Surgical control of chronic migrainous neuralgia by trigeminal ganglio-rhizolysis

Robert E. Maxwell M.D., Ph.D.1
View More View Less
  • 1 Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

✓ Chronic migrainous neuralgia is not diagnosed as often as the periodic or “cluster” form of Horton's syndrome. The distinguishing features of chronic migrainous neuralgia, compared with the periodic variety, are the frequency and persistence of the attacks of hemicraniofacial pain and the intractability to medical management. Eight male patients ranging in age from 22 to 45 years received prompt, although transient, pain relief by blockade of the Gasserian ganglion on the side of their hemifacial pain with a local anesthetic. Prolonged relief was subsequently achieved by percutaneous radiofrequency trigeminal ganglio-rhizolysis. There were no significant complications from this procedure. Review of the literature indicated that other ablative neurosurgical procedures, such as alcohol injection of the Gasserian ganglion and trigeminal rhizotomy by the subtemporal craniectomy approach, have relieved migrainous neuralgia, but with a greater risk and incidence of complications. The characteristic clinical features of migrainous neuralgia and the medical and surgical approaches to therapy are discussed.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1.

    Anthony M, & Lance JW: Histamine and serotonin in cluster headache. Arch Neurol 25:225231, 1971 Anthony M, Lance JW: Histamine and serotonin in cluster headache. Arch Neurol 25:225–231, 1971

    • Search Google Scholar
    • Export Citation
  • 2.

    Apfelbaum RI: A comparison of percutaneous radiofrequency trigeminal neurolysis and microvascular decompression of the trigeminal nerve for the treatment of tic douloureux. Neurosurgery 1:1621, 1977 Apfelbaum RI: A comparison of percutaneous radiofrequency trigeminal neurolysis and microvascular decompression of the trigeminal nerve for the treatment of tic douloureux. Neurosurgery 1:16–21, 1977

    • Search Google Scholar
    • Export Citation
  • 3.

    Appenzeller O, , Becker WJ, & Ragaz A: Cluster headache. Ultrastructural aspects and pathogenetic mechanisms. Arch Neurol 38:302306, 1981 Appenzeller O, Becker WJ, Ragaz A: Cluster headache. Ultrastructural aspects and pathogenetic mechanisms. Arch Neurol 38:302–306, 1981

    • Search Google Scholar
    • Export Citation
  • 4.

    Cawthorne T, , Dott NM, & Gaylor JB: Facial pain. Proc R Soc Med 44:10331038, 1951 Cawthorne T, Dott NM, Gaylor JB: Facial pain. Proc R Soc Med 44:1033–1038, 1951

    • Search Google Scholar
    • Export Citation
  • 5.

    Celander O, & Folkow B: The nature and distribution of afferent fibres provided with the axon reflex arrangement. Acta Physiol Scand 29:359370, 1953 Celander O, Folkow B: The nature and distribution of afferent fibres provided with the axon reflex arrangement. Acta Physiol Scand 29:359–370, 1953

    • Search Google Scholar
    • Export Citation
  • 6.

    Ekbom KA: Ergotamine tartrate orally in Horton's “histaminic cephalgia” (also called Harris's “ciliary neuralgia”); new method of treatment. Acta Psychiatr Neurol Suppl 46:105113, 1947 Ekbom KA: Ergotamine tartrate orally in Horton's “histaminic cephalgia” (also called Harris's “ciliary neuralgia”); new method of treatment. Acta Psychiatr Neurol Suppl 46:105–113, 1947

    • Search Google Scholar
    • Export Citation
  • 7.

    Ekbom KA: Lithium for cluster headache: review of the literature and preliminary results of long-term treatment. Headache 21:132139, 1981 Ekbom KA: Lithium for cluster headache: review of the literature and preliminary results of long-term treatment. Headache 21:132–139, 1981

    • Search Google Scholar
    • Export Citation
  • 8.

    Ekbom KA: Migraine in patients with cluster headache. Headache 14:6972, 1974 Ekbom KA: Migraine in patients with cluster headache. Headache 14:69–72, 1974

    • Search Google Scholar
    • Export Citation
  • 9.

    Ekbom KA, & Olivarius BD: Chronic migrainous neuralgia—diagnostic and therapeutic aspects. Headache 11:97101, 1971 Ekbom KA, Olivarius BD: Chronic migrainous neuralgia—diagnostic and therapeutic aspects. Headache 11:97–101, 1971

    • Search Google Scholar
    • Export Citation
  • 10.

