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Trigeminal neuralgia without neurovascular compression presents earlier than trigeminal neuralgia with neurovascular compression

Andrew L. Ko, Albert Lee, Ahmed M. Raslan, Alp Ozpinar, Shirley McCartney, and Kim J. Burchiel

I n 1934, Dandy proposed neurovascular compression (NVC) as an etiology for trigeminal neuralgia (TN). In his series, he reported that the superior cerebellar artery caused NVC in 30.7% of patients. 6 He noted veins, tumors, and vascular and cranial malformations as other “gross findings” causing compression of the trigeminal nerve; nevertheless, in 40% of cases, he observed no evidence of a gross lesion. 6 He did document, however, that his posterior fossa approach did not allow for visualization of the entire root entry zone (REZ). After years of

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Repeat Gamma Knife surgery for trigeminal neuralgia: long-term results

Clinical article

Brent Y. Kimball, Jeffrey M. Sorenson, and David Cunningham

, Larkins MV , Jho HD : The long-term outcome of microvascular decompression for trigeminal neuralgia . N Engl J Med 334 : 1077 – 1083 , 1996 2 Brisman R : Gamma knife surgery with a dose of 75 to 76.8 Gray for trigeminal neuralgia . J Neurosurg 100 : 848 – 854 , 2004 3 Brisman R : Repeat gamma knife radiosurgery for trigeminal neuralgia . Stereotact Funct Neurosurg 81 : 43 – 49 , 2003 4 Brown JA , Gouda JJ : Percutaneous balloon compression of the trigeminal nerve . Neurosurg Clin N Am 8 : 53 – 62 , 1997 5 Brown JA , McDaniel

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Microvascular sling decompression for trigeminal neuralgia secondary to ectatic vertebrobasilar compression

Case report

James L. Stone, Terry Lichtor, and Robert M. Crowell

V ascular compression of the trigeminal nerve secondary to basilar artery ectasia is an unusual cause of trigeminal neuralgia. 2, 5, 7, 11 The surgical outcome for patients with this phenomenon is relatively poor. 1–3, 8, 10, 12, 16–18 The tortuous vertebrobasilar artery is often firm and difficult to move, and decompression by the insertion of a prosthesis between the artery and the nerve is not easily achieved. Various surgical techniques have been employed in such cases, including selective trigeminal rhizotomy 9 and thermocoagulation. 12 There are only

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Percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia

Sean Mullan and Terry Lichtor

F or many years alcohol injection and partial retrogasserian section remained the standard methods of treatment of trigeminal neuralgia. Although they relieved the lancinating pain, they were unsatisfactory in that they produced a deep anesthesia in all instances, an uncomfortable paresthesia in some, and a distressing analgesia dolorosa in a few. These complications, together with an incidence of keratitis in those who had denervation of the first division, led to an ongoing search for a better method. Historical Review In 1937, Lee 5 suggested that

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Radiosurgery and Trigeminal Neuralgia

Neurosurgical Forum: Letters to the Editor To The Editor Yücel Kanpolat , M.D. Ali Savas , M.D., Ph.D. Ankara University, School of Medicine Vrije Universiteit Medical Center Ankara, Turkey 1018 1019 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

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External carotid artery fistula due to microcompression of the gasserian ganglion for relief of trigeminal neuralgia

Case report

Rogelio Revuelta, Edgar Nathal, Jorge Balderrama, Alejandro Tello, and Marco Zenteno

Microcompression of the gasserian ganglion and other percutaneous injection procedures have been considered successful low-risk procedures for some cases of trigeminal neuralgia; however, there is a small percentage of patients who suffer vascular complications related to these procedures that can lead to morbidity. Venous or arterial bleeding may occur secondary to puncture of venous or arterial structures located near the foramen ovale. 4, 6, 9 The internal carotid artery may also be punctured within the area of the cavernous sinus, causing a carotid-cavernous fistula. 3, 7

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Gamma knife radiosurgery for trigeminal neuralgia associated with multiple sclerosis

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

incidence of MS in TN patients is similarly low: 2.4% in a large series of 800 patients reported by Jensen and colleagues. 8 Trigeminal neuralgia is usually a sequela to the diagnosis of MS that develops in a mean interval of 10 to 11 years 15 but rarely occurs as the presenting symptom. The authors of one report 15 indicated that 0.3% of MS patients presented with TN. The diagnosis of TN predating that of MS has also been reported. 4 Multiple sclerosis—associated TN has the same chronic, paroxysmal pain characteristics of essential TN and, except for the presence of

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Microvascular decompression for trigeminal neuralgia in elderly patients

Raymond F. Sekula Jr., Edward M. Marchan, Lynn H. Fletcher, Kenneth F. Casey, and Peter J. Jannetta

elderly patients requiring treatment for TN in the US should increase substantially in the future. Despite reports that MVD for elderly patients with medically refractory TN above the ages of 65 and 70 years 2 , 8 has been shown to be both safe and efficacious, other “second-tier” treatments are frequently offered to elderly patients due to concerns of fitness for surgery. In an effort to add to the existing literature, we retrospectively analyzed our elderly population of patients to determine if microvascular decompression for trigeminal neuralgia in elderly

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Gamma knife radiosurgery for trigeminal neuralgia: the dry-eye complication

Shinji Matsuda, Toru Serizawa, Makato Sato, and Junichi Ono

factor in the manifestation of complications. The efficacy of GKS for TN should thus be improved if the irradiated volume of VB 12 is kept to less than 28 mm 3 . References 1. Brisman R , Mooij R : Gamma knife radiosurgery for trigeminal neuralgia: dose-volume histograms of the brainstem and trigeminal nerve. J Neurosurg (Suppl 3) 93 : 155 – 158 , 2000 Brisman R, Mooij R: Gamma knife radiosurgery for trigeminal neuralgia: dose-volume histograms of the brainstem and trigeminal nerve. J Neurosurg (Suppl 3) 93: 155

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Bilateral trigeminal neuralgia: a 14-year experience with microvascular decompression

Ian F. Pollack, Peter J. Jannetta, and David J. Bissonette

B ilateral trigeminal neuralgia (TN) is uncommon, occurring in 1% to 6% of patients with TN in most large series. 1, 7, 10, 13, 16, 18, 34 Although the association of bilateral symptoms with multiple sclerosis has been emphasized by several authors, 13–16, 22, 34 the vast majority of cases are of the so-called “idiopathic” variety. Operative treatment has often been deferred in these individuals because of concerns of producing bilateral trigeminal sensory or motor deficits with ablative procedures. Techniques employed (with varying degrees of success) to