Trigeminal neuralgia and pain related to multiple sclerosis
G. CruccuA. BiasiottaS. Di RezzeMarco FiorelliF. GaleottiP. InnocentiS. MameliEnrico MillefioriniAndrea Truini
176
Citation
38
Reference
10
Related Paper
Citation Trend
Abstract:
Although many patients with multiple sclerosis (MS) complain of trigeminal neuralgia (TN), its cause and mechanisms are still debatable. In a multicentre controlled study, we collected 130 patients with MS: 50 patients with TN, 30 patients with trigeminal sensory disturbances other than TN (ongoing pain, dysaesthesia, or hypoesthesia), and 50 control patients. All patients underwent pain assessment, trigeminal reflex testing, and dedicated MRI scans. The MRI scans were imported and normalised into a voxel-based, 3D brainstem model that allows spatial statistical analysis. The onset ages of MS and trigeminal symptoms were significantly older in the TN group. The frequency histogram of onset age for the TN group showed that many patients fell in the age range of classic TN. Most patients in TN and non-TN groups had abnormal trigeminal reflexes. In the TN group, 3D brainstem analysis showed an area of strong probability of lesion (P<0.0001) centred on the intrapontine trigeminal primary afferents. In the non-TN group, brainstem lesions were more scattered, with the highest probability for lesions (P<0.001) in a region involving the subnucleus oralis of the spinal trigeminal complex. We conclude that the most likely cause of MS-related TN is a pontine plaque damaging the primary afferents. Nevertheless, in some patients a neurovascular contact may act as a concurring mechanism. The other sensory disturbances, including ongoing pain and dysaesthesia, may arise from damage to the second-order neurons in the spinal trigeminal complex.Keywords:
Hypoesthesia
Trigeminal Nerve
Spinal trigeminal nucleus
Hypoesthesia
Cite
Citations (1)
Cerebellopontine angle lipomas are benign mass lesions and rarely result trigeminal neuralgia. A 61-year-old male with right-sided trigeminal neuralgia in V2 and V3 divisions without sensory disturbances is reported in the article. MRI revealed mass lesion 11´11´4 mm on the lateral pontine surface spreading to the right trigeminal nerve root entry zone. No signs of neurovascular compression were found. Microsurgical exploration of the cerebellopontine angle showed a fatty mass adherent to the brainstem with incorporation of inferior part of trigeminal nerve root. Fatty tissue resection was followed by partial sensory trigeminal rhizotomy. Histological examination identified lipoma. Postoperative MRI showed small residual tissue with minimal ischemic area near trigeminal nerve root entry zone. Mild hypoesthesia within V2 and V3 trigeminal branches occurred after surgery. Trigeminal neuralgia completely resolved, and medications were discontinued. This clinical case and literature review clearly demonstrated successful elimination of trigeminal neuralgia in patients with cerebellopontine angle lipoma after resection of mass lesion and partial trigeminal rhizotomy.Липомы мостомозжечкового угла представляют собой доброкачественные объемные образования и редко сопровождаются тригеминальной невралгией. В работе представлено клиническое наблюдение правосторонней тригеминальной невралгии в области второй и третьей ветвей без чувствительных нарушений, обусловленной липомой мостомозжечкового угла у 61-летнего мужчины. При магнитно-резонансной томографии (МРТ) выявлено объемное образование размером 11×11×4 мм, расположенное на боковой поверхности моста мозга и распространяющееся на входную зону правого корешка тройничного нерва. Признаки нейроваскулярного конфликта не обнаружены. При микрохирургической эксплорации мостомозжечкового угла обнаружена сращенная со стволом головного мозга жировая ткань с вовлечением в нее нижних отделов корешка тройничного нерва. Жировая ткань резецирована с последующим проведением парциальной сенсорной тригеминальной ризотомии. При гистологическом исследовании получено заключение — липома. Послеоперационная МРТ показала наличие небольшой остаточной ткани новообразования с минимальной областью ишемических изменений вблизи входной зоны корешка тройничного нерва. После хирургического вмешательства у пациента развилась легкая гипестезия во второй и третьей ветвях тройничного нерва. Тригеминальная невралгия полностью регрессировала, лекарственная терапия отменена. Представленное клиническое наблюдение и обзор литературы показали, что успешное устранение тригеминальной невралгии, обусловленной липомой мостомозжечкового угла, достигается частичной резекцией новообразования с парциальной тригеминальной ризотомией.
