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Repeat posterior fossa exploration for patients with persistent or recurrent idiopathic trigeminal neuralgia

Nelly Amador and Bruce E. Pollock

Neurosurgeons would like to be perfect and, like all physicians, want our patients to do well. A “failed” patient is a signal that we are not perfect and that the forces of nature have again outwitted us. We cannot hide these failures, avoid them, or ignore them. Rather, we can learn from them and, frequently, can make the patients feel better or even cure them. 12 P eter J. J annetta , M.D., and D avid J. B issonette , P.A.C., 1985 Trigeminal neuralgia is one of the most common and disabling forms of facial pain. It is characterized by

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Radiographic evaluation of trigeminal neurovascular compression in patients with and without trigeminal neuralgia

Clinical article

Jonathan P. Miller, Feridun Acar, Bronwyn E. Hamilton, and Kim J. Burchiel

, distortion of the nerve, contact by 2 vessels, and nerve distortion (p < 0.001, Fisher exact test). F ig . 3. Graph showing the extent (upper) and site (lower) of NVC. Trigeminal neuralgia is associated with more severe (p < 0.01) and more proximal (p < 0.001) NVC. There was a tendency for the development of more severe compression with more advanced patient age across all groups ( Fig. 4 ). The analysis revealed a correlation of 0.249 between the 2 variables (r 2 = 0.062), which was significant (F[1,88] = 5.82, p < 0.05). There was no difference in this

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Demonstration of neurovascular compression in trigeminal neuralgia with magnetic resonance imaging

Comparison with surgical findings in 52 consecutive operative cases

James F. M. Meaney, Paul R. Eldridge, Lawrence T. Dunn, Thomas E. Nixon, Graham H. Whitehouse, and John B. Miles

D espite a large body of supportive evidence, the concept of neurovascular compression (NVC) in the etiology of trigeminal neuralgia (TGN) is not yet universally accepted. 1 Some of the reluctance to accept this theory stems from lack of a standardized definition of the “root entry zone,” 18 conflicting evidence regarding the incidence of vascular compression both in patients undergoing exploratory surgery for TGN 2, 5, 7, 9, 11, 18, 21, 22, 30 and in controls examined at postmortem, 17–19, 26, 31 and the possibility that the neurovascular relationships

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Endoscopic versus open microvascular decompression for trigeminal neuralgia: a systematic review and comparative meta-analysis

Nirmeen Zagzoog, Ahmed Attar, Radwan Takroni, Mazen B. Alotaibi, and Kesh Reddy

M icrovascular decompression (MVD) has become the accepted surgical technique for the treatment of trigeminal neuralgia (TN) because of its positive surgical outcomes and prevention of long-term recurrence. For some patients, pharmacological treatment is sufficient for adequate control of TN symptoms: severe, episodic facial pain caused by injury and inflammation of the trigeminal or fifth cranial nerve. 8 , 12 , 15 , 19 , 20 , 28 Ablative procedures have been deemed effective at improving acute TN symptoms, but MVD has demonstrated superiority in terms of

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Targeting the cranial nerve: microradiosurgery for trigeminal neuralgia with CISS and 3D-Flash MR imaging sequences

Vasilios A. Zerris, Georg C. Noren, William A. Shucart, Jeff Rogg, and Gerhard M. Friehs

W ith traditional surgical treatments for trigeminal neuralgia the presence of vascular compression guides both the selection of the appropriate procedure and the likelihood of symptomatic improvement. Brisman, et al., 5 recently demonstrated that the presence of contact between a blood vessel and the trigeminal or fifth cranial nerve, as revealed on high-resolution MR imaging, may predict a particularly favorable response to GKS. As a result, interest has been renewed in defining imaging methods that may be used during stereotactic microradiosurgery to

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Impact of target location on the response of trigeminal neuralgia to stereotactic radiosurgery

Clinical article

Zhiyuan Xu, David Schlesinger, Krisztina Moldovan, Colin Przybylowski, Xingwen Sun, Cheng-Chia Lee, Chun-Po Yen, and Jason Sheehan

