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Percutaneous trigeminal ganglion compression for trigeminal neuralgia

Experience in 22 patients and review of the literature

Jeffrey A. Brown and Mark C. Preul

P ercutaneous trigeminal ganglion compression (PTGC) was introduced by Mullan in 1978 and its description was published in 1983. 19 The present paper describes the results of PTGC in a series of 22 patients and summarizes the results of all other published PTGC studies. 1, 2, 5, 7–9, 18, 19 The procedure is based on the technique of trigeminal ganglion compression performed by Shelden, et al. 21 through a temporal craniotomy. In 1952, Taarnhøj 25 had reported on a series of patients treated by decompressing the posterior root rather than by sectioning it

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Kim J. Burchiel and Thomas K. Baumann

about the neuronal mechanism of TN, we developed a recording technique 1 that makes it possible to monitor the action potential discharge of individual trigeminal ganglion neurons in afflicted patients. Case Report Intraoperative Microneurographic Recording The experimental procedure was approved by the Oregon Health & Science University Institutional Review Board. A 70-year-old man in whom TN affected the second and third trigeminal division on the right side of his face gave informed consent for an intraoperative recording session, which was undertaken

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Peter Langford, Michael E. Holt and R. Andrew Danks

P ercutaneous balloon compression of the trigeminal ganglion has become a well-accepted treatment for trigeminal neuralgia 3 since it was first described by Mullan and Lichtor. 7 The long-term results and low complication rates associated with this procedure are comparable to those related to other percutaneous techniques. 10 In this report we describe a rare complication of this procedure: an accessory meningeal artery—cavernous sinus fistula. Case Report History and First Presentation Ten years ago, at the age of 72 years, this patient underwent

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David J. Skirving and Noel G. Dan

T here are three well-established percutaneous procedures for the treatment of trigeminal neuralgia, but no consensus as to which is best. Each method results in a certain number of recurrences and complications. The aim is pain relief with a minimum of unwanted sensory deficits. The senior author (N.G.D.) first performed PBC of the trigeminal ganglion in June 1980, following a visit and introduction to the method by its developer, Dr. Sean Mullan, before its first published description. This paper presents the results of 531 procedures performed in 496

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Mark C. Preul, Phillip B. Long, Jeffrey A. Brown, Manuel E. Velasco and Michael T. Weaver

P ercutaneous trigeminal ganglion compression for relief of trigeminal neuralgia was introduced in 1983 by Mullan and Lichtor. 25 Percutaneous compression is reported as an effective procedure in several series published to date. 4–9, 11–13, 25, 29 The procedure is a modification of the approach described in 1955 by Shelden, et al. , 28 for selective compression of fibers of the trigeminal ganglion under direct visualization through a subtemporal craniectomy. Earlier, Shelden, et al. , had treated 10 patients with trigeminal neuralgia by decompressing

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Berkley L. Rish

T he complications associated with percutaneous radiofrequency thermocoagulation of the trigeminal ganglion for tic douloureux include: diplopia, dysesthesia, anesthesia dolorosa, masseter paresis, neuroparalytic keratitis, and herpetic eruptions. 2–4 Occasional mention has been made of puncturing the carotid artery. 2–4 Yet, the possible morbidity associated with direct carotid artery injury or the possibility of the thermocoagulation lesion affecting the artery has not been stressed since a report in 1931 by Kirschner. 1 Onofrio 3 reported that it is

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Sean Mullan and Terry Lichtor

operation for trigeminal neuralgia four years plus after operation. J Neurosurg 16 : 653 – 655 , 1959 Svien HJ, Love JG: Results of decompression operation for trigeminal neuralgia four years plus after operation. J Neurosurg 16: 653–655, 1959 11. Sweet WH , Wepsic JG : Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers. Part 1: Trigeminal neuralgia. J Neurosurg 40 : 143 – 156 , 1974 Sweet WH, Wepsic JG: Controlled thermocoagulation of trigeminal ganglion

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Terry Lichtor and John F. Mullan

I n 1978, percutaneous microcompression (PMC) of the trigeminal ganglion was initiated in the treatment of trigeminal neuralgia that was refractory to carbamazepine (Tegretol). In 1983, we published our experience in the management of 50 patients. 5 The present paper brings up to date the results in 100 patients who have been followed for periods ranging between 1 and 10 years. Sixty-two percent were female. There was one patient in the second decade of life, one in the third, four in the fourth, 13 in the fifth, 17 in the sixth, 24 in the seventh, 27 in the

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Richard A. Lende and Dennis A. Poulos

and, therefore, markedly alters the function of the sensory root.” The functional significance of the trigeminal ganglion may be clarified by studies that determine the details of its spatial organization. Recently, certain aspects of somatotopic localization in the ganglion have been investigated with techniques of microelectrode recording. Kerr and Lysak 7 recorded responses to many physiological stimuli in cats and one monkey. Darian-Smith, et al. , 4 recorded responses to both electrical and tactile stimulation of the skin in cats. Zucker and Welker 13

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Frederick W. L. Kerr

N umerous studies of sensory ganglia using light microscopy had been reported by the turn of the century. Cajal summarized much of that information in his treatise of 1909; 12 since then this technique has added only minor details. Electron microscopic studies of the trigeminal ganglion, however, have now added substantially to our knowledge of the fine structure of the trigeminal ganglion and have permitted a more accurate evaluation of normal variants. One of the major problems inherent in the study of materials suspected of harboring lesions is to