Hypoesthesia
Trigeminal Nerve
Rhizotomy
Cite
Citations (2)
To evaluate the indication of subsequent operations after failed microvascular decompression (MVD) for the treatment of trigeminal neuralgia, the intraoperative findings and long-term results of 16 subsequent operations are reported.Subsequent exploration of the posterior fossa was performed for lack of pain relief (3 patients) and recurrent neuralgia (13 patients) after an average of 17 months (range, 4-62 mo). In all patients, typical arterial compression patterns at the root entry zone of the trigeminal nerve were found in the first procedure. The mean follow-up period after subsequent operation was 90 months (range, 78-104 mo).New arterial neurovascular conflicts were found in nine patients. After subsequent MVD procedures, seven patients were pain-free (with one recurrence after 6 mo), one had constant marked relief, and one was unchanged. Second exploration revealed no abnormalities in the other seven patients who experienced continued or recurrent pain; only careful neurolysis of the trigeminal nerve was performed in those patients. Initially, all seven patients obtained complete pain relief, but two experienced late recurrences after 64 and 68 months, respectively. Thus, subsequent operations failed in all 4 patients who had undergone prior destructive procedures but were successful in those 12 patients who had undergone only previous MVD. Two patients developed severe sequelae, and the other nine had minor complications, especially permanent (four patients) or transitory (three patients) ipsilateral trigeminal hypoesthesia.Subsequent MVD seems to have good long-term results. However, because of the significantly high incidence of complications, the indication for subsequent operations should be restricted to younger patients to avoid destructive procedures. In general, glycerol rhizolysis or radiofrequency rhizotomy may be the treatment of choice after failed MVD.
Hypoesthesia
Microvascular Decompression
Trigeminal Nerve
Neurolysis
Neurovascular bundle
Nerve compression syndrome
Cite
Citations (94)
To evaluate the efficacy of gasserian ganglion balloon compression in patients with trigeminal neuralgia associated with multiple sclerosis (MS).Eight patients (3 men, 5 women), aged from 46 to 66 years (mean age 55 years), with trigeminal neuralgia associated with MS underwent surgery. An average duration of the pain syndrome was 8,4 years. Six patients had previous surgeries due to facial pain. Percutaneous balloon compression of gasserian ganglion was performed to all patients. Follow up period was from 2 to 24 months.Six patients (75%) reported 100% of pain relief right after the surgery, 2 patients (25%) reported a significant decrease of pain (2-3 points on VAS). Pain recurrence occurred in 3 patients: in 4 months, in 12 months and in 6 months. All of them were operated repeatedly. After the surgery, hypoesthesia on the side of surgery was observed in all patients with a trend towards regression. There was no keratopathy or any complications.Percutaneous balloon compression of gasserian ganglion is an effective and minimally invasive method which can be performed repeatedly in patients with trigeminal neuralgia associated with MS.Цель исследования. Оценка эффективности баллонной микрокомпрессии (БМК) гассерова узла в лечении тригеминальной невралгии (ТН) у пациентов с рассеянным склерозом (РС). Материал и методы. Были прооперированы 8 пациентов (3 мужчины и 5 женщин) в возрасте от 46 до 66 лет (средний - 55 лет) с симптоматической ТН, обусловленной РС. Средняя продолжительность болевого синдрома - 8,4 года. В анамнезе 6 пациентов перенесли операции по поводу лицевых болей. Всем больным была проведена БМК гассерова узла. Катамнез составил от 2 до 24 мес. Результаты. Сразу после операции 100% эффект был достигнут у 6 (75%) больных, у 2 болевой синдром стал менее интенсивным (2-3 балла по визуальной аналоговой шкале). Рецидив болевого синдрома наблюдался в 3 случаях: через 4, 6 и 12 мес, в связи с чем пациенты были оперированы повторно. У всех больных после вмешательства отмечалось онемение половины лица с тенденцией к регрессу. Кератопатии и другие осложнения не наблюдались. Заключение. БМК гассерова узла является эффективным малоинвазивным методом лечения фармакорезистентной ТН и может неоднократно применяться у пациентов с РС при рецидиве болевого синдрома.
