Branches of Trigeminal Nerve Causing Idiopathic Trigeminal Neuralgia and Effectiveness of Microvascular Decompression for Immediate Pain Relief (original) (raw)
Related papers
A Clinical Study in Cases of Trigeminal Neuralgia and Microvascular Decompression
2021
Trigeminal neuralgia is one of the most painful conditions affecting area of face supplied by trigeminal nerve, which has a major impact on quality of life. There are few reports of trigeminal neuralgia in oriental population. The objective of this study is to evaluate of important clinical factors about trigeminal neuralgia and analysis of outcome after micro vascular decompression. This study includes 150 cases of trigeminal neuralgia treated with micro vascular decompression in VSGH and SVP hospital, Ahmedabad over the period of 10 years. In this study, the peak incidence of Trigeminal neuralgia was in 50-69 age groups with male preponderance (male-female ratio- 1.17:1). Most common complaint was typical trigeminal neuralgic pain along one side of face over a period of 2-5 years. The right side of face and V2+V3 segment of trigeminal nerve was involved more commonly. Intraoperatively, an arterial loop compressing trigeminal nerve was found in 90% of the patients. Duration of post...
Results of Microvascular Decompression Surgery in the Treatment of Trigeminal Neuralgia
2021
INTRODUCTION: Trigeminal neuralgia (TN) develops as a result of the trigger of one or more branches of the trigeminal nerve by stimuli. Most cases of TN are usually caused by compression of the trigeminal nerve root, within a few millimeters from its exit from the pons. In this study, we aimed to present our experience regarding the microvascular decompression surgical approach and its results in the treatment of patients who applied to the clinic with a diagnosis of TN and who did not respond to any of the treatments. METHODS: Microvascular decompression (MVD) surgery was performed on a total of 7 patients with TN who applied to the clinic between 2020 and 2021, and the information of the patients was retrospectively evaluated using surgery reports, epicrisis, and magnetic resonance images (MRI). RESULTS: It was observed that all 7 patients with TN were initially administrated carbamazepine and/or oxcarbazepine, implemented radiofrequency thermocoagulation treatment and gamma knife radiosurgery. Subsequently, all the patients underwent MVD surgery. No complications developed in the postoperative period and complaints of TN in all patients completely resolved in the early period. DISCUSSION AND CONCLUSION: In patients who are unresponsive to treatments, thin-section 2
Clinical presentation of trigeminal neuralgia and the rationale of microvascular decompression
Neurological Sciences, 2008
Among the facial pain syndromes, trigeminal neuralgia has a special position for many reasons. Already described in the Romans age, the specific features of its severe symptoms, the therapeutic debate and the recent curative possibilities, make this complex pain syndrome a unique entity. The clinical onset is predominantly unilateral and is described as an electric, lancinating, focal and sharp pain. It can last seconds to minutes initially, and sometimes can last as long as 1 hour. Usually the patient is symptom-free between attacks. Later in the course of the disease, patients report dull, aching, constant pain in the same distribution as the paroxysms. The pain can be triggered by non-noxious stimuli like chewing, talking, swallowing, wind on the face, cold and light touch. Thought to be attributable to fifth cranial nerve dysfunction, the first surgical attempts aimed to interrupt nerve continuity by means of a rizothomy, with disappearance of both pain and sensory disturbances. Further investigations claimed nerve compression by vascular structures as responsible of nervous dysfunction. Hence the attempt to perform a decompression in order to relieve the symptoms and maintain physiologic nerve function. From the successful attempts of first microvascular decompression descends the now standardised and widespread technique that is commonly used today to treat trigeminal neuralgia.
Long-Term Follow-Up of Microvascular Decompression for Trigeminal Neuralgia
Skull Base, 2011
We conducted a study to evaluate the follow-up characteristics of patients with trigeminal neuralgia (TN) and to evaluate the factors affecting long-term outcome of microvascular decompression (MVD) in TN. Between 1983 and 2003, 156 patients with TN treated with MVD by 4 neurosurgeons at University Medical Centre Groningen/the Netherlands were evaluated. Baseline data from operative outcome were evaluated using univariate and multivariate analysis. The group consisted of 156 patients with TN: 90 females and 66 males with a median follow-up period of 9.7 years. The average age of initial symptoms was 51 years. The average duration of symptoms was 58 months. Postoperative 22 patients had a facial hyperpathia or hyperesthesia. Postoperatively, 137 patients had immediate relief. Postoperatively 1 year, 140 patients still had a good outcome of the operation. Twenty-seven patients with good immediate postoperative results had recurrent pain. From the group of patients with typical TN, 82% had good long-term results after operation. Patients with typical TN and immediate postoperative remission, in univariate analysis, had significantly more often an excellent/good postoperative outcome. Immediate postoperative remission is an independent predictive factor for a good longterm outcome. The long-term results of MVD in majority of patients were good with no mortalities and no major morbidities. Patients with typical TN had better long-term outcomes and less recurrence.