S tereotactic radiosurgery (SRS) has shown promise in treating patients with medically refractory trigeminal neuralgia (TN). 8 , 10 , 12 , 17–19 , 21 However, the duration of pain relief (PR) tends to lessen over time. Therefore, various modifications of the radiosurgical technique for TN have been devised to improve outcomes including duration of PR. 4 , 6 The lack of a precise pathophysiology for TN poses a significant hindrance to curative treatment. It remains uncertain whether different targeting locations 8 , 12 , 13 , 17 impact the rate of

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Diffusion tensor imaging reveals microstructural differences between subtypes of trigeminal neuralgia

Matthew S. Willsey, Kelly L. Collins, Erin C. Conrad, Heather A. Chubb, and Parag G. Patil

trigeminal root with neurovascular compression revealed by high resolution diffusion tensor imaging . Asian Pac J Trop Med 5 : 749 – 752 , 2012 22805730 10.1016/S1995-7645(12)60119-9 4 DeSouza DD , Davis KD , Hodaie M : Reversal of insular and microstructural nerve abnormalities following effective surgical treatment for trigeminal neuralgia . Pain 156 : 1112 – 1123 , 2015 25782366 10.1097/j.pain.0000000000000156 5 DeSouza DD , Hodaie M , Davis KD : Abnormal trigeminal nerve microstructure and brain white matter in idiopathic trigeminal neuralgia

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Effect of lesion temperature on the durability of percutaneous radiofrequency rhizotomies to treat trigeminal neuralgia

Kellen L. Mulford, David P. Darrow, Rajiv Dharnipragada, Madelyn Woolums, Donald R. Nixdorf, Stephen J. Haines, and Andrew W. Grande

U p to half of all patients with classic, idiopathic, or secondary trigeminal neuralgia (TN) will require surgical treatment. 1 – 4 Microvascular decompression (MVD) fails in nearly 40% of patients long term, and up to 30% of patients with TN are not ideal candidates for decompression because of the presence of multiple sclerosis (MS) or the lack of neurovascular conflict. 5 – 8 As a result, more than half of all patients with TN will require an ablative procedure to treat their pain. The most common procedure for recurrent TN pain, for those without

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External assessment of preoperative scores for predicting outcome after microvascular decompression for trigeminal neuralgia

Michael E. Xie, Kyra Halbert-Elliott, Sumil K. Nair, Jinwoo Jun, Bryan C. Dong, Kathleen R. Ran, Collin B. Kilgore, Anita Kalluri, Vivek S. Yedavalli, Christopher M. Jackson, Michael Lim, Judy Huang, Chetan Bettegowda, and Risheng Xu

.9) 92 (22.9) 4 (7.0) 52 (25.9) 7 (13.2)  5 39 (8.5) 23 (8.7) 16 (8.2) 35 (8.7) 4 (7.0) 19 (9.5) 5 (9.4) Adapted with permission from Wolters Kluwer Health, Inc.: DM Panczykowski, RH Jani, MA Hughes, RF Sekula Jr, Development and evaluation of a preoperative trigeminal neuralgia scoring system to predict long-term outcome following microvascular decompression, Neurosurgery , 2020:87(1):71-79, , © Congress of Neurological Surgeons. Values are presented as the

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Gamma Knife surgery used as primary and repeated treatment for idiopathic trigeminal neuralgia

Chuan-Fu Huang, Hsien-Tang Tu, Wen-Shan Liu, Shyh-Ying Chiou, and Long-Yau Lin

abstract form at the 14th International Meeting of the Leksell Gamma Knife Society, Quebec, Canada, May 21, 2008. References 1 Barker FG II , Jannetta PJ , Bissonette DJ , Larkins MV , Jho HD : The long-term outcome of microvascular decompression of trigeminal neuralgia . N Engl J Med 334 : 1077 – 1083 , 1996 10.1056/NEJM199604253341701 2 Brisman R : Gamma knife radiosurgery for primary management for trigeminal neuralgia . J Neurosurg 93 : 3 Suppl 159 – 161 , 2000 10.3171/jns.2000.93.supplement_3.0159 3 Broggi G , Franzini A