Medical Literature on Trigeminal Neuralgia 

Database Search on PubMed:  week of June 9, 2003

filtering by  Richard A. Lawhern, Ph.D.


For more resources on face pain, see my homepage: "Giving Something Back"


Companion Collection:  "Medical Literature on Trigeminal Neuropathy"


First, a word of explanation:  This article provides a collection of filtered Abstracts on trigeminal neuralgia, from the National Library of Medicine, obtained by searching PubMed at National Institutes of Health.  For readers who may not be familiar with PubMed, it is a major resource for physicians, researchers, and the public at large.  If you are a chronic pain patient or trying to support someone who is, then you may -- and should -- learn your way around in this resource by selecting the following link and running some inquiries of your own:   


Gateway to Pub Med...


The citations which follow were generated by Pub Med, at the top of a stack of almost 3700 "hits" on the term "Trigeminal Neuralgia," dated approximately between April 2002 and May 2003.  In the original Pub Med search results, titles are displayed in response to the search, and the Abstracts are hot-linked from the titles.  However, I have waded through the lot, to detect citations which seem most directly of interest and use.  My reading is not perfect.  But I've been doing this as an informed layman for about seven years, so I'll hope by this time to have reasonably good instincts.  


Each citation is organized as follows:


- Authors, if known

- "Abstract " [if the article has one] or "No Abstract - " if the only thing carried at Pub Med is a notation that the article exists.

- Journal Title, volume and date

-PMID - Pub Med ID number - a unique tracking number assigned to each citation in the Pub Med database (of over 9 million).  


For articles that seem to offer information of direct interest to face pain patients, I have downloaded and included the Abstract  with its citation description.  Titles of such abstracts are in bold print.  As you read, please be mentally prepared to see a few differences of opinion even between the so-called "experts," concerning the efficacy of treatments and even the origins of this disorder.  


When publishers send abstracts to PubMed for indexing, they are increasingly providing hot-links to on-line full-text sources for the original articles.  So far, very little of this material is actually "free".  If you're willing to pay a fee for obtaining the full text, then you may want to enter the Pub Med gateway and search for a PMID number as your target.  Links to full text, if available,  are provided along with the abstract. 


If you're living near a major University that has a medical school, you may be able to find the journal in the library and make a copy.  For lesser known journals and if you don't have a University nearby, you can take the citation to a good county library and ask whether they can obtain the item on interlibrary loan.  


Feel free to inquire if you need assistance translating this material.  Many doctors write for the consumption of other doctors, not the general public.  Email link: Richard A. Lawhern, Ph.D.   


This is one of many places to start, as you learn about trigeminal neuralgia and other facial pain syndromes.  Other resources are referenced in a collection of bookmarks found on my main page:  "Giving Something Back"


Citations and Abstracts from PubMed

1: Kalkanis SN, Eskandar EN, Carter BS, Barker FG 2nd, FG. 
Abstract -  Microvascular Decompression Surgery in the United States, 1996 to 2000: Mortality Rates, Morbidity Rates, and the Effects of Hospital and Surgeon Volumes.
Neurosurgery. 2003 Jun;52(6):1251-1262.
PMID: 12762870 [PubMed - as supplied by publisher]

Microvascular Decompression Surgery in the United States, 1996 to 2000: Mortality Rates, Morbidity Rates, and the Effects of Hospital and Surgeon Volumes.

Kalkanis SN, Eskandar EN, Carter BS, Barker FG 2nd, FG.

Neurosurgical Service, Massachusetts General Hospital, and Department of Surgery, Harvard Medical School, Boston, Massachusetts.

