrequency Treatment of Idiopathic Trigeminal Neuralgia (Conventional vs. Pulsed): A Prospective Randomized Control Study.

Background:Idiopathic trigeminal neuralgia (TGN) is a chronic pain disorder causing unilateral, severe brief stabbing recurrent pain in the distribution of one or more branches of the trigeminal nerve. Conventional radiofrequency (CRF) and pulsed radiofrequency (PRF) are two types of minimally invasive treatment. CRF selectively ablates the part of ganglion to provide the relief, but it has been found to be associated with some side effects such as dysesthesia or sensory loss in 6%–28% and loss of corneal reflex in 3%–8% of patients. PRF is a comparatively newer modality which is a nondestructive and neuromodulatory method of delivering radiofrequency energy to the gasserian ganglion to produce a therapeutic effect.Aims:We aimed to compare the efficacy of CRF with long-duration, fixed voltage PRF in the treatment of idiopathic TGN.Setting:This study was conducted in a tertiary care center research institute.Study Design:This was a prospective randomized trial.Materials and Methods:Twenty-seven adult patients of TGN were included in the study and randomly allocated into two groups (CRF and PRF). All procedures were performed operation suite with C-arm fluoroscopic guidance. Both, pre- and postprocedure, the patients were assessed for pain on the Visual Analog Scale (VAS) and Barrow Neurological Institute (BNI) Pain Intensity Scale at 1 week and thereafter at 1, 2, 3, and 6 months. Patients with a BNI score ≥4 after 1 month were considered a failure and offered other modes of treatment. A reduction in VAS score ≥50% and a BNI score <4 were considered as effective.Statistical Analysis:Discreet variables were recorded as proportions, ordinal variables and continuous variables with non-Gaussian distribution as medians with interquartile range, and continuous variables with Gaussian distribution as mean ± standard deviation. Association between ordinal variables was tested by Fisher's exact test/Chi-square test whenever appropriate. Equality of means/median was tested by using paired/unpaired t-test or nonparametric tests depending upon the distribution of data. P ≤ 0.5 was considered statistically significant. Data analysis was performed using STATA version 13.04 windows.Results:Efficacy in terms of decrease in VAS ≥50% at 1 month was 33.33% and 83.33% in the PRF and CRF groups, respectively, which was statistically significant(P = 0.036). Effective reduction in BNI scores at the 7th day, 1 month, and 2 months postprocedure was evaluated and found in 41.67% and 83.33% of patients in the PRF and CRF groups, respectively, which was statistically insignificant (P = 0.089). There was a statistically significant reduction in BNI scores in PRF and CRF group patients at 3 and 6 months (at 3 months, 33.33% and 83.33%, P = 0.036 and at 6 months, 25% and 83.33%, P = 0.012). In the CRF group, mild hypoesthesia was evident in three patients which improved by the end of 1 month while no side effects were seen in the PRF group.Conclusion:CRF is a more effective procedure to decrease pain in comparison to long-duration, fixed voltage PRF for the treatment of idiopathic TGN. Although the side effects are more with CRF, they are mild and self-limiting.

REVIEW ON COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) IN ORAL HEALTH

Background: Complementary and Alternative Medicine (CAM) is a cluster of heterogeneous medical and health care systems, practices and products that can be used along with conventional medicine. This review article is about CAM system that is being used in oral health, challenges of such uses and the need for global regulations while using CAM products as medicines.&#x0D; Discussion: These systems are integral part of culture. Ayurvedic therapies are used for alleviating various oral conditions. Herbal mouth rinses and dentifrices are used for plaque control which is the basic process in oral care. Though deficiency exists regarding reports of controlled studies of Homeopathic medicines in pain conditions, Homeopathy is effective in the treatment of idiopathic trigeminal neuralgia. Last decade had witnessed an increasing interest in medicinal plants thereby promoting them as alternatives to standard conventional medicines.&#x0D; These therapeutics are gaining importance in a global scale. Limited access to conventional oral care, lower costs and general belief of minimal toxicity enhances the use of Ayurveda, Herbal and Homeopathic medicines and therapies in oral diseases. Budgetary allocations for this traditional system care of different countries, designing research programs to focus on traditional medicines and implementation of laws for propagation of CAM systems reflects the global inclination towards this system of healthcare.&#x0D; Conclusion: Considering the broadened scope of CAM therapeutics in dental healthcare, it is recommended that a dental professional be consulted prior to using these products in an attempt to reduce the probability of side effects or drug interactions.