Hypoesthesia
Trigeminal Nerve
Trigeminal ganglion
Cite
Citations (2)
Objective To explore the value of 3.0T MR trigeminal nerve imaging in showing vascular conflicts of trigeminal nerve and evaluate it's clinical significance of etiological diagnosis of trigeminal neuralgia. Materials and Methods Collect data of 35 patients who were diagnosed as trigeminal neuralgia in our hospital from 2011.10 to 2012.10, all of them had MRI trigeminal nerve imaging examination(including T2-SPC sequence and T1-VIBE sequence). Two experts in nervous system imaging analyzed the relationship between trigeminal nerve and adjacent vessels in MRI trigeminal nerve imaging,and evaluated the relationship between vascular conflicts of trigeminal nerve and clinical symptoms. Using the SPSS 16.0 package for c2 test,P 0.05 is considered statistically significant difference. Results In the trigeminal nerve imaging,considering the 35 cases of patients with trigeminal neuralgia(unilateral pain),there were 31 cases with vascular conflicts or adjacent to trigeminal nerve in symptoms side,and 4 cases with no relationship with the blood vessels beside trigeminal nerve;there were 6 cases with vascular adjacent to trigeminal nerve in Symptomless side,and 29 cases with no relationship with the blood vessels beside. After Statistical analysis, vascular conflicts or adjacent to trigeminal nerve displayed by trigeminal nerve imaging had close relationship with trigeminal neuralgia symptoms,and there was significant statistics difference. Conclusion 3.0T MR trigeminal nerve imaging can clearly show vascular conflicts of the trigeminal nerve,with high positive rate,and it has a good correlation with the clinical symptoms. So it has played an important role in etiological diagnosis of trigeminal neuralgia.
Trigeminal Nerve
Cite
Citations (0)
OBJECTIVE: To evaluate the indication of subsequent operations after failed microvascular decompression (MVD) for the treatment of trigeminal neuralgia, the intraoperative findings and long-term results of 16 subsequent operations are reported. METHODS: Subsequent exploration of the posterior fossa was performed for lack of pain relief (3 patients) and recurrent neuralgia (13 patients) after an average of 17 months (range, 4-62 mo). In all patients, typical arterial compression patterns at the root entry zone of the trigeminal nerve were found in the first procedure. The mean follow-up period after subsequent operation was 90 months (range, 78-104 mo). RESULTS: New arterial neurovascular conflicts were found in nine patients. After subsequent MVD procedures, seven patients were pain-free (with one recurrence after 6 mo), one had constant marked relief, and one was unchanged. Second exploration revealed no abnormalities in the other seven patients who experienced continued or recurrent pain; only careful neurolysis of the trigeminal nerve was performed in those patients. Initially, all seven patients obtained complete pain relief, but two experienced late recurrences after 64 and 68 months, respectively. Thus, subsequent operations failed in all 4 patients who had undergone prior destructive procedures but were successful in those 12 patients who had undergone only previous MVD. Two patients developed severe sequelae, and the other nine had minor complications, especially permanent (four patients) or transitory (three patients) ipsilateral trigeminal hypoesthesia. CONCLUSION: Subsequent MVD seems to have good long-term results. However, because of the significantly high incidence of complications, the indication for subsequent operations should be restricted to younger patients to avoid destructive procedures. In general, glycerol rhizolysis or radiofrequency rhizotomy may be the treatment of choice after failed MVD.
Hypoesthesia
Microvascular Decompression
Trigeminal Nerve
Neurovascular bundle
Neurolysis
Cite
Citations (12)
Neurosurgical management of classical trigeminal neuralgia is based on three types of techniques: an “etiological” and nondestructive technique, microvascular decompression (MVD), which consists in decompressing the trigeminal nerve in the cerebello-pontine angle, where a vascular compression is frequently found at the origin of pain; percutaneous lesioning techniques (thermorhizotomy, microcompression by balloon, injection of glycerol), aimed at disrupting the transmission of the nociceptive message; and radiosurgery. During the consultation, the neurosurgeon will try to answer three questions: “Is this a trigeminal neuralgia?”; “Is it a classical form?”; and “Is it resistant to medical treatment?”. He will present to the patient the different surgical possibilities, emphasizing the “benefit/risk” balance, and propose the most adapted to his case. In a patient in good general condition, with a clear vascular compression at magnetic resonance imaging (MRI), it seems logical to discuss the first-line MVD, as this reference technique addresses the cause of classical trigeminal neuralgia and has a high probability level of good evolution on the long term. Radiosurgery can also be offered as an alternative because of its less invasiveness and morbidity (in particular, a very low rate of hypoesthesia compared to percutaneous techniques). A patient with an altered general condition or recurrence after MVD (without MRI residual vascular compression) may be referred for surgery or radiosurgery. Depending on the technique chosen, the patient should be informed that pain relief will often be “at the cost” of a hypoesthesia more or less pronounced. Between these two extreme and relatively easy cases, all intermediate situations are possible. In the absence of a randomized controlled study evaluating the different surgical techniques, the American Academy of Neurology and the European Federation of Neurological Societies admit that formal recommendations on surgical treatment cannot be made. However, these Scientific Societies indicate that (1) patients with an MVD have a longer pain-free period than other surgical techniques, at the cost of significant morbidity, reduced in teams with high activity in neuralgia and (2) radiosurgery is the technique with the least complication.