OBJECTIVE: Microvascular decompression (MVD) is associated with low mortality and morbidity rates at specialized centers, but many MVD procedures are performed outside such centers. We studied short-term end points after MVD in a national hospital discharge database sample. METHODS: A retrospective cohort study was performed by using the Nationwide Inpatient Sample, 1996 to 2000. RESULTS: The sample included 1326 MVD procedures for treatment of trigeminal neuralgia, 237 for treatment of hemifacial spasm, and 27 for treatment of glossopharyngeal neuralgia, performed at 305 hospitals by 277 identified surgeons. The mortality rate was 0.3%, and the rate of discharge other than to home was 3.8%. Neurological complications were coded in 1.7% of cases, hematomas in 0.5%, and facial palsies in 0.6%, with 0.4% of patients requiring ventriculostomies and 0.7% postoperative ventilation. Trigeminal nerve section was also coded for 3.4% of patients with trigeminal neuralgia, more commonly among older patients (P = 0.08), among female patients (P = 0.03), and at teaching hospitals (P = 0.02). The median annual caseloads were 5 cases per hospital (range, 1-195 cases) and 3 cases per surgeon (range, 1-107 cases). With adjustment for age, sex, race, primary insurance, diagnosis (trigeminal neuralgia versus hemifacial spasm versus glossopharyngeal neuralgia), geographic region, admission type and source, and medical comorbidities, outcomes at discharge were superior at higher-volume hospitals (P = 0.006) and with higher-volume surgeons (P = 0.02). Complications were less frequent after surgery performed at high-volume hospitals (P = 0.04) or by high-volume surgeons (P = 0.01). The rate of discharge other than to home was 5.1% for the lowest-volume-quartile hospitals, compared with 1.6% for the highest-volume-quartile hospitals. Volume and mortality rate were not significantly related, but three of the four deaths in the series followed procedures performed by surgeons who had performed only one MVD procedure that year. Length of stay (median, 3 d) and hospital volume were not significantly related. Hospital charges were slightly higher at higher-volume hospitals (P = 0.007). CONCLUSION: Although most MVD procedures in the United States are performed at low-volume centers, mortality rates remain low. Morbidity rates are significantly lower at high-volume hospitals and with high-volume surgeons.

PMID: 12762870

2: [No authors listed] 
Abstract -  Misoprostol in the treatment of trigeminal neuralgia associated with multiple sclerosis.
J Neurol. 2003 May;250(5):542-545.
PMID: 12736732 [PubMed - as supplied by publisher]

Misoprostol in the treatment of trigeminal neuralgia associated with multiple sclerosis.

Multiple sclerosis can be associated with trigeminal neuralgia which is often difficult to treat in this specific condition. We performed an open prospective trial on the efficacy and safety of the prostaglandin-E1-analogue misoprostol (600 &mgr;g per day) in the reduction of attack frequency and pain intensity in patients with refractory trigeminal neuralgia associated with multiple sclerosis. Eighteen patients completed the study period and 14 of them showed a reduction of more than 50 % in attack frequency and intensity beginning five days after treatment onset. There were only mild and transient drug related side effects in three patients. One patient stopped taking misoprostol after the study period because of severe menorrhagia. Our results suggest that misoprostol is effective and safe in the treatment of this specific type of refractory trigeminal neuralgia.

PMID: 12736732

3: Brotons A, Penarrocha M. 
Abstract -  Neurogenic pain and maxillofacial ischemic osteonecrosis. A review.
Med Oral. 2003 May-Jul;8(3):157-65.
PMID: 12730650 [PubMed - in process]

Neurogenic pain and maxillofacial ischemic osteonecrosis. A review.

Brotons A, Penarrocha M.

Unidad de Cirugia Bucal, Universidad de Valencia, C/ Gasco Oliag 1, 46010, Valencia, Spain.

Cavitary alveolar osteopathy was described as an oral disorder of infectious origin characterized by the presence of osteopathic alveolar cavity lesions of significant size though radiologically undetectable and secondary to dental extractions for chronic infectious processes of the alveolar bone of the jaws. Such cavitary alveolar osteopathy has been implicated as a common cause in the origin of idiopathic trigeminal neuralgia and atypical facial pain. The concept of cavitary alveolar osteopathy caused by ischemic necrosis of alveolar bone was introduced in 1992. Recent coagulation studies have reported ischemic alterations in alveolar bone marrow as a cause of cavitation; following tooth extraction, maxillary osteonecrosis could result from thrombosis with or without hyperfibrinolysis, which in turn would lead to obstruction of the vascular spaces - thereby compromising regional blood flow.

PMID: 12730650

4: Deseure KR, Koek W, Adriaensen HF, Colpaert FC. 
Abstract -  Continuous administration of the 5-HT1A agonist, F 13640 attenuates allodynia-like behavior in a rat model of trigeminal neuropathic pain.
J Pharmacol Exp Ther. 2003 May 2 [epub ahead of print]
PMID: 12730352 [PubMed - as supplied by publisher]

Continuous administration of the 5-HT1A agonist, F 13640 attenuates allodynia-like behavior in a rat model of trigeminal neuropathic pain.

Deseure KR, Koek W, Adriaensen HF, Colpaert FC.

University of Antwerp.

