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Elizabeth Bullitt, John M. Tew and Jane Boyd

F acial pain is a common complaint that leads thousands of patients to seek medical attention every year. The annual incidence of trigeminal neuralgia alone is one per 25,000 adults, 37 and thus an estimated 15,000 patients in the United States develop trigeminal neuralgia every year. Other types of facial pain occur even more frequently, and the etiology of many of these disorders is often obscure. Tumors involving the trigeminal nerve represent an unusual but important cause of both trigeminal neuralgia and atypical facial pain. Most tumors producing

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Sharona Ben-Haim, Zaman Mirzadeh and William S. Rosenberg

D eep brain stimulation (DBS) is a well-established evidence-based therapy for patients with Parkinson’s disease 8 , 18 , 23 , 26 , 27 and essential tremor, 2 , 19 and it is approved for dystonia 14 , 25 and obsessive-compulsive disorder under a humanitarian device exemption. Although not yet supported by Level I evidence, DBS has demonstrated efficacy in patients with epilepsy, 9 Tourette’s syndrome, 24 depression, 6 , 17 and anorexia. 16 Despite the early successful use of DBS in the 1970s to target the somatosensory thalamus for intractable facial pain

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Gideon Findler and Moshe Feinsod

S ince the introduction of trigeminal somatosensory evoked response (TSER) monitoring as a routine test in various neurological conditions in our service, 2 many hydrocephalic patients have been examined. In most, the TSER showed low amplitudes with no significant abnormal changes in the latencies of the waves (unpublished data). However, in one of the hydrocephalic patients, who also presented with facial pain, the TSER from the affected side of the face showed changes in both amplitudes and latencies of waves. A description of this case follows. Case

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Margareta B. E. Eriksson, Bengt H. Sjölund and Göran Sundbärg

P atients with chronic so-called intractable facial pain may present management problems. This is true for typical trigeminal neuralgia (tic douloureux) as well as for atypical forms of facial pain. 1, 18, 24 In the treatment of tic douloureux, systemic administration of carbamazepine 3, 5 has for many years replaced alcohol blocks 13 as the treatment of choice. About 70% of the patients are said to report good or excellent analgesia initially. 25, 32 However, side effects are frequent, often due to overdosage, and long-term follow-up studies have shown

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Ronald F. Young

ganglion or the trigeminal sensory root. It is also unclear whether this distinction between stimulation loci is of any practical importance. Electrical stimulation of the trigeminal ganglion or nerve root has been used to treat chronic facial pain, usually associated with various forms of injury to either the peripheral branches of the trigeminal nerve or the trigeminal nerve root, so-called “trigeminal neuropathy.” 16 The number of patients reported as being treated with a permanent percutaneously placed electrode, however, is very small and the follow-up intervals

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Darian R. Esfahani, Marc T. Pisansky, Rima M. Dafer and Douglas E. Anderson

N europathic facial pain is characterized by stabbing, burning, dysesthetic sensation, which can ultimately diminish quality of life. When pharmacological treatment cannot provide effective pain relief or patients are unable to tolerate the side effects of medications, surgical intervention may be warranted. Conventional surgical approaches include microvascular decompression of the trigeminal nerve, 3 , 12 stereotactic radiosurgery, 22 , 48 percutaneous glycerol retrogasserian rhizotomy, 2 and percutaneous balloon compression. 29 , 39 In recent years

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Glen S. Merry and Kenneth G. Jamieson

the posterior fossa. An anterolateral combined with a supra-infratentorial approach along the petrous temporal bone provided exposure of the persistent trigeminal artery and trigeminal and abducent nerves in the case reported here. Case Report A 31-year-old woman was admitted to the Royal Brisbane Hospital on April 14, 1974, complaining of low back pain and left sciatica which resulted from a fall 4 days previously. She later suffered severe left facial pain in the area of the trigeminal nerve. There was also pain, paresthesia, and some decreased power in the

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Giovanni Broggi and Angelo Franzini

T he value of percutaneous radiofrequency trigeminal thermo-rhizotomy (TRZ) is well established in the treatment of tic douloureux 1, 6, 9–11 and in the management of cancer pain of the face. 7 Few reports have dealt specifically with TRZ performed in patients suffering from symptomatic facial pain of non-neoplastic origin. 8 This study presents the results of TRZ in 20 patients suffering from trigeminal pain secondary to multiple sclerosis, basilar impression, intracranial aneurysms, and retinal hemorrhage. The indications for this treatment are discussed

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Jaimie M. Henderson and Shivanand P. Lad

✓Trigeminal neuropathic pain is a syndrome of severe, constant facial pain related to disease of or injury to the trigeminal nerve or ganglion. Causes of this type of pain can include injury from sinus or dental surgery, skull and/or facial trauma, or intentional destruction for therapeutic reasons (deafferentation) as well as intrinsic pathological conditions in any part of the trigeminal system. Motor cortex stimulation (MCS) is a relatively new technique that has shown some promise in the treatment of trigeminal neuropathic pain. This technique has the potential to revolutionize the treatment of chronic pain. The authors present a review of the literature, focusing on surgical technique, device programming, safety, and efficacy, and suggest some initial guidelines for standardization of these aspects. It is important to evaluate MCS critically in a prospective, controlled fashion.

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John Y. K. Lee, H. Isaac Chen, Christopher Urban, Anahita Hojat, Ephraim Church, Sharon X. Xie and John T. Farrar

N eurosurgeons are often involved in the diagnosis and surgical management of patients with facial pain and/or TN. 2 Despite the severe nature of such pain, the consistent measurement of pain intensity and interference with common activities remains problematic. For example, in most published studies, the only outcome after surgical procedures for TN is pain intensity measured on either a 3- 2 or 5-point scale. 17 Surprisingly, according to a recent review of surgical studies on TN, 221 of 222 studies did not report the measurement of pain preoperatively