    Friedman AP, & Losin S: Evaluation of UML-491 in the treatment of vascular headaches. Arch Neurol 4:241245, 1961 Friedman AP, Losin S: Evaluation of UML-491 in the treatment of vascular headaches. Arch Neurol 4:241–245, 1961

    • Search Google Scholar
    • Export Citation
  • 11.

    Friedman AP, & Mikropoulos HE: Cluster headaches. Neurology 8:653663, 1958 Friedman AP, Mikropoulos HE: Cluster headaches. Neurology 8:653–663, 1958

    • Search Google Scholar
    • Export Citation
  • 12.

    Gardner WJ, , Stowell A, & Dutlinger R: Resection of the greater superficial petrosal nerve in the treatment of unilateral headache. J Neurosurg 4:105114, 1947 Gardner WJ, Stowell A, Dutlinger R: Resection of the greater superficial petrosal nerve in the treatment of unilateral headache. J Neurosurg 4:105–114, 1947

    • Search Google Scholar
    • Export Citation
  • 13.

    Harris W: Ciliary (migrainous) neuralgia and its treatment. Br Med J 1:457460, 1936 Harris W: Ciliary (migrainous) neuralgia and its treatment. Br Med J 1:457–460, 1936

    • Search Google Scholar
    • Export Citation
  • 14.

    Harris W: Neuritis and Neuralgia. London: Oxford University Press, 1926, 418 pp Harris W: Neuritis and Neuralgia. London: Oxford University Press, 1926, 418 pp

    • Search Google Scholar
    • Export Citation
  • 15.

    Heyck H: Headache and Facial Pain. Differential Diagnosis. Pathogenesis. Treatment. Chicago/London: Year Book Medical, 1981, p 274 Heyck H: Headache and Facial Pain. Differential Diagnosis. Pathogenesis. Treatment. Chicago/London: Year Book Medical, 1981, p 274

    • Search Google Scholar
    • Export Citation
  • 16.

    Horton BT: Histaminic cephalgia (Horton's headache or syndrome). Maryland Med J 10:178203, 1961 Horton BT: Histaminic cephalgia (Horton's headache or syndrome). Maryland Med J 10:178–203, 1961

    • Search Google Scholar
    • Export Citation
  • 17.

    Horton BT: The use of histamine in the treatment of specific types of headaches. JAMA 116:377383, 1941 Horton BT: The use of histamine in the treatment of specific types of headaches. JAMA 116:377–383, 1941

    • Search Google Scholar
    • Export Citation
  • 18.

    Horton BT, , McLean AR, & Craig WM: New syndrome of vascular headache: results of treatment with histamine: preliminary report. Mayo Clin Proc 14:257260, 1939 Horton BT, McLean AR, Craig WM: New syndrome of vascular headache: results of treatment with histamine: preliminary report. Mayo Clin Proc 14:257–260, 1939

    • Search Google Scholar
    • Export Citation
  • 19.

    Jammes JL: The treatment of cluster headaches with prednisone. Dis Nerv Syst 36:375376, 1975 Jammes JL: The treatment of cluster headaches with prednisone. Dis Nerv Syst 36:375–376, 1975

    • Search Google Scholar
    • Export Citation
  • 20.

    Kiernan JA: The involvement of mast cells in vasodilatation due to axon reflexes in injured skin. Q J Exp Physiol 57:311317, 1972 Kiernan JA: The involvement of mast cells in vasodilatation due to axon reflexes in injured skin. Q J Exp Physiol 57:311–317, 1972

    • Search Google Scholar
    • Export Citation
  • 21.

    Kudrow L: Comparative results of prednisone, methysergide and lithium therapy in cluster headache, in Green R (ed): Current Concepts in Migraine Research. New York: Raven Press, 1978, pp 159163 Kudrow L: Comparative results of prednisone, methysergide and lithium therapy in cluster headache, in Green R (ed): Current Concepts in Migraine Research. New York: Raven Press, 1978, pp 159–163

    • Search Google Scholar
    • Export Citation
  • 22.

    Kudrow L: Lithium prophylaxis for chronic cluster headache. Headache 17:1518, 1977 Kudrow L: Lithium prophylaxis for chronic cluster headache. Headache 17:15–18, 1977

    • Search Google Scholar
    • Export Citation
  • 23.

    Kunkel RS, & Dohn DF: Surgical treatment of chronic migrainous neuralgia. Cleve Clin Q 41:189192, 1974 Kunkel RS, Dohn DF: Surgical treatment of chronic migrainous neuralgia. Cleve Clin Q 41:189–192, 1974

    • Search Google Scholar
    • Export Citation
  • 24.