F 13640 is a recently discovered high-efficacy 5- HT1A receptor agonist that produces central analgesia through the neuroadaptive mechanisms of inverse tolerance and co-operation. In a rat model of trigeminal neuropathic pain, the chronic constriction injury of the infraorbital nerve causes allodynia-like behavior that develops within two weeks and remains stable thereafter. We report that, early after surgery during which time allodynia develops, the continuous two-week infusion of 0.63 mg/day of F 13640, inhibited the allodynia-like behavior, whereas 5 mg/day of morphine showed no significant effect. When F 13640 infusion was initiated, late after surgery when allodynia was well established, it produced an anti-allodynic effect that was apparent during the entire infusion period. In contrast, morphine infusion caused an initially marked anti-allodynic effect to which tolerance developed within the two-week infusion period. The GABA-B receptor agonist baclofen (1.06 mg/day) that has a recognized usefulness in the treatment of trigeminal neuralgia, demonstrated effectiveness in both conditions. The data are consistent with a theory of nociceptive signal transduction, as well as with earlier data, in demonstrating the neuroadaptive mechanisms of inverse tolerance and cooperation. That is, in contrast with morphine, the anti-allodynic effect induced by 5- HT1A receptor activation does not decay, but, if anything, grows with chronicity. Also, 5- HT1A receptor activation appeared to co- operate with nociceptive stimulation in, paradoxically, inducing an anti-allodynic effect. The data presented here suggest that F 13640 may perhaps offer a lasting treatment of trigeminal neuralgia.

5: Plas J. 
Abstract -  [Cranial nerve vascular compression syndromes and neurogenic hypertension]
Rozhl Chir. 2003 Mar;82(3):123-8. Review. Czech.
PMID: 12728559 [PubMed - indexed for MEDLINE]

6: Miyazono M, Inoue T, Matsushima T. 
Abstract -  [A surgical case of hemifacial spasm caused by a tortuous, enlarged, and calcified vertebral artery]
No Shinkei Geka. 2003 Apr;31(4):437-41. Japanese.
PMID: 12704826 [PubMed - in process]

7: Tamura Y, Shimano H, Kuroiwa T, Miki Y. 
Abstract -  Trigeminal neuralgia associated with a primitive trigeminal artery variant: case report.
Neurosurgery. 2003 May;52(5):1217-20.
PMID: 12699569 [PubMed - in process]

8: Carrazana E, Mikoshiba I. 
Abstract -  Rationale and evidence for the use of oxcarbazepine in neuropathic pain.
J Pain Symptom Manage. 2003 May;25(5 Suppl):S31-5.
PMID: 12694990 [PubMed - in process]

Rationale and evidence for the use of oxcarbazepine in neuropathic pain.

Carrazana E, Mikoshiba I.

Neuroscience, Clinical Development and Medical Affairs, Novartis Pharmaceuticals, East Hanover, NJ, USA

Oxcarbazepine is a second-generation antiepileptic drug (AED) with proven efficacy in managing partial epileptic seizures, with or without secondary generalization, in adults and children. The overlap between the underlying pathophysiologic mechanisms of some epilepsy models and neuropathic pain models supports the rationale for using certain AEDs in the treatment of neuropathic pain. Several AEDs have reportedly produced analgesia in a range of neuropathic pains, including painful diabetic neuropathy (PDN) and post-herpetic neuralgia. Increasing evidence suggests that oxcarbazepine can provide significant analgesia in several neuropathic pain conditions, including trigeminal neuralgia and PDN, and is also may be effective in treating neuropathic pain refractory to other AEDs, such as carbamazepine and gabapentin. The analgesic effects of oxcarbazepine, and its generally improved safety and tolerability profile compared with other standard AEDs, suggests that oxcarbazepine will be an important addition to the neuropathic pain armamentarium. The rationale and evidence to support the efficacy of oxcarbazepine are presented here.

PMID: 12694990

9: Chong MS, Bajwa ZH. 
Abstract -  Diagnosis and treatment of neuropathic pain.
J Pain Symptom Manage. 2003 May;25(5 Suppl):S4-S11.
PMID: 12694987 [PubMed - in process]

Diagnosis and treatment of neuropathic pain.

Chong MS, Bajwa ZH.

Department of Neurology, King's College Hospital, London, and The Medway Hospital, Gillingham, Kent, UK

Currently, no consensus on the optimal management of neuropathic pain exists and practices vary greatly worldwide. Possible explanations for this include difficulties in developing agreed diagnostic protocols and the coexistence of neuropathic, nociceptive and, occasionally, idiopathic pain in the same patient. Also, neuropathic pain has historically been classified according to its etiology (e.g., painful diabetic neuropathy, trigeminal neuralgia, spinal cord injury) without regard for the presumed mechanism(s) underlying the specific symptoms. A combined etiologic/mechanistic classification might improve neuropathic pain management. The treatment of neuropathic pain is largely empirical, often relying heavily on data from small, generally poorly-designed clinical trials or anecdotal evidence. Consequently, diverse treatments are used, including non-invasive drug therapies (antidepressants, antiepileptic drugs and membrane stabilizing drugs), invasive therapies (nerve blocks, ablative surgery), and alternative therapies (e.g., acupuncture). This article reviews the current and historical practices in the diagnosis and treatment of neuropathic pain, and focuses on the USA, Europe and Japan.

