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Magnetic resonance imaging of vascular compression in trigeminal neuralgia

Case report

Bowen Y. Wong, Gary K. Steinberg, and Larry Rosen

T he clinical diagnosis of trigeminal neuralgia is usually not difficult to make, given the classic symptomatology that characterizes this syndrome; 2 however, the pathogenesis of this condition remains in dispute. Dandy 4 first observed the association of vascular abnormalities impinging on the trigeminal dorsal root. Jannetta 7 reported a series of 414 patients without multiple sclerosis who underwent microvascular decompression for trigeminal neuralgia; 95% of these patients showed abnormal vessels compressing the trigeminal nerve. Other surgical series

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Trigeminal neuralgia due to cholesteatoma of Meckel's cave

Case report

Dhirendra S. Mehta, Gauri Bazaz Malik, and Jawahar Dar

T he peripheral versus central etiology of trigeminal neuralgia remains obscure. Cushing and Eisenhardt 3 considered that peripheral lesions produce secondary neuralgia. Stookey and Ransohoff 14 indicated that a sensory deficit was the most common finding in secondary neuralgia, while Henderson 8 wrote that impairment of sensation never occurs in trigeminal neuralgia even in patients with disseminated sclerosis. However, typical trigeminal neuralgia due to tumors, without sensory loss, have been reported. 6, 12, 16 Both Olivecrona 12 and Gardner 5 noted

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Gamma knife radiosurgery for recurrent trigeminal neuralgia

Andrew G. Shetter, C. Leland Rogers, Francisco Ponce, Jeffrey A. Fiedler, Kris Smith, and Burton L. Speiser

has an 85% chance of achieving excellent-to-good pain control over a mean follow-up interval of 13.5 months. Adverse side effects were limited to the new onset of mild facial numbness in eight patients (42%) that was believed to be an acceptable tradeoff for pain control by all the involved patients. Two other studies have addressed the issue of repeated GKS for trigeminal neuralgia. Pollock, et al., 6 reported on 10 patients who underwent a second GKS treatment after experiencing significant but temporary pain control after the initial procedure. At a median

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Percutaneous retrogasserian glycerol rhizolysis in the management of trigeminal neuralgia

Kim J. Burchiel

T he discovery by Håkanson 11, 12 that injections of glycerol into the cistern of Meckel's cave in patients with trigeminal neuralgia produced lasting pain relief with little sensory loss represented a major contribution in the treatment of this disorder. Previous reviews have indicated that this method had the advantages of ease and simplicity of administration. Initial follow-up data suggested that the results were comparable to those of most other methods of rhizolysis, but that the complications which often ensued after denervation were largely avoided by

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Trigeminal neuralgia resulting from auditory brainstem implant cable compression

Case report

Marc S. Schwartz, Derald E. Brackmann, Eric P. Wilkinson, John L. Go, and Felipe Santos

T rigeminal neuralgia is a syndrome of paroxysmal lancinating facial pain in the distribution of the branches of the trigeminal nerve. In 1934, Dandy 5 hypothesized that trigeminal neuralgia was the result of direct compression of the trigeminal nerve. The MVD of the trigeminal nerve for trigeminal neuralgia has since become an established form of treatment, yielding long-term success in alleviating the patient's symptoms. In a series of 500 patients, Apfelbaum 1 showed that 81% had pain relief at 14 years. In a larger series of 1185 patients published by

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Trigeminal neuralgia treated by radiofrequency coagulation

John P. Latchaw Jr., Russell W. Hardy Jr., Sarah B. Forsythe, and Allan F. Cook

M any clinicians employ percutaneous radiofrequency coagulation (RC) when treating patients whose tic douloureux is no longer responsive to medication. Radiofrequency coagulation in these patients is associated with reduced length of hospitalization, successful short-term results, avoidance of general endotracheal anesthesia, and low morbidity and mortality rates. The long-term results of this procedure have been less well defined. The object of this study was to investigate the long-term results from RC in patients with trigeminal neuralgia. Clinical

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Trigeminal Neuralgia

Neurosurgical Forum: Letters to the Editor To The Editor Jason Sheehan , M.D., Ph.D. Ladislau Steiner , M.D., PH.D. University of Virginia Charlottesville, Virginia 1173 1173 Abstract Object. Microvascular decompression (MVD) and percutaneous ablation surgery have historically been the treatments of choice for medically refractory trigeminal neuralgia (TN). Gamma knife surgery (GKS) has been used as an alternative, minimally invasive treatment in TN. In the present study, the authors

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Gamma knife radiosurgery for idiopathic and secondary trigeminal neuralgia

Jin Woo Chang, Jong Hee Chang, Yong Gou Park, and Sang Sup Chung

I t is well known that microvascular compression at the trigeminal REZ causes trigeminal neuralgia. 8 Additionally, an extensive list of neoplasms, including both primary benign and malignant tumors such as schwannoma, meningioma, epidermoid, lipoma, primary malignant melanoma, and metastases from head and neck carcinoma, have been reported to cause trigeminal sensory neuropathy. 1, 2, 4, 10 Trigeminal neuralgia is thus classified as primary or idiopathic if there is no visible cause. Secondary or lesion-related trigeminal neuralgia is associated with a

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Stereotactic radiosurgery for idiopathic trigeminal neuralgia

Bruce E. Pollock, Loi K. Phuong, Deborah A. Gorman, Robert L. Foote, and Scott L. Stafford

microvascular decompression for trigeminal neuralgia. N Engl J Med 334 : 1077 – 1083 , 1996 Barker FG II, Jannetta PJ, Bissonette DJ, et al: The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334: 1077–1083, 1996 10.1056/NEJM199604253341701 3. Bederson JB , Wilson CB : Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. J Neurosurg 71 : 359 – 367 , 1989 Bederson JB, Wilson CB: Evaluation of microvascular decompression

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Trigeminal Neuralgia

Neurosurgical Forum: Letters to the Editor To The Editor Bing H. Tang , M.D. Chang-Hua Christian Hospital Chang-Hua, Taiwan 647 648 Abstract Object. Microvascular decompression (MVD) has become one of the primary treatments for typical trigeminal neuralgia (TN). Not all patients with facial pain, however, suffer from the typical form of this disease; many patients who present for surgical intervention actually have atypical TN. The authors compare the results of MVD performed for typical and atypical TN at