Masticatory Dysfunction After Computed Tomography-Guided Plasma Ablation vs. Radiofrequency Ablation on Gasserian Ganglion for Idiopathic Trigeminal Neuralgia: A Randomized Controlled Trial.

We aimed to evaluate masticatory dysfunction after two different types of ablation on the Gasserian ganglion for the treatment of idiopathic trigeminal neuralgia. We hypothesized that low-temperature plasma radiofrequency ablation (LTP-RFA) was noninferior to radiofrequency thermocoagulation (RFT) with respect to initial efficacy. In the randomized, single-blind, parallel-group, noninferiority trial, 204 participants with idiopathic trigeminal neuralgia were randomly allocated to receive plasma ablation in the LTP-RFA group and radiofrequency ablation in the RFT group in a 1:1 ratio, with random block sizes of four or six. Participants were examined at baseline (T0), on the day of discharge (T1), and at the 6-month follow-up (T2). The primary end point was the clinincal effective rate in the LTP-RFA group compared with that in the RFT group after intervention on the day of discharge. Noninferiority was prespecified at -10%. The intention-to-treat analysis revealed that the initial efficacy rates were 91.2% in LTP-RFA group and 93.1% in RFT group (rate ratio [RR] = 0.979, 95% confidence interval [CI]: 0.904-1.061, P = 0.795). The difference between the two groups was 1.9% (95% CI: -5.6% to 9.4%), which showed that LTP-RFA demonstrated noninferiority compared with RFT in initial efficacy. Compared with the RFT group, the LTP-RFA group exhibited a significantly greater improvement in the maximum voltage of the masseter muscles with mean differences of 11.40 (95% CI: 10.52 to 12.27, P < 0.001) at T1 and 17.41 (95% CI: 14.68 to 20.13, P < 0.001) at T2, respectively. Similar results were observed for the asymmetry index of occlusion, the maximum voltage of the anterior temporalis, and the activity index of anterior temporalis/ masseter muscles. No serious adverse events were observed in either group. Compared with the RFT group, noninferior efficacy for pain relief and improvement of masticatory function was revealed in the LTP-RFA group.

Efficacy of gabapentin in the treatment of trigeminal neuralgia: A systematic review of randomized controlled trials.

The aim of this systematic review was to determine the efficacy of gabapentin (GBP) in the treatment of pain of idiopathic trigeminal neuralgia (TN). A comprehensive literature search was conducted using the Cumulative Index of Nursing and Allied Health Literature (EBSCO Industries), Emcare (Ovid), Medline (Ovid), Medline (PubMed), Scopus (Elsevier) and Web of Science (Clarivate Analytics). The inclusion criteria comprised randomized controlled trials of GBP as a monotherapy in the treatment of idiopathic TN in adult participants and publications in English. All other study methodologies were excluded. The search yielded 1472 articles, and after exclusion, 11 full-text articles were eligible for full-text analysis. Only two studies met the inclusion criteria. There is insufficient evidence either to support or refute the efficacy of GBP in the management of idiopathic TN. Therefore, further well-designed placebo-controlled trials are required to confirm the efficacy of GBP in managing TN pain as a single therapy.

Comparison of the short-term outcomes after low-temperature plasma radiofrequency ablation (coblation) in the Gasserian ganglion for the treatment of idiopathic trigeminal neuralgia.