PMID: 12694987

10: Fehr J. 
No Abstract -  [A different headache]
Schweiz Rundsch Med Prax. 2003 Mar 19;92(12):558-61. German. No Abstract -  available.
PMID: 12693148 [PubMed - indexed for MEDLINE]

11: Huang E, Teh BS, Zeck O, Woo SY, Lu HH, Chiu JK, Butler EB, Gormley WB, Carpenter LS. 
Abstract -  Gamma knife radiosurgery for treatment of trigeminal neuralgia in multiple sclerosis patients.
Stereotact Funct Neurosurg. 2002;79(1):44-50.
PMID: 12677104 [PubMed - indexed for MEDLINE]

Gamma knife radiosurgery for treatment of trigeminal neuralgia in multiple sclerosis patients.

Huang E, Teh BS, Zeck O, Woo SY, Lu HH, Chiu JK, Butler EB, Gormley WB, Carpenter LS.

Baylor College of Medicine, Houston, Tex 77030, USA.

BACKGROUND: Trigeminal neuralgia is a paroxysmal pain syndrome commonly associated with multiple sclerosis. While gamma knife radiosurgery has been shown to be an effective treatment for most cases of trigeminal neuralgia, it is considered to be less efficacious in patients with multiple sclerosis and less viable as a treatment option. METHODS: Seven patients with multiple-sclerosis-associated trigeminal neuralgia were identified from 50 consecutive patients treated for trigeminal neuralgia at the Memorial-Hermann Gamma Knife Radiosurgery Center. A Leksell gamma knife was used to deliver 80 or 90 Gy to a single 4-mm isocenter targeting the fifth nerve root entry zone into the pons. The patients were followed for a median period of 28 months and graded on a scale of 1 to 5, adopted from the Barrow Neurological Institute. RESULTS: All 7 patients showed excellent responses to radiosurgery with complete resolution of their pain and cessation of pain medications. The time to maximal response varied from 1 day to 8 months after treatment. The only complication was persistent facial numbness over the distribution of V2 and V3 which occurred in 4 patients. One patient experienced a recurrence of pain (grade 3) 24 months after radiation treatment, and she is currently being treated with carbamazepine. CONCLUSIONS: Gamma knife radiosurgery is an effective treatment option for trigeminal neuralgia patients with multiple sclerosis. These patients should be informed that there appears to be a higher incidence of facial numbness and that a longer period of several months should be allowed before the full effects of treatment may be observed as compared to the general population. Copyright 2002 S. Karger AG, Basel

PMID: 12677104

12: Cheshire WP. 
No Abstract -  Trigeminal neuralgia feigns the terrorist.
Cephalalgia. 2003 Apr;23(3):230. No Abstract -  available.
PMID: 12662192 [PubMed - in process]

13: Pollock JR, Akinwunmi J, Scaravilli F, Powell MP. 
Abstract -  Transcranial surgery for pituitary tumors performed by sir victor horsley.
Neurosurgery. 2003 Apr;52(4):914-26.
PMID: 12657189 [PubMed - in process]

14: Hannerz J, Linderoth B. 
Abstract -  Neurosurgical treatment of short-lasting, unilateral, neuralgiform hemicrania with conjunctival injection and tearing.
Headache. 2003 Apr;43(4):429.
PMID: 12656740 [PubMed - in process]

15: Tang BH. 
No Abstract -  Trigeminal neuralgia.
J Neurosurg. 2003 Mar;98(3):647; author reply 647-8. No Abstract -  available.
PMID: 12650444 [PubMed - indexed for MEDLINE]

16: Fukuda H, Ishikawa M, Okumura R. 
Abstract -  Demonstration of neurovascular compression in trigeminal neuralgia and hemifacial spasm with magnetic resonance imaging: comparison with surgical findings in 60 consecutive cases.
Surg Neurol. 2003 Feb;59(2):93-9; discussion 99-100.
PMID: 12648904 [PubMed - indexed for MEDLINE]

Demonstration of neurovascular compression in trigeminal neuralgia and hemifacial spasm with magnetic resonance imaging: comparison with surgical findings in 60 consecutive cases.

Fukuda H, Ishikawa M, Okumura R.

