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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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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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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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Success of microvascular decompression with and without prior surgical therapy for trigeminal neuralgia

David Barba and John F. Alksne

T he etiology and treatment of trigeminal neuralgia continues to generate controversy in the neurosurgical literature. Even though Dandy 4 suggested in 1934 that an abnormality in the posterior fossa could be responsible for tic douloureux, until recently most neurosurgical interventions have been destructive in nature and aimed at the distal portions of the trigeminal nerve. In 1967, Jannetta 5 confirmed Dandy's observations, and developed the microvascular decompression operation which offers relief of pain without facial numbness, thus opening a new

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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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A successful case of multiple stereotactic radiosurgeries for ipsilateral recurrent trigeminal neuralgia

Emily Daugherty, Shripal Bhavsar, Seung Shin Hahn, Daniel Bassano, and Walter Hall

pain that is intense and episodic. Trigeminal neuralgia affects women more often than men. 5 Patients may have spontaneous pain or certain triggers for pain, including chewing, talking, teeth brushing, shaving, face touching, or cold stimuli. Patients will often demonstrate a pattern of avoidance behaviors, and in severe instances, the disorder can lead to dramatic weight loss. Subsequent workup yields normal neurological examination findings, and when performed, MRI is negative for structural compression via bone or tumors in classic TN. The role of imaging in

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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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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

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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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Peripheral nerve field stimulation in medically refractory trigeminal neuralgia attributed to multiple sclerosis

Johann Klein, Timo Siepmann, Gabriele Schackert, Tjalf Ziemssen, and Tareq A. Juratli

T rigeminal neuropathic pain occurs more often in patients with multiple sclerosis (MS) than in the general population with reported incidence rates of 1.9%–6.3%. 16 , 32 , 37 The symptoms can be indistinguishable from those in classic trigeminal neuralgia (CTN), with paroxysmal, short-lived, stabbing or sharp pain attacks in the distribution of one or more trigeminal nerve branches, which can be triggered by talking, chewing, or brushing teeth. 44 Yet, while CTN is caused by neurovascular contact, the most likely reason for trigeminal