Background: Low-temperature plasma radiofrequency ablation (coblation) is a relatively novel technique with promising applications in neuropathic pain. A nerve stimulator was modified and connected to a plasma knife head to solve the problem of accessing the Gasserian ganglion for treatment of trigeminal neuralgia (TN).Objective: To compare the therapeutic effects and short-term outcomes of coblation vs radiofrequency thermocoagulation for the treatment of primary TN.Methods: This was a retrospective cohort study of 217 inpatients who had undergone surgical treatment for primary TN between September 2017 and June 2018 at the Xuanwu Hospital, Capital Medical University. The patients were grouped according to the procedure they selected after an informed comprehensive discussion with their surgeon: the coblation group and the radiofrequency group. Pain, numbness, and muscle atrophy were evaluated before surgery, on the day of surgery, and at 3 days, 5 days, and 3 months after surgery.Results: In the coblation and radiofrequency groups, the pain relief rates were 74.7% and 85.5% on day 1 (P=0.066), 85.3% and 97.3% on day 3 (P=0.003), and 97.7% and 88.2% at 3 months (P=0.134). At 3 months after surgery, 69.3% of the patients in the coblation group and 42.7% in the radiofrequency group had no pain (P<0.001). The multivariable analysis showed that the risk of numbness in the coblation group was independently lower than in the radiofrequency group at 3 months after surgery and (OR=0.243, 95%CI: 0.122–0.484, P<0.001). Three months after the surgery, no recurrence was found in both of the coblation group and the radiofrequency group. Postoperative pain score ≥4 points was considered as a sign of failure this series at 3 months after surgery. The failure rate in coblation group is 2.7% (n=2) and a radiofrequency group is 4.5% (n=5), but there was no statistical difference between the two groups (P=0.703).Conclusion: Coblation could reduce the risk of postoperative numbness in patients with primary TN.

Radiofrequency Thermoablation of the Gasserian Ganglion Versus the Peripheral Branches of the Trigeminal Nerve for Treatment of Trigeminal Neuralgia: A Randomized, Control Trial

Background: Trigeminal neuralgia is the most painful condition of facial pain leading to impairment of routine activities. Although radiofrequency thermoablation (RFT) of the Gasserian ganglion is widely used for the treatment of idiopathic trigeminal neuralgia in patients having ineffective pain relief with medical therapy, the incidence of complications like hypoesthesia, neuroparalytic keratitis, and masticatory muscles weakness is high. Recent case reports have shown the effectiveness of RFT of the peripheral branches of the trigeminal nerve for relief of refractory chronic facial pain conditions including trigeminal neuralgia. Objectives: This study was conducted to compare the efficacy and safety of RFT of the peripheral branches of the trigeminal nerve with RFT of the Gasserian ganglion for the management of idiopathic trigeminal neuralgia. Study Design: Prospective, randomized, observer-blinded, clinical trial. Setting: Tertiary care hospital and medical education and research institute. Methods: A total of 40 adult patients of idiopathic trigeminal neuralgia were randomly allocated into 2 groups. The control group received RFT of the Gasserian ganglion while the study group received RFT of the peripheral branches of trigeminal nerve. The procedures were performed in the operation room under all aseptic precautions with fluoroscopic guidance. Post-procedure, the patients were assessed for loss of sensation along the nerve distribution and the adequacy of pain relief on the Numerical Rating Scale (NRS). The patients were followed up for 3 month to assess the quality of pain relief by the NRS and the Barrow Neurological Institute (BNI) pain intensity scale. Improvement in pain was considered excellent if patients had complete pain relief without any medication, good if there was significant reduction in pain (&gt; 50%) with or without medication, and poor if there was less than 50% reduction in pain with medications. Patients were also assessed for numbness and any other side effects. Patients’ satisfaction with the procedure was recorded. Results: Nineteen patients in the control group and 18 in study group had effective pain relief of up to 3 months. Their pain scores were comparable at all time intervals, though the number of patients receiving supplementary medications was more in study group at 2 months (P = 0.015). The patients showed overall satisfaction score of 8.5 (8-9) and 8 (7-9) in control and study groups respectively. The average procedure duration was 30 (30-38) minutes in the control group and 28 (25-40) minutes in the study group. Most of the patients in both groups had mild numbness after the procedure. One patient in the control group had lower eyelid swelling and another had mild weakness of the masseter muscle, which resolved few days later. No major complication was reported in the study group except for 1 patient who reported local ecchymosis. Limitations: The main limitation of the study is that the patients and the investigator performing the procedure were not blinded, though the person who assessed the patient during follow-up was blinded to the group assignment. Another limitation is that we could not follow up with the patients after 3 months due to time constraints. Conclusion: We found that radiofrequency thermoablation of the peripheral branches of the trigeminal nerve is an effective and safe procedure for the management of idiopathic trigeminal neuralgia. Key words: Idiopathic trigeminal neuralgia, radiofrequency thermoablation, Gasserian ganglion, peripheral nerve branches, pain, trigeminal nerve