Department of Neurological Surgery and Radiology, Kitano Hospital, Osaka, Japan

BACKGROUND: Until recently, it has been impossible to demonstrate vascular compression at the root entry or exit zone (REZ) of the trigeminal nerve and facial nerve in patients with trigeminal neuralgia (TN) and hemifacial spasm (HFS) preoperatively, although surgical findings have revealed apparent neurovascular compression and its correction has resulted in a good outcome in most cases. Revealing the anatomic correlation between nerves and vessels at the REZ preoperatively would be useful to predict operative findings. METHODS: To assess whether the vascular contact of the nerve at the REZ could be demonstrated preoperatively, high-resolution magnetic resonance tomographic angiography (MRTA) was performed in 21 patients with TN and 39 with HFS. Neuroradiological findings were compared with the operative findings in all patients. Contralateral asymptomatic nerves were evaluated as a control. RESULTS: MRTA correctly identified offending vessels in 14 (67%) of the 21 TN and 34 (87%) of the 39 HFS patients. Failure to identify neurovascular contact was noted in the cases with compression by veins or small arteries, thickened arachnoid, or distal compression. Neurovascular contact was also observed in 15% of the asymptomatic nerves. The deformity of the nerve seemed to be a more important factor for determining operative indication. CONCLUSIONS: MRTA could demonstrate offending vessels in TN and HFS at a high rate and was useful to predict operative findings. MRTA gave supportive evidence of surgical indications in patients with TN and HFS, although attention should be paid to the fact that MRTA did not necessarily detect all of the offending vessels.

PMID: 12648904

17: Song SJ, Wen SQ, Huang JZ. 
Abstract -  [Serum levels of soluble intercellular adhesion molecule-1 in patients with cerebral infarct]
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2003 Feb;32(1):56-8. Chinese.
PMID: 12640712 [PubMed - indexed for MEDLINE]

18: Chakraborty A, Bavetta S, Leach J, Kitchen N. 
Abstract -  Trigeminal neuralgia presenting as Chiari I malformation.
Minim Invasive Neurosurg. 2003 Feb;46(1):47-9.
PMID: 12640584 [PubMed - indexed for MEDLINE]

19: Turner CL, Mendoza N, Illingworth RD, Kirkpatrick PJ. 
Abstract -  Measurement of pulse pressure profiles in patients with trigeminal neuralgia.
J Neurol Neurosurg Psychiatry. 2003 Apr;74(4):533-5.
PMID: 12640085 [PubMed - indexed for MEDLINE]

Measurement of pulse pressure profiles in patients with trigeminal neuralgia.

Turner CL, Mendoza N, Illingworth RD, Kirkpatrick PJ.

Academic Department of Neurosurgery, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK.

Applanation tonometry is a non-invasive method of assessing the arterial blood pressure profiles in both the peripheral and systemic circulation. In this study the authors examined whether there were differences in these profiles in patients with trigeminal neuralgia. The carotid artery and derived aortic blood pressure waveforms were obtained using a pulse wave analysis system. The ratio of the pressure wave amplitude above the systolic shoulder to the total systolic blood pressure (augmentation index, AIx) was recorded. Thirty two patients with trigeminal neuralgia (16 male and 16 female) and 100 controls (50 male and 50 female) were recruited. Eleven patients had been treated by microvascular decompression, mean (SD) time from surgery 17 (24) months (range 3-86 months). For the patients with trigeminal neuralgia, the right and left carotid artery AIxs (mean (SD)) were 120.6 (21.7)% and 120.7 (19.1)% respectively. Corresponding values for the control group were 120.5 (19.3)% and 120.9 (19.5)%. The calculated AIx for the ascending aorta was 27.7 (10.1)% and 27.2 (10.5)% for the patients with trigeminal neuralgia and controls respectively. No significant differences were seen in either the right or left carotid artery (p=0.5 and p=0.6 respectively) or the derived ascending aorta (p=0.8). The results show that there does not seem to be a generalised increase in arterial stiffness in patients with trigeminal neuralgia.

Publication Types:

* Clinical Trial
* Controlled Clinical Trial

PMID: 12640085

20: Rainov NG, Heidecke V. 
Abstract -  Motor cortex stimulation for neuropathic facial pain.
Neurol Res. 2003 Mar;25(2):157-61. Review.
PMID: 12635515 [PubMed - indexed for MEDLINE]

Motor cortex stimulation for neuropathic facial pain.

Rainov NG, Heidecke V.

University of Liverpool, Department of Neurological Science, Walton Centre for Neurology and Neurosurgery NHS Trust, Clinical Sciences Centre for Research and Education, Lower Lane, Liverpool L9 7LJ, UK.

Facial neuralgia is the last common pathway for a variety of pathological conditions with different etiology. Neuropathic facial pain is often refractory to routine medical or surgical treatments. We present here a long-term follow-up of two patients with unilateral facial neuropathic pain due to idiopathic trigeminal neuropathy or to surgical trauma to the glossopharyngeal nerve, respectively. These patients have been treated by other modalities for several years without obtaining satisfactory pain relief. Electrical stimulation of the motor cortex (MCS) with a quadripolar electrode contralateral to the painful area of the face was attempted in both cases for control of the facial pain, and resulted in immediate analgesia with more than 50% pain reduction. During a follow-up period of 72 months, a sufficient (> 50%) and stable analgesic effect of MCS was observed. These cases are discussed and the recent literature on MCS is reviewed in an attempt to identify indications for MCS as well as key structures in the brain for mediating the MCS effect.

