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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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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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Teflon-induced granuloma following treatment of trigeminal neuralgia by microvascular decompression

Report of two cases

Ishwar C. Premsagar, Timothy Moss, and Hugh B. Coakham

M icrovascular decompression (MVD) is a non-ablative procedure that is used to treat trigeminal neuralgia (TN); it yields good results in approximately 90% of cases without causing numbness to the face. 4, 5, 10, 11, 14, 16–18, 24, 27, 29 Recently MVD has been used with increasing frequency to treat a variety of neurovascular compression syndromes, including hemifacial spasm, 15, 27 glossopharyngeal neuralgia, 19 intractable tinnitus, 26 disabling vertigo, 25 torticollis, 31 sudden hearing loss, 30 and intractable hiccups. 20 In an in vitro study of

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Trigeminal neuralgia: a quantitative sensory perception threshold study in patients who had not undergone previous invasive procedures

David Bowsher, John B. Miles, Carol E. Haggett, and Paul R. Eldridge

T he pathophysiology of “idiopathic” trigeminal neuralgia has been much disputed. Most observers have failed to find clinical changes in sensation in the affected areas and, correlatively, no convincing anatomicopathological changes in the peripheral portion of the nerve. Lewy and Grant, 15 however, maintained that there is a change in the tactile and thermal thresholds in trigeminal neuralgia, and Nurmikko, 19 using quantitative methods similar to those used in the present investigation, demonstrated a change in tactile and temperature thresholds. More

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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

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Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit

Douglas Kondziolka, L. Dade Lunsford, John C. Flickinger, Ronald F. Young, Sandra Vermeulen, Christopher M. Duma, Deane B. Jacques, Robert W. Rand, Jean Regis, Jean-Claude Peragut, Luis Manera, Mel H. Epstein, and Christer Lindquist

L ars Leksell's first radiosurgical procedure in 1951 was undertaken for the treatment of trigeminal neuralgia. 15 In that first case, he aimed the radiation beam generated by an orthovoltage x-ray tube at the trigeminal ganglion using a conventional stereotactic frame system. The use of an external energy source as a surgical tool to manage trigeminal neuralgia has a long history, including radiofrequency-generated thermal energy for percutaneous rhizotomy 2, 27 and mechanical energy for balloon compression. 3 Other techniques with proven substantiated

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Evaluation of endorphin content in the CSF of patients with trigeminal neuralgia before and after Gasserian ganglion thermocoagulation

Giuseppe Salar, Salvatore Mingrino, Marco Trabucchi, Angelo Bosio, and Carlo Semenza

pharmacologically treated trigeminal neuralgia and in another group not treated pharmacologically. The CSF endorphin values were further compared in the same patients with the values obtained after Gasserian ganglion thermocoagulation and complete remission of pain. In addition, these endorphin values were compared with those of a group of subjects who had no pain problem. Clinical Material and Methods Ten patients with idiopathic trigeminal neuralgia were studied. Their ages ranged from 35 to 55 years (mean 46 years). Five were men and five women. Four patients complained

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Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia

Joshua B. Bederson and Charles B. Wilson

classified as nonablative. TABLE 1 General characteristics of the patient population * Feature No. total patients 252 sex (F/M) 176/76 age at onset of pain (yrs)  mean 52.2 ± 0.8  range 23–78 duration of symptoms (yrs)  mean 7.9 ± 0.4  range 0.5–42 age at operation (yrs)  mean 59.9 ± 0.7  range 24–85 * Six patients experienced trigeminal neuralgia on both sides of the face, with age at onset, duration of symptoms, and age at operation

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Gamma Knife radiosurgery for trigeminal neuralgia: the impact of magnetic resonance imaging–detected vascular impingement of the affected nerve

Clinical article

Jason P. Sheehan, Dibyendu Kumar Ray, Stephen Monteith, Chun Po Yen, James Lesnick, Ronald Kersh, and David Schlesinger

, when required, by muscle relaxants like baclofen. In medically intractable cases, other treatment options include alcohol injection, glycerol rhizotomy, microvascular decompression, and stereotactic radiosurgery. Radiosurgery has become an increasingly attractive minimally invasive option with good potential for long-term pain relief. The exact pathogenesis of trigeminal neuralgia is still unknown, but it is commonly agreed that vasculature compression near the root entry zone of the trigeminal nerve at the pons is an important offending agent, with findings of

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Ectopic brain tissue in the trigeminal nerve presenting as rapid-onset trigeminal neuralgia: case report

Jeffrey H. Zimering, Jonathan J. Stone, Audrey Paulzak, John D. Markman, Mahlon D. Johnson, and G. Edward Vates

I ntracranial glioneuronal hamartoma comprises an exceedingly rare subset of all cerebellopontine angle mass lesions, which can elicit signs and symptoms through cranial nerve involvement. The sudden onset of symptoms due to nerve compression by a small, firm glioneuronal heterotopia has been reported. Yet, to our knowledge, this is the first report of trigeminal neuralgia arising through the presumed compressive effects of a small glioneuronal heterotopia that lacked evidence of vascular co-compression and instead probably involved T-cell–mediated processes