Acupuncture treatment on idiopathic trigeminal neuralgia: A systematic review protocol.

Introduction:The objective of this systematic review protocol is to provide the methods for evaluating the effectiveness and safety of acupuncture on the treatment of idiopathic trigeminal neuralgia (ITN).Methods and analysis:We will search randomized controlled trials (RCTs) on this subject in 8 electronic databases and they are Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), the Wan-Fang Database, and Chinese Scientific Journal Database (VIP database). Other relevant literatures will be manually searched as a complement. Only RCTs related to acupuncture for ITN in English or Chinese will be included, without limitation of publication types. The risk of bias and trial quality will be assessed by the Cochrane collaboration's tool. All data will be analyzed by RevMan V.5.3.3 statistical software.Ethics and dissemination:Ethical approval is not necessary as this paper does not involve patient data. This protocol will be disseminated by a peer-review journal or conference presentation.Trial registration number:PROSPERO CRD42015022173Strengths and limitations of this study:This systematic review will evaluate the effectivity and safety of acupuncture treatment on idiopathic trigeminal neuralgia. Two authors will perform independently study selection, data extraction and quality assessment, in order to ensure that all included studies are not personal bias. The result of this systematic review may give clinicians more ways to assist patient in relieving trigeminal neuralgia.This shortage of systematic review is due to language barriers, only 2 languages of the trials can be included, other related studies may be missing. Different methods of acupuncture and quality of methodologies may result in essential heterogeneity.

Idiopathic Trigeminal Neuralgia: A Case Report

AbstractTrigeminal neuralgia (TN) is the most frequent type of neuropathic facial pain affecting one or more branches of trigeminal nerve. Here, a 51-year-old woman diagnosed with idiopathic trigeminal neuralgia (ITN) presented with complaints of pain over right side of the face with redness of the eyes and excessive lachrymation since 5 years with weekly acute episodes of shooting pain. Chelidonium was chiefly prescribed followed by few doses of Spigelia as per indications which provided adequate pain relief. The complaints flared up following stressful circumstances for which Pulsatilla was prescribed after detailed case taking. The frequency, duration and intensity of pain reduced after homoeopathic treatment. The need for conventional medicine was also reduced. This suggests positive role of individualised homoeopathy in the treatment of ITN. Further studies should be undertaken to evaluate the role of homoeopathy in ITN.

Percutaneous radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: Experience in 106 patients

Percutaneous radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: Experience in 106 patients

Comparative study between effects of conventional and pulsed radiofrequency in the treatment of idiopathic trigeminal neuralgia

Objectives The aim of this study was to compare the effects of conventional radiofrequency (CRF) versus pulsed radiofrequency (PRF) in the treatment of idiopathic trigeminal neuralgia pain. Background The treatment of idiopathic trigeminal neuralgia (ITN) is often a challenge in clinical practice. Nowadays, radiofrequency (RF) is one of the most effective options for treatment. Patients and methods A comparative study was carried out in Menoufia and Zagazig university hospitals. Overall, 40 adult patients suffering from ITN were randomly assigned to two groups (20 in each). The CRF group was treated with CRF and the PRF group was treated with PRF. Results There were significant improvements in both groups as regards Visual Analog Score and Patient Satisfaction Score, which was higher in the CRF group at 6 months of follow-up. The possibility of repeating RF was higher in the PRF group than in the CRF group. Conclusion Both CRF and PRF are effective in relieving pain associated with trigeminal neuralgia. PRF appears to be a relatively safe and effective procedure in the treatment of persistent pain of ITN in a shorter duration compared with CRF.