Publication Types:

* Review
* Review of Reported Cases

PMID: 12635515

21: Lee ST, Chen JF. 
Abstract -  Percutaneous trigeminal ganglion balloon compression for treatment of trigeminal neuralgia--part I: pressure recordings.
Surg Neurol. 2003 Jan;59(1):63-6; discussion 66-7.
PMID: 12633968 [PubMed - indexed for MEDLINE]

Percutaneous trigeminal ganglion balloon compression for treatment of trigeminal neuralgia--part I: pressure recordings.

Lee ST, Chen JF.

Department of Neurosurgery, Chang Gung University & Memorial Hospital, 5 Fu-Shing Street, 333 Kweishan, Taoyuan, Taiwan.

BACKGROUND: The purpose of this study was to establish standards for the pressure monitoring system and to define the pressure pattern during percutaneous trigeminal ganglion compression for treatment of trigeminal neuralgia. METHODS: Seventy-five patients with intractable trigeminal neuralgia who underwent percutaneous trigeminal ganglion balloon compression were included in this study. A computerized pressure system was used for pressure monitoring and analysis. RESULTS: The procedural pressure patterns of the balloon opening pressure and the initial compression pressure were identified. On average, the balloon opening pressure was 2956 +/- 185 mm Hg in Meckel's cave (area 2) and it was much higher than that outside the foramen ovale (area 1, 2402 +/- 172 mm g), or in the posterior fossa (area 3, 2120 +/- 127 mm Hg) (p < 0.05). The average initial compression pressure in area 2 was 1204 +/- 105 mm Hg, and it was also significantly higher than those in area 1 (728 +/- 42 mm Hg) and area 3 (458 +/- 72 mm Hg) (p < 0.05). CONCLUSIONS: The pressure monitoring system has proven to be accurate, reliable, and extremely useful for monitoring the percutaneous trigeminal ganglion balloon compression procedure.

PMID: 12633968

22: Lord SM, Bogduk N. 
Abstract -  Radiofrequency procedures in chronic pain.
Best Pract Res Clin Anaesthesiol. 2002 Dec;16(4):597-617. Review.
PMID: 12516894 [PubMed - indexed for MEDLINE]

Radiofrequency procedures in chronic pain.

Lord SM, Bogduk N.

Division of Anaesthesia, Intensive Care & Pain Management, John Hunter Hospital, Locked Bag 1, Hunter Region Mail Centre, New South Wales 2310, Australia.

Radiofrequency current is simply a tool used for creating discrete thermal lesions in neural pathways in order to interrupt transmission. In pain medicine, radiofrequency lesions have been used to interrupt nociceptive pathways at various sites. This is a palliative treatment not without complications, so its use should be limited to those patients with cancer pain or chronic non-cancer pain for whom conservative non-surgical therapies have been ineffective or intolerable. With the development of alternatives such as intrathecal opioid infusion and neuromodulation technologies, the number of patients considered for neuroablative therapy may dwindle. Nevertheless, there is evidence that radiofrequency neurotomy has an important role in the management of trigeminal neuralgia, nerve root avulsion and spinal pain. In this chapter the evidence for efficacy and safety is reviewed and interrogated with special emphasis on the available randomized controlled trails and systematic review.

Publication Types:

* Review
* Review, Tutorial

PMID: 12516894 

23: Thayer T. 
No Abstract -  Acupuncture: the best of the rest.
SAAD Dig. 2002 Jul;19(3):5-8. No Abstract -  available.
PMID: 12613346 [PubMed - indexed for MEDLINE]

24: Schnitzler ES, Gusek-Schneider GC, Lang CJ. 
Abstract -  [Myokymia of the obliquus superior muscle and cryptogenetic epilepsy]
Klin Monatsbl Augenheilkd. 2003 Jan-Feb;220(1-2):54-6. German.
PMID: 12612849 [PubMed - in process]

25: [No authors listed] 
Abstract -  [In Process Citation]
Zh Vopr Neirokhir Im N N Burdenko. 2002 Oct-Dec;(4):11-5. Russian.
PMID: 12608141 [PubMed - in process]

26: Whitmarsh TE. 
Abstract -  Homeopathy in multiple sclerosis.
Complement Ther Nurs Midwifery. 2003 Feb;9(1):5-9. Review.
PMID: 12604318 [PubMed - indexed for MEDLINE]

Homeopathy in multiple sclerosis.

