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Combined extra-intradural temporal rhizotomy for the treatment of trigeminal neuralgia

Results in 409 patients

Giulio Morello, Mario Bianchi, and Franco Migliavacca

T rigeminal rhizotomy for essential trigeminal neuralgia was first performed in 1891 by Horsley, et al., 7 using the intradural temporal route. It was not a subtemporal rhizotomy as understood today, that is, section of the root in the middle cranial fossa, but rather a temporal craniectomy, opening of the dura, raising of the temporal lobe, exposure of the root proximally to the porus trigemini, and “avulsion of the nerve from its attachment to the pons.” A technique similar to juxtapontine rhizotomy but carried out transtentorially was later described by

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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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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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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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Long-term outcome after operation for trigeminal neuralgia in patients with posterior fossa tumors

Fred G. Barker II, Peter J. Jannetta, Ramesh P. Babu, Spiros Pomonis, David J. Bissonette, and Hae Dong Jho

I t is well known that an occasional patient with a posterior fossa tumor will present with symptoms of typical trigeminal neuralgia and that the pain may be relieved by tumor resection. Most reports of this phenomenon have been confined to small case series with short-term follow-up periods. To those patients who present with complaints of pain, the long-term prognosis for postoperative pain relief is of particular interest. We have reviewed our experiences with 26 patients with posterior fossa tumors who presented with trigeminal neuralgia during a 20-year

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Coexistent trigeminal neuralgia, hemifacial spasm, and hypertension: preoperative imaging of neurovascular compression

Case report

Eric S. Ballantyne, Rosalind D. Page, James F. M. Meaney, Thomas E. Nixon, and John B. Miles

T he cause of trigeminal neuralgia and hemifacial spasm is multifactorial, and surgery has been reserved for severe cases that have ceased to respond to medical treatment and are considered to be physically fit enough to undergo surgery. 1, 19, 24 With improved anesthetic capabilities and the protective benefits of intraoperative monitoring of brain-stem function, surgery has become more readily recommended. 9 However, it has been reported that surgical exploration fails to reveal vascular compression in up to 16% of cases; 1, 19, 24 thus, there is an

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Trigeminal neuralgia and hemifacial spasm as false localizing signs in patients with a contralateral mass of the posterior cranial fossa

Report of three cases

Nobuki Matsuura and Akinori Kondo

T rigeminal neuralgia and hemifacial spasm result from mechanical compression of the cranial nerves by surrounding vessels. The compressing lesions are usually ipsilateral to the symptoms. 6, 11, 12 Trigeminal neuralgia and hemifacial spasm have been reported as false localizing signs of a mass in the contralateral posterior cranial fossa, although they are extremely rare and the underlying pathophysiological mechanisms remain to be elucidated. 2, 4, 8, 9, 13, 14, 17, 21, 23 Because there are few reports of patients who have undergone exploratory

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Isolated hypertrophic interstitial neuropathy of the trigeminal nerve associated with trigeminal neuralgia

Case report of an entity not previously described

David S. Baskin, Jeannette J. Townsend, and Charles B. Wilson

microscopic documentation in only one case. 4 We report the first case in which isolated HIN of the trigeminal nerve was histologically documented in a patient with trigeminal neuralgia who had no symptoms or signs of involvement of the nervous system elsewhere. Case Report This 41-year-old right-handed American Indian man was admitted to the Neurosurgery Service at the University of California, San Francisco, on May 7, 1980, with a 3-year history of left facial pain in the distribution of the first and second division of the trigeminal nerve. He described the pain

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Racial disparities in the diagnosis and management of trigeminal neuralgia

Kevin Reinard, David R. Nerenz, Azam Basheer, Rizwan Tahir, Timothy Jelsema, Lonni Schultz, Ghaus Malik, Ellen L. Air, and Jason M. Schwalb

E pidemiological studies have estimated the incidence rate of trigeminal neuralgia (TN) in a range from 11.0 to 42.0 cases per 100,000 people per year with a female preponderance. 17 While TN can afflict people of any age, the majority of patients are between the ages of 50 and 60 years. 10 A paucity of literature is dedicated to the racial epidemiology of TN, although some epidemiological studies have been performed at the Mayo Clinic in Rochester, Minnesota, 13 , 14 and the University of São Paulo in Brazil. 15 While the Mayo study found no

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Temporal glioblastoma causing trigeminal neuralgia

Case illustration

Shreeram Deshpande, George J. Kaptain, and Louis H. Pobereskin

trigeminal neuralgia or atypical facial pain both in the posterior and middle fossa. Irritation of the gasserian ganglion through compression or infiltration most commonly results from extraaxial intracranial masses, 1 direct extension of infratemporal tumors, 3 or meningeal carcinomatosis. 2 Patients with gliomas rarely present with facial pain as a result of ganglionic infiltration 4 because spontaneous dural invasion is uncommon. 5 This case highlights the importance of imaging studies in evaluating trigeminal neuralgia or atypical facial pain. References 1. Cheng