Evaluation of the Retrogasserian Opioid Application in the Treatment of Idiopathic Trigeminal Neuralgia.

To evaluate the clinical outcomes of the retrogasserian opioid application in patients with type 1 trigeminal neuralgia. A total of 37 patients (12 male, 25 female; average age 56.2 ± 5.4 years) who were administered retrogasserian opioid due to type 1 trigeminal neuralgia between February 2012 and May 2015 were included in the study. A visual analogue scale was used to evaluate pain at the last preoperative and postoperative visits (median follow-up period: 13 months, mean follow-up period: 15.6 months). All parameters were analysed using Wilcoxon signed-rank and Mann-Whitney U tests, with p < 0.05 considered statistically significant. Visual analogue scale scores of all 37 patients were significantly improved in the postoperative period. The average visual analogue scale scores were 7.9 ± 0.62 preoperatively and 2.9 ± 0.5 postoperatively. All changes were statistically significant. Percutaneous retrogasserian opioid injection in type 1 trigeminal neuralgia is an effective and safe method of pain control.

Three-dimensionally printed personalized guide plate for percutaneous radiofrequency thermal coagulation in idiopathic trigeminal neuralgia

Radiofrequency thermocoagulation (RFT) is used widely for the treatment of idiopathic trigeminal neuralgia (TN). Precise puncture and placement of the electrode needle tip are crucial for successful RFT. This technical note introduces a novel method for performing RFT using a customized, three-dimensionally (3D)-printed guide plate. Eleven patients with idiopathic TN were treated using this method between February and July 2016. Three had V2 branch TN and eight had V3 branch TN. Punctures in eight patients were successful at the first attempt; slight adjustments were required subsequently in the other three patients. The puncture time in all cases was less than 1min. The patients reported pain relief immediately after RFT, and no complications were observed in any patient. Thus, the customized 3D-printed guide plate offers the advantages of precise placement of the puncture needle and minimal complications.

Endoscope-assisted neurectomy and inferior alveolar nerve avulsion in treating trigeminal neuralgia

ObjectiveTo explore endoscope-assisted surgical treatment for idiopathic trigeminal neuralgia (TN), with neurectomy and avulsion of the inferior alveolar nerve (IAN), when patients are not willing to undergo intracranial procedures. Clinical materials and methodsFive TN patients with inferior alveolar neuralgia in the mandibular branch were admitted; endoscope-assisted inferior alveolar neurectomy and avulsion was performed for TN treatment. Clinical observation and postoperative follow-up were conducted. ResultsAfter the operation, all patients had complete relief of pain, with mild postoperative swelling, limited mouth opening, and fast recovery. Patients were followed up for 3–24 months. Facial numbness and paresthesia were felt in the IAN distribution area of the operated side, with no recurrence. ConclusionEndoscope-assisted neurectomy and avulsion of the IAN is a safe surgical method to treat TN in the mandibular branch when craniotomy is contraindicated or when patients decline neurosurgical options. It is effective in pain relief, with limited invasiveness and speedy recovery.

Comparison of nerve combing and percutaneous radiofrequency thermocoagulation in the treatment for idiopathic trigeminal neuralgia

IntroductionIdiopathic trigeminal neuralgia (ITN) is a common pain disease in elderly people. Many methods have been used to alleviate the pain of patients, but few studies in the literature have compared the effect of nerve combing and percutaneous radiofrequency thermocoagulation. ObjectiveThe purpose of this study was to describe and evaluate the clinical outcome of idiopathic trigeminal neuralgia after nerve combing (NC) and compare them with those obtained using percutaneous radiofrequency thermocoagulation (RF). MethodsThe study included 105 idiopathic trigeminal neuralgia patients with similar symptom, age and underlying disease, which were divided into two groups. One group was treated by nerve combing (50 patients), the other by RF (55 cases). All patients were considered medical failures prior to the surgeries. A questionnaire was used to assess the long-term outcomes: pain relief, recurrence, complication and need for additional treatment. ResultsThe median duration of follow-up in both groups was 90 months. Satisfactory relief was noted in 41 patients (82%), 5 patients (10%) initially experienced pain relief, then recurred, and four patients (8%) were designated poor among the group NC. In the group RF, satisfactory relief was noted in 42 patients (76.4%). There were eight “pain free with recurrence patients (14.5%) and 5 poor cases (9.1%). No statistically significant differences existed in the outcomes between both groups (p>0.05). Postoperative morbidity included dysesthesia, diplopia, partial facial nerve palsy, hearing loss, tinnitus, cerebrospinal fluid leak, meningitis and mortality. ConclusionNerve combing and RF are both satisfactory treatment strategies for patients with ITN. Because of the higher risk of sensory morbidity and surgical risk as open surgery, RF is preferred as the recommended procedure for patients with ITN.