Whitmarsh TE.

Glasgow Homeopathic Hospital, 1053 Great Western Road, Glasgow G12 9UY, Scotland, UK.

Multiple sclerosis (MS) is the most common disease of the central nervous system affecting people between the ages of 20 and 40 years in the UK, Northern Europe and the USA. No definitive treatment yet exists to halt the almost inevitable decline in function and accumulation of disability over the years in sufferers. Management is largely directly of symptoms which arise variably in the course of the condition. Such problems as urinary incontinence, sexual dysfunction, cramps and spasms, tremor and trigeminal neuralgia can often be helped to some extent using conventional therapies. These treatments though are not effective in everyone, or cause unacceptable side-effects and there are some commonly reported symptoms, such as fatigue or emotional lability for which there are no generally accepted treatments. Here, a knowledge of complementary and alternative medicine (CAM) can bring benefits to the person with MS. CAM is widely used by people with MS and some studies in this area are briefly summarised. It is interesting to reflect what lies behind all this CAM use and what that might tell conventional medicine about just what it is the MS sufferer really wants from their carers. Homeopathy is a form of CAM unique in the UK in having been available in the NHS since the foundation in 1948. Medical homeopaths in the UK have always been concerned with the integration of the best of conventional and complementary treatments for the benefit of their patients. Glasgow Homeopathic Hospital has around 100 admissions each year of people with MS at different stages of the condition and aims at an integrated response to their distress. Different therapeutic modalities are employed, but a homeopathic approach in particular is of benefit in MS. By its nature, it is a whole-person approach and allows for complete individualisation of treatment, taking account of the minutiae of someone's life. This is discussed and some examples of homeopathic treatments, which seem to be more generalisable for commonly encountered MS symptoms, are given.

Publication Types:

* Review
* Review, Tutorial

PMID: 12604318

27: Pareja J, Caminero A, Sjaastad O. 
Abstract -  SUNCT Syndrome: diagnosis and treatment.
Headache. 2003 Mar;43(3):306.
PMID: 12603673 [PubMed - as supplied by publisher]

SUNCT Syndrome: diagnosis and treatment.

Pareja J, Caminero A, Sjaastad O.

8: CNS Drugs. 2002;16(6):373-383 Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing (SUNCT) is a syndrome predominant in males, with a mean age of onset around 50 years. The attacks are strictly unilateral, generally with the pain persistently confined to the ocular/periocular area. Most attacks are moderate to severe in intensity and burning, stabbing or electrical in character. The mean duration of paroxysms is 1 minute, with a usual range of 10 to 120 seconds (total range 5 to 250 seconds). Prominent, ipsilateral conjunctival injection and lacrimation regularly accompany the attacks. Nasal stuffiness/rhinorrhoea are frequently noted. In addition, there is subclinical forehead sweating. During attacks, there is increased intraocular pressure on the symptomatic side and swelling of the eyelids. No changes in pupil diameter have been observed. Attacks can be triggered mostly from trigeminally innervated areas, but also from the extratrigeminal territory. There are also spontaneous attacks. An irregular temporal pattern is the rule, with symptomatic periods alternating with remissions in an unpredictable fashion. During active periods, the frequency of attacks may vary from <1 attack/day to>30 attacks/hour. The attacks predominate during the daytime, nocturnal attacks being seldom reported. A SUNCT-like picture has been described in some patients with either intra-axial or extra-axial posterior fossa lesions, mostly vascular disturbances/ malformations. In the vast majority of patients, however, aetiology and pathogenesis are unknown. In SUNCT syndrome, there is a lack of persistent, convincingly beneficial effect of drugs or anaesthetic blockades that are generally effective in cluster headache, chronic paroxysmal hemicrania, trigeminal neuralgia, idiopathic stabbing headache (Ajabs and jolts syndrome'), and other headaches more faintly resembling SUNCT syndrome. Single reports have claimed that carbamazepine, lamotrigine, gabapentin, corticosteroids or surgical procedures may be of help. However, caution is recommended when assessing any therapy in a disorder such as SUNCT syndrome, in which the rather chaotic and unpredictable temporal pattern makes the assessment of any drug/therapeutic effect per se a particularly difficult matter. Comment: Another excellent review article. If you want to learn about the rare, short trigeminal autonomic cephalgia (TAC), this is a thorough and thoughtful place to start. SJT

PMID: 12603673

28: Zhao Y, Jiang X, Liu Y. 
Abstract -  [Observation of vasoactive intestinal polypeptide in patients with trigeminal neuralgia: a 16-cases report]
Hua Xi Kou Qiang Yi Xue Za Zhi. 2002 Feb;20(1):33-4, 38. Chinese.
PMID: 12593198 [PubMed - in process]

[Observation of vasoactive intestinal polypeptide in patients with trigeminal neuralgia: a 16-cases report]

[Article in Chinese]

Zhao Y, Jiang X, Liu Y.