    Kunkle EC, , Pfeiffer JB Jr, & Wilhoit WM, et al: Recurrent brief headache in “cluster” pattern. Trans Am Neurol Assoc 77:240243, 1952 Kunkle EC, Pfeiffer JB Jr, Wilhoit WM, et al: Recurrent brief headache in “cluster” pattern. Trans Am Neurol Assoc 77:240–243, 1952

    • Search Google Scholar
    • Export Citation
  • 25.

    Mathew NT: Clinical subtypes of cluster hadache and response to lithium therapy. Headache 18:2630, 1978 Mathew NT: Clinical subtypes of cluster hadache and response to lithium therapy. Headache 18:26–30, 1978

    • Search Google Scholar
    • Export Citation
  • 26.

    Mathew NT: Indomethacin responsive headache syndromes. Headache 21:147150, 1981 Mathew NT: Indomethacin responsive headache syndromes. Headache 21:147–150, 1981

    • Search Google Scholar
    • Export Citation
  • 27.

    McArdle MJ: Variant of migraine, in Smith R (ed): Second Migraine Symposium, London, 1967. Proceedings. London: William Heinemann, 1967, pp 19 McArdle MJ: Variant of migraine, in Smith R (ed): Second Migraine Symposium, London, 1967. Proceedings. London: William Heinemann, 1967, pp 1–9

    • Search Google Scholar
    • Export Citation
  • 28.

    Nugent GR, & Berry B: Trigeminal neuralgia treated by differential percutaneous radiofrequency coagulation of the Gasserian ganglion. J Neurosurg 40:517523, 1974 Nugent GR, Berry B: Trigeminal neuralgia treated by differential percutaneous radiofrequency coagulation of the Gasserian ganglion. J Neurosurg 40:517–523, 1974

    • Search Google Scholar
    • Export Citation
  • 29.

    Onofrio BM: Radiofrequency percutaneous Gasserian ganglion lesions. Results in 140 patients with trigeminal pain. J Neurosurg 42:132139, 1974 Onofrio BM: Radiofrequency percutaneous Gasserian ganglion lesions. Results in 140 patients with trigeminal pain. J Neurosurg 42:132–139, 1974

    • Search Google Scholar
    • Export Citation
  • 30.

    Pearce JMS: Chronic migrainous neuralgia. A variant of cluster headache. Brain 103:149159, 1980 Pearce JMS: Chronic migrainous neuralgia. A variant of cluster headache. Brain 103:149–159, 1980

    • Search Google Scholar
    • Export Citation
  • 31.

    Peatfield RC: Lithium in migraine and cluster headache: a review. J R Soc Med 74:432436, 1981 Peatfield RC: Lithium in migraine and cluster headache: a review. J R Soc Med 74:432–436, 1981

    • Search Google Scholar
    • Export Citation
  • 32.

    Peatfield RC, & Rose FC: Treatment of migraine and cluster headache. Practitioner 225:13211325, 1981 Peatfield RC, Rose FC: Treatment of migraine and cluster headache. Practitioner 225:1321–1325, 1981

    • Search Google Scholar
    • Export Citation
  • 33.

    Rhoton AL Jr, , Maniscaico JE, & Hoagland HV, et al: Percutaneous stereotaxic radiofrequency lesions for trigeminal neuralgia. J Fla Med Assoc 64:488493, 1977 Rhoton AL Jr, Maniscaico JE, Hoagland HV, et al: Percutaneous stereotaxic radiofrequency lesions for trigeminal neuralgia. J Fla Med Assoc 64:488–493, 1977

    • Search Google Scholar
    • Export Citation
  • 34.

    Rooke ED, , Rushton JG, & Peters GA: Vasodilating headache: a suggested classification and results of prophylactic treatment with UML 491 (methysergide). Mayo Clin Proc 37:433443, 1962 Rooke ED, Rushton JG, Peters GA: Vasodilating headache: a suggested classification and results of prophylactic treatment with UML 491 (methysergide). Mayo Clin Proc 37:433–443, 1962

    • Search Google Scholar
    • Export Citation
  • 35.

    Sjaastad O, , Egge K, & Hørven I, et al: Chronic paroxysmal hemicrania; mechanical precipitation of attacks. Headache 19:3136, 1979 Sjaastad O, Egge K, Hørven I, et al: Chronic paroxysmal hemicrania; mechanical precipitation of attacks. Headache 19:31–36, 1979

    • Search Google Scholar
    • Export Citation
  • 36.

    Sweet WH, & Wepsic JG: Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers. Part 1: Trigeminal neuralgia. J Neurosurg 40:143156, 1974 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

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 421 62 7
Full Text Views 190 1 0
PDF Downloads 78 2 0
EPUB Downloads 0 0 0