Application of stereotactic surgical planning system in foramen ovale puncture for the treatment of trigeminal neuralgia

Objective To investigate the practical application value of stereotactic surgical planning system in the foramen ovale puncture for the treatment of idiopathic trigeminal neuralgia. Methods A total of 112 patients with trigeminal neuralgia admitted at the Department of Neurosurgery, the Second Hospital, Shandong University from October 2008 to March 2013 were enrolled. Using stereotactic techniques to complete the radiofrequency treatment of trigeminal neuralgia after foramen ovale puncture of gasserian ganglion. Different from the traditional mounting of the stereotactic frame, this study used reversed mounting frame. The simulation puncture was conducted after the CT scan dicom data were inputted into the stereotactic surgical planning system. The target coordinates, percutaneous puncture point coordinates, and puncture paths were ultimately determined. Results Using the above methods, 112 patients completed foramen ovale punctures. Twenty-five puncture paths were corrected by the stereotactic surgical planning system before procedure (the correction rate was 22.3%). The one-time success rate of foramen ovale puncture was 100% after setting the paths. No serious complications occurred, such as internal carotid artery injury and bleeding, diplopia, and keratitis. The immediate effective rate was 100%, one-year effective rate was 95.5%%, and two-year effective rate was 90.2%. Conclusion Preoperative setting puncture paths using the stereotactic surgical planning system for the treatment of trigeminal neuralgia is accurate, safe, and effective. Key words: Trigeminal neuralgia; Foramen ovale; Punctures; Stereotaxic techniques; Neuronavigation

Evaluation of therapeutic effectiveness and safety of botulinum toxin type A in the treatment of idiopathic trigeminal neuralgia in patients older than 70 years

To evaluate therapeutic effectiveness and safety of botulinum toxin type A in the treatment of idiopathic trigeminal neuralgia in patients older than 70 years. The total 64 patents were involved from neurology clinic and inpatient department from Aug 2008 to Sep 2013. They were divided into two groups according to the age (older than 70 years versus younger than 60 years. The therapeutic dose, safety, effectiveness were compared between two groups. Visual analog scores were employed to measure the degree of pain. The mean dosage was (88 ± 30) U in the group aged above 70 years old, and (72 ± 33) U in the group aged below 60 years old respectively. There was no significant difference of dosage between the two groups. The average visual analog score of all patients was (7.7 ± 2.2) before the treatment and decreased to (4.4 ± 2.9) one month after the treatment. To be precise, the average visual analog score of the group aged above 70 years old was (8.2 ± 1.9) before and (4.5 ± 3.2) after the treatment, and the visual analog score of the group aged below 60 years old was (7.2 ± 2.4) before and (4.4 ± 2.5) after the treatment. The effect of botulinum toxin type A in the treatment of idiopathic trigeminal neuralgia was considered statistically significant. The D-value of visual analog score in the elderly group was (3.5 ± 3.6), and (2.8 ± 3.5) in the younger group. There was no significant difference in the D-value between the two groups. Five patients had transient minor side effects in the former group and two patients had transient minor side effects in latter group. There was no significant difference in the incidence rate of side effects between the two groups (P > 0.05). Botulinum toxin type A is safe and effective in the treatment of idiopathic trigeminal neuralgia for the patients older than 70 years and the dosages of it are approximate to the patients under 60 years old.