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Preoperative visualization of neurovascular anatomy in trigeminal neuralgia

Jonathan Miller, Feridun Acar, Bronwyn Hamilton, and Kim Burchiel

like to express our appreciation and thanks to Shirley McCartney, Ph.D., and Andy Rekito, M.S., for contributions to this manuscript, and to Valerie Anderson, Ph.D., for electronic institutional review board assistance. References 1 Akimoto H , Nagaoka T , Nariai T , Takada Y , Ohno K , Yoshino N : Preoperative evaluation of neurovascular compression in patients with trigeminal neuralgia by use of three-dimensional reconstruction from two types of high-resolution magnetic resonance imaging . Neurosurgery 51 : 956 – 962 , 2002 2 Anderson

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Microvascular decompression after failed Gamma Knife surgery for trigeminal neuralgia: a safe and effective rescue therapy?

Clinical article

Raymond F. Sekula Jr., Andrew M. Frederickson, Peter J. Jannetta, Sanjay Bhatia, and Matthew R. Quigley

T rigeminal neuralgia is a debilitating facial pain disorder. When medications fail, procedures including percutaneous glycerol rhizotomy, percutaneous radiofrequency rhizotomy, percutaneous balloon compression rhizolysis, stereotactic radiosurgical rhizolysis (GKS), and MVD are available to the patient. Because the safety, efficacy, and durability of MVD for trigeminal neuralgia in the young and elderly have been established, many clinicians view MVD as the first line of treatment when medications fail. 2 , 3 , 21 , 23 , 50 , 51 , 55 , 58 In the past 2

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Results of repeated gamma knife radiosurgery for medically unresponsive trigeminal neuralgia

Bruce E. Pollock, Robert L. Foote, Scott L. Stafford, Michael J. Link, Deborah A. Gorman, and Paula J. Schomberg

T he treatment of patients with medically unresponsive trigeminal neuralgia with GKS is not new. Leksell 11 performed GKS in 63 patients with trigeminal neuralgia between 1968 and 1982. Imaging quality of the trigeminal nerve or ganglion during this period was poor, however, and the precise radiation dose delivered was unknown. Lindquist, et al., 12 later reported the outcomes for 46 of these patients. Approximately 50% became pain free initially, but the pain recurred in most patients over the next several years. Rand, et al., 15 treated 12 patients with

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Percutaneous retrogasserian glycerol injection in the management of trigeminal neuralgia: long-term follow-up results

Takamitsu Fujimaki, Takanori Fukushima, and Shinichiro Miyazaki

S ince its introduction by Håkanson 8 in 1981, percutaneous retrogasserian glycerol injection has become an increasingly popular form of therapy for trigeminal neuralgia. 1, 2, 4, 11, 13, 16–18, 20, 22, 26 Several authors have reported that this procedure avoids sensory loss and dysesthesia. 8, 13, 26 The role of percutaneous retrogasserian glycerol injection in the treatment of trigeminal neuralgia is, however, still controversial because of the pain recurrence and significant sensory deficit associated with it. 2, 3, 16, 21, 22 This report analyzes our

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The effect of single-application topical ophthalmic anesthesia in patients with trigeminal neuralgia

A randomized double-blind placebo-controlled trial

Douglas Kondziolka, Thomas Lemley, John R. W. Kestle, L. Dade Lunsford, Gerhard H. Fromm, and Peter J. Jannetta

T he management of trigeminal neuralgia has intrigued physicians for several hundred years. Recently, letters to the editor in both the Journal of the American Medical Association 10, 11 and the Journal of Neurosurgery 7 described the long-term value of single-application topical ophthalmic anesthesia (two drops of 0.5% proparacaine hydrochloride) onto the cornea ipsilateral to the trigeminal neuralgia. Reportedly, this observation was made by a physician with trigeminal neuralgia who had a topical anesthetic agent applied to his eye during an

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Trigeminal neuralgia: definition and classification

