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Nerve atrophy and a small cerebellopontine angle cistern in patients with trigeminal neuralgia

Clinical article

Seong-Hyun Park, Sung-Kyoo Hwang, Sun-Ho Lee, Jaechan Park, Jeong-Hyun Hwang, and In-Suk Hamm

length of the cisternal segment of the trigeminal nerve on the affected side (7.9 mm) was significantly shorter (17.7%) than the mean length on the unaffected side (9.6 mm; p = 0.001). The mean length of the cisternal segment ranged from 4.9 to 14.2 mm on the affected side and from 6.7 to 12.8 mm on the unaffected side. Discussion Trigeminal neuralgia is a paroxysmal lancinating pain syndrome involving 1 or more branches of the trigeminal nerve. The presence of a vascular component has frequently been associated with TN, and neurovascular conflict has been

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Comparison of the results of 2 targeting methods in Gamma Knife surgery for trigeminal neuralgia

Shinji Matsuda, Toru Serizawa, Osamu Nagano, and Junichi Ono

on a review of the literature. A large, multi-center study is necessary to determine whether the anterior or posterior targeting method can be considered superior. Disclaimer The authors report no conflicts of interest concerning the materials or methods used in this study or the findings specified in this paper. References 1 Brisman R : Microvascular decompression vs. gamma knife radiosurgery for typical trigeminal neuralgia: preliminary findings . Stereotact Funct Neurosurg 85 : 94 – 98 , 2007 10.1159/000097925 2 Brisman R , Mooij R

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Mechanism of trigeminal neuralgia: an ultrastructural analysis of trigeminal root specimens obtained during microvascular decompression surgery

Marshall Devor, Ruth Govrin-Lippmann, and Z. Harry Rappaport

-19-08589.1999 8. Beaver DL : Electron microscopy of the gasserian ganglion in trigeminal neuralgia. J Neurosurg 26 (Suppl 1) : 138 – 150 , 1967 Beaver DL: Electron microscopy of the gasserian ganglion in trigeminal neuralgia. J Neurosurg 26 (Suppl 1): 138–150, 1967 10.3171/jns.1967.26.1part2.0138 9. Beaver DL , Moses HL , Ganote CE : Electron microscopy of the trigeminal ganglion. III. Trigeminal neuralgia. Arch Pathol 79 : 571 – 582 , 1965 Beaver DL, Moses HL, Ganote CE: Electron microscopy of

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Patterns of opioid use in patients with trigeminal neuralgia undergoing neurosurgery

Andrew I. Yang, Brendan J. McShane, Frederick L. Hitti, Sukhmeet K. Sandhu, H. Isaac Chen, and John Y. K. Lee

T he first-line treatment for trigeminal neuralgia (TN) is pharmacological. Carbamazepine (CBZ) remains the only medication for TN approved by the US FDA. The American Academy of Neurology–European Federation of Neurological Societies guidelines recommend CBZ and oxcarbazepine (OCBZ) as first-line agents for TN. 3 Based on two placebo-controlled studies on patients with TN included in a Cochrane review on CBZ, the number needed to treat to achieve at least a 50% reduction in pain was 1.9. 25 The tolerability of CBZ, however, is relatively poor. Based on three

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Gamma Knife Surgery for Trigeminal Neuralgia

Neurosurgical Forum: Letters to the Editor To The Editor Ming-Chien Kao , M.D., D.M.Sc. National Taiwan University Hospital Taiwan, People's Republic of China 160 161 Abstract Object. Stereotactic radiosurgery is an increasingly used and the least invasive surgical option for patients with trigeminal neuralgia. In this study, the authors investigate the clinical outcomes in patients treated with this procedure. Methods. Independently acquired data from 220 patients with idiopathic trigeminal neuralgia who

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Degree of distal trigeminal nerve atrophy predicts outcome after microvascular decompression for Type 1a trigeminal neuralgia

Yifei Duan, Jennifer Sweet, Charles Munyon, and Jonathan Miller

M icrovascular decompression (MVD) has emerged as the most common surgical procedure for medically refractory trigeminal neuralgia (TN). 20 While it can be curative for a majority of patients with typical TN symptoms, the response to MVD is sometimes incomplete and some patients do not respond at all. 16 Risk factors for pain recurrence include lack of immediate relief, longer preoperative duration of symptoms, female sex, lack of vascular compression at surgery, and a significant component of constant, rather than episodic, pain. 2 , 14 , 16 , 22

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Outcomes of Gamma Knife surgery for trigeminal neuralgia secondary to vertebrobasilar ectasia

Clinical article

Kyung-Jae Park, Douglas Kondziolka, Hideyuki Kano, Oren Berkowitz, Safee Faraz Ahmed, Xiaomin Liu, Ajay Niranjan, John C. Flickinger, and L. Dade Lunsford

was 13 months (range 3–77 months) between their last surgical procedure and the latest follow-up evaluation. Three patients (15%) achieved BNI Grade I; 3 (15%) had Grade II; 6 (30%) had Grade IIIa; and 3 (15%) had Grade IIIb. Five patients (25%) continued to have uncontrolled or severe pain (BNI Grades IV and V) ( Fig. 1 ). Discussion Trigeminal neuralgia is estimated to have an annual incidence of 27 per 100,000. The pain is characterized by sharp, intermittent, and often severe attacks of pain affecting the dermatomal distribution of the trigeminal nerve. 3

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Stereotactic gamma knife surgery for trigeminal neuralgia: detailed analysis of treatment response

Rabih G. Tawk, Mary Duffy-Fronckowiak, Bryan E. Scott, Ronald A. Alberico, Aidnag Z. Diaz, Matthew B. Podgorsak, Robert J. Plunkett, and Robert A. Fenstermaker

). Thus, the true complication rates may have been underestimated in series with short-term follow ups. Our results indicate that 1.5 years should elapse before accurately defining the subgroup of patients with side effects. As such, it is difficult to draw firm conclusions about complication rates based on studies with relatively short-term follow ups. The variable natural history of TN also increases the difficulty in analyzing results of case series. Trigeminal neuralgia is characterized by periods of partial or complete spontaneous remission in many patients. This

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Gamma knife radiosurgery for trigeminal neuralgia: dose—volume histograms of the brainstem and trigeminal nerve

Ronald Brisman and R. Mooij

with MS the isocenter tended to be farther from the brainstem than in other patients. Placing the isocenter closer to the brainstem might improve the results. There appear to be differences between the dose—volume histogram calculated on the left and right sides during GKS for TN, even when the same isodose is placed tangential to the brainstem. References 1. Kondziolka D , Lunsford LD , Flickinger JC , et al : Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit. J Neurosurg

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Trigeminal nerve dysfunction after Gamma Knife surgery for trigeminal neuralgia: a detailed analysis

Clinical article

Shinji Matsuda, Osamu Nagano, Toru Serizawa, Yoshinori Higuchi, and Junichi Ono

neuralgia and other types of facial pain as they relate to the half-life of cobalt . J Neurosurg 105 : 730 – 735 , 2006 2 Brisman R : Microvascular decompression vs. gamma knife radiosurgery for typical trigeminal neuralgia: preliminary findings . Stereotact Funct Neurosurg 85 : 94 – 98 , 2007 3 Hayashi M , Trigeminal neuralgia . Yamamoto M : Japanese Experience with Gamma Knife Radiosurgery Basel , Karger , 2009 . 22 : 182 – 190 4 Kondziolka D , Lunsford LD , Flickinger JC , Young RF , Vermeulen S , Duma CM , : Stereotactic