Hypoesthesia
Microvascular Decompression
Trigeminal Nerve
Cite
Citations (0)
Neurosurgical management of classical trigeminal neuralgia is based on three types of techniques: an “etiological” and nondestructive technique, microvascular decompression (MVD), which consists in decompressing the trigeminal nerve in the cerebello-pontine angle, where a vascular compression is frequently found at the origin of pain; percutaneous lesioning techniques (thermorhizotomy, microcompression by balloon, injection of glycerol), aimed at disrupting the transmission of the nociceptive message; and radiosurgery. During the consultation, the neurosurgeon will try to answer three questions: “Is this a trigeminal neuralgia?”; “Is it a classical form?”; and “Is it resistant to medical treatment?”. He will present to the patient the different surgical possibilities, emphasizing the “benefit/risk” balance, and propose the most adapted to his case. In a patient in good general condition, with a clear vascular compression at magnetic resonance imaging (MRI), it seems logical to discuss the first-line MVD, as this reference technique addresses the cause of classical trigeminal neuralgia and has a high probability level of good evolution on the long term. Radiosurgery can also be offered as an alternative because of its less invasiveness and morbidity (in particular, a very low rate of hypoesthesia compared to percutaneous techniques). A patient with an altered general condition or recurrence after MVD (without MRI residual vascular compression) may be referred for surgery or radiosurgery. Depending on the technique chosen, the patient should be informed that pain relief will often be “at the cost” of a hypoesthesia more or less pronounced. Between these two extreme and relatively easy cases, all intermediate situations are possible. In the absence of a randomized controlled study evaluating the different surgical techniques, the American Academy of Neurology and the European Federation of Neurological Societies admit that formal recommendations on surgical treatment cannot be made. However, these Scientific Societies indicate that (1) patients with an MVD have a longer pain-free period than other surgical techniques, at the cost of significant morbidity, reduced in teams with high activity in neuralgia and (2) radiosurgery is the technique with the least complication.
Hypoesthesia
Microvascular Decompression
Trigeminal Nerve
Cite
Citations (0)
Background: Trigeminal neuralgia is one of the most debilitating orofacial pain syndromes. It is important to clarify the source of pain because of some cases of trigeminal neuralgia associates withintracranial tumor. In such cases, it is said that there are some clinical features such as abnormal sensationin the ipsilateral division, disturbance of the other cranial nerves and so on. The purpose of this study was to investigate whether trigeminal neuralgia associated with intracranial tumor concomitants with abnormal sensations, especially hypoesthesia, and whether it can be detect with quantitative sensory testing (QST). Methods: Seven intracranial tumor patients complaining trigeminal neuralgia like symptoms (eleven divisions) and ten idiopathic trigeminal neuralgia patients (ten divisions) and ten normal control subjects (ten divisions) were enrolled in this study. Neurological examinations were undergone and electric detection threshold (EDT) and current perception threshold (CPT) were measured as QST for allpatients in initial visit. Results: Only four patients complicated abnormal sensations in STN group.Especially, patient who felt numbness in ipsilateral divisions is one in seven. QST abnormalities werenot found in the symptomatic divisions. There were no significant differences among the each group statistically. Conclusions: There is not always symptomatic findings or QST abnormalities in trigeminal neuralgia due to brain tumor. These results suggest that trigeminal neuralgia is not only a paroxysmal peripheral nerve disorder, but also that central structures may be involved.
Hypoesthesia
Trigeminal Nerve
Cite
Citations (0)
Objective:To investigate the value of blink reflex (BR) in patients with trigeminal herpes zoster. Methods:BR was determined in 18 patients with trigeminal herpes zoster in acute and recovery phases respectively.Results:BR was normal in acute stages in 11 of the patients.The latency of R1,R2 and R2′ prolonged and the amplitude decreased in 6 of the patients.The waveform of R1,R2 and R2′disappeared in the another one .Some patients of the later 7 ones had trigeminal neuralgia and hypoesthesia in the trigeminal area in recovery phase .Conclusion: BR might be abnormal in part of patients with trigeminal herpes zoster. The prognosis for patients with trigeminal herpes zoster might be estimated based on BR results.
Hypoesthesia
Trigeminal Nerve
Cite
Citations (0)