Jorge L. Eller, Ahmed M. Raslan, and Kim J. Burchiel

Based on specific, objective, and reproducible criteria, a classification scheme for trigeminal neuralgia (TN) and related facial pain syndromes is proposed. Such a classification scheme is based on information provided in the patient's history and incorporates seven diagnostic criteria, as follows. 1) and 2) Trigeminal neuralgia Types 1 and 2 (TN1 and TN2) refer to idiopathic, spontaneous facial pain that is either predominantly episodic (as in TN1) or constant (as in TN2) in nature. 3) Trigeminal neuropathic pain results from unintentional injury to the trigeminal nerve from trauma or surgery. 4) Trigeminal deafferentation pain results from intentional injury to the nerve by peripheral nerve ablation, gangliolysis, or rhizotomy in an attempt to treat either TN or other related facial pain. 5) Symptomatic TN results from multiple sclerosis. 6) Postherpetic TN follows a cutaneous herpes zoster outbreak in the trigeminal distribution. 7) The category of atypical facial pain is reserved for facial pain secondary to a somatoform pain disorder and requires psychological testing for diagnostic confirmation. The purpose of a classification scheme like this is to advocate a more rigorous, standardized natural history and outcome studies for TN and related facial pain syndromes.

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The importance of autonomic symptoms in trigeminal neuralgia

Clinical article

H. Neil Simms and Christopher R. Honey

A utonomic symptoms in association with trigeminal neuralgia (TN) were reported as long ago as 1914, when Patrick 31 noted that vasomotor and secretory signs are often seen during paroxysms of pain. The group of headache disorders known as the trigeminal autonomic cephalgias (TACs) also result in autonomic symptoms in association with headache or facial pain. The TACs include short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). 15 , 24 A diagnosis of SUNCT requires at least 20 attacks of pain, typically with a

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CyberKnife radiosurgery for trigeminal neuralgia: unanticipated iatrogenic effect following successful treatment

Case report

Anuj V. Peddada, D. James Sceats, Gerald A. White, Gyongyver Bulz, Greg L. Gibbs, Barry Switzer, Susan Anderson, and Alan T. Monroe

, Mitchell LT , Hodge CJ , Montgomery CT , Bogart JA , : Gamma knife surgery for trigeminal neuralgia: improved initial response with two isocenters and increasing dose . J Neurosurg 102 : Suppl 185 – 188 , 2005 2 Balamucki CJ , Stieber VW , Ellis TL , Tatter SB , Deguzman AF , McMullen KP , : Does dose rate affect efficacy? The outcomes of 256 gamma knife surgery procedures for trigeminal neuralgia and other types of facial pain as they relate to the half-life of cobalt . J Neurosurg 105 : 730 – 735 , 2006 3 Broggi G

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Trigeminal neuralgia in the presence of ectatic basilar artery and basilar invagination: treatment by foramen magnum decompression

Case report

Atul Goel and Abhidha Shah

F ifth cranial nerve root entry zone compression due to an arterial or venous loop is an established cause of trigeminal neuralgia. Ectatic vertebral and basilar arteries have been frequently seen to cause vascular compression of the root entry zone of CN V. 5 , 9 , 11 Microvascular decompression has been the most accepted treatment in this clinical situation. We describe the case of a patient with long-standing trigeminal neuralgia and an ectatic basilar artery and basilar invagination. Basilar invagination has rarely been associated with trigeminal

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Pathophysiology of trigeminal neuralgia: new evidence from a trigeminal ganglion intraoperative microneurographic recording

Case report

Kim J. Burchiel and Thomas K. Baumann

. Baumann TK , Burchiel KJ : A method for intraoperative microneurographic recording of unitary activity in the trigeminal ganglion of patients with trigeminal neuralgia. J Neurosci Methods 132 : 19 – 24 , 2004 Baumann TK, Burchiel KJ: A method for intraoperative microneurographic recording of unitary activity in the trigeminal ganglion of patients with trigeminal neuralgia. J Neurosci Methods 132: 19–24, 2004 2. Devor M , Amir R , Rappaport ZH : Pathophysiology of trigeminal neuralgia: the ignition hypothesis