Long-term follow-up of microvascular decompression for management of trigeminal neuralgia
Egyptian Journal of Neurosurgery, 2022
Background: Trigeminal neuralgia (TN) is mostly caused by neurovascular compression of the trigeminal nerve and the root entry zone at the brain stem. Microvascular decompression (MVD) has been established as a standard treatment for trigeminal neuralgia in patients not adequately controlled by medications. Objectives: Reporting the long-term outcome of MVD in our group of patients with follow-up period equal to or more than five years. Patients and methods: Twenty-one patients operated by MVD for TN were followed up for at least five years, they were evaluated describing the patient criteria and operative findings, complications, and the long-term clinical outcome. Results: Sixteen of the twenty-one patients had complete pain relief maintained for up to five years and three of them up to eight years. Two patients had significant improvement but with mild occasional pain not requiring medications only one of them had his occasional pain maintained till five years, three patients experienced persistent pain which was still there after five years one of them showed mild improvement in his pain after one year of follow-up. Complications were mild and/or transient most frequent were headache nausea and dizziness. Conclusion: In the long-term follow-up, microvascular decompression still maintains its clinical benefit with most patients still pain free after at least five years and up to eight years. It is safe procedures and should be considered in every patient with failed medical treatment.
Outcome of medical and surgical management in intractable idiopathic trigeminal neuralgia
2009
Background: The neurovascular conflict in trigeminal neuralgia is an intractable condition; medical treatment is usually of long duration and can be annoying for both patients and clinicians. Aim: This prospective study was designed to assess the outcome of microvascular decompression (MVD) in patients with more than 3 years' history of intractable idiopathic trigeminal neuralgia (TN) and poor response to drugs. Materials and Methods: Twenty-one patients (8 females and 13 males) with intractable idiopathic TN (group 1) underwent MVD and were followed up for 2 years. Group 2 (n = 15), which included 6 females and 9 males, received pharmacotherapy. The outcome responses of pain relief were evaluated using a 10-cm visual analog scale (VAS) and the Barrow Neurological Institute (BNI) scoring system. The patients' morbidity was recorded as well. Results: All patients fulfilling the inclusion criteria were offered MVD surgery. Freedom from pain was achieved immediately after surge...
Journal of Neurosurgery, 2007
Object. The purpose of this study was to evaluate the long-term efficacy of microvascular decompression (MVD) and to identify the factors affecting outcome in patients treated for primary trigeminal neuralgia (TN). Only the cases with a clear-cut neurovascular conflict (vascular contact and/or compression of the root entry zone of the trigeminal nerve) found at surgery and treated with "pure" MVD (decompression of the root without any additional lesioning or cutting of the adjacent rootlets) were retained. Methods. The study included 362 patients who were followed up over a period of 1 to 18 years (median follow-up 7.2 years). A Kaplan-Meier survival analysis was generated at 1 and 15 years of follow-up for all of the considered factors. According to Kaplan-Meier analysis, the success rate (defined as pain-free patients without any medication) was 91% at 1 year and estimated to be 73.38% after 15 years of follow-up. Results. None of the following patient-related factors played any significant role in prognosis: sex, patient age at surgery, history of systemic hypertension, duration of neuralgia before surgery, or history of failed trigeminal surgery. Patients with atypical neuralgia (a baseline of permanent pain) had the same outcome as those with a typical (purely spasmodic) presentation. In addition, the side and topography of the trigeminal nerve did not play a role, whereas involvement of all three divisions of the nerve had a negative effect on outcome. Concerning anatomical factors, neither the type of the compressive vessel nor its location along or around the root was found to be significant. However, the severity of compression was important-the more severe the degree of compression, the better the outcome (p = 0.002). The authors also found that presence of focal arachnoiditis had a negative influence on outcome (p = 0.002). Conclusions. Pure MVD can offer patients affected by a primary TN a 73.38% probability of long-term (15 years) cure of neuralgia. The presence of a clear-cut and marked vascular compression at surgery (and possibly-although not yet reliably-on preoperative magnetic resonance imaging) is the guarantee of a higher than 90% success rate.
MNJ (Malang Neurology Journal), 2021
Background: Trigeminal Neuralgia is a common condition of facial pain and its significantly affect patients’ daily life. Microvascular decompression is one of the interventional pain management for trigeminal neuralgia. There is still a little data obtained on evaluation of facial pain after microvascular decompression in Indonesia. Objective: This research aimed to evaluate facial pain after microvascular decompression of trigeminal neuralgia patients in Dr. Soetomo General Hospital, PHC Hospital, and Bangil General Hospital, Indonesia. Methods: The research design was a pretest-posttest with total sampling. Data were obtained from medical records from January 2018 until June 2019. Researches used Numeric Rating Scale (NRS) as pain measurement. The data obtained were analyzed by descriptive statistical test, normality test, and paired t-test. Results: Trigeminal Neuralgia patients that has been treated with microvascular decompression have an average facial reduction from 7.33±2.29...
Surgical neurology international, 2016
In this article, the authors described their experience in microvascular decompression for trigeminal neuralgia. The microvascular decompression technique used in the authors' institution is described in a step by step manner with some illustrative cases as well as a cadaver dissection to highlight the differences with other previously described techniques. Since 2013, 107 patients were operated in the Neurosurgery Division of the University of São Paulo using the described technique, with a shorter operative time and avoiding cerebellar retractor compared with classic techniques. Our modified microvascular decompression technique for trigeminal neuralgia can be used with safety and efficiency for treating trigeminal neuralgia.