Department of Stomatology, Changzheng Hospital, Second Military Medical University.

OBJECTIVE: The aim of this study was to observe whether vasoactive intestinal polypeptide (VIP) participated in the attack of trigeminal neuralgia, and to understand further its pathogenetic mechanism. METHODS: Sixteen patients were studied. During the attacks the venous blood was sampled from both the external jugular vein and cubital fossa vein ipsilateral to the pain, and after operations the venous blood from the external jugular vein was sampled again, the external jugular vein blood of eleven normal volunteers was collected as the control. Plasma levels of VIP were determined using sensitive radioimmunoassays. RESULTS: During the attacks of trigeminal neuralgia the levels of VIP in the external jugular vein blood were significantly higher than that in the cubital fossa vein blood, postoperative external jugular vein blood and the external jugular vein blood of normal volunteers. CONCLUSION: VIP indeed participates in the attack of trigeminal neuralgia in the local region, the role of VIP may be relating to enhancing the effects of substance P in local neurogenic inflammation.

PMID: 12593198

29: Quinones-Hinojosa A, Chang EF, Khan SA, McDermott MW. 
Abstract -  Isolated trigeminal nerve sarcoid granuloma mimicking trigeminal schwannoma: case report.
Neurosurgery. 2003 Mar;52(3):700-5 discussion 704-5. Review.
PMID: 12590697 [PubMed - indexed for MEDLINE]

30: Goebel A, Moore A, Weatherall R, Roewer N, Schedel R, Sprotte G. 
Free in PMC Intravenous immunoglobulin in the treatment of primary trigeminal neuralgia refractory to carbamazepine: a study protocol[ISRCTN33042138].
BMC Neurol. 2003 Jan 30 [epub ahead of print]
PMID: 12590652 [PubMed - as supplied by publisher]

Intravenous immunoglobulin in the treatment of primary trigeminal neuralgia refractory to carbamazepine: a study protocol[ISRCTN33042138].

Goebel A, Moore A, Weatherall R, Roewer N, Schedel R, Sprotte G.

Nuffield Department of Anaesthetics, University of Oxford, Oxford Ox3 9DU, England, UK.

BACKGROUND: We have recently reported successful treatment of patients with chronic pain syndromes using human pooled intravenous immunoglobulin (IVIG) in a prospective, open-label cohort study. A randomised, placebo controlled, double blinded study is needed to confirm these results. We chose to study patients with carbamazepine resistant primary Trigeminal Neuralgia (rpTN), as these had responded particularly well to IVIG.A protocol involving the use of IVIG in rpTN is complex for three reasons: 1. The effect of IVIG does not follow simple dose-response rules; 2. The response pattern of patients to IVIG was variable and ranged between no effect at all and pain free remission between two weeks and >1 year; 3. TN is characterized by extremely severe pain, for which operative intervention is (if temporarily) helpful in most patients. DESIGN: A placebo controlled, parallel, add-on model was developed and the primary outcome variable defined as the length of time during which patients remain in the study. Study groups are compared using Kaplan-Maier survival analysis. Patients record their response to treatment ("severe, moderate, slight, no pain"). The study coordinator monitors pain diaries. Severe or moderate pain of three days duration will result in termination of the study for that patient. CONCLUSIONS: This study design utilizes a method of survival analysis and is novel in chronic pain research. It allows for both early departure from the study and voluntary crossover upon non-response. It may be applicable to the analysis of IVIG efficacy in other chronic pain syndromes.

PMID: 12590652  Editor's Note:  Full Text Article available free. 


31: Wentzky P, Berndt S. 
Abstract -  [Neuralgia of the trigeminal nerve as first symptom of a primary central nervous system lymphoma of non-Hodgkin's type]
Fortschr Neurol Psychiatr. 2003 Feb;71(2):67-71. German.
PMID: 12579469 [PubMed - indexed for MEDLINE]

32: Paulus W, Evers S, May A, Steude U, Wolowski A, Pfaffenrath V. 
Abstract -  [Therapy and prophylaxis of facial neuralgias and other forms of facial pain syndromes -- revised recommendations of the German Society of Migraine and Headache]
Schmerz. 2003 Jan;17(1):74-91. Review. German.
PMID: 12579391 [PubMed - indexed for MEDLINE]

[Therapy and prophylaxis of facial neuralgias and other forms of facial pain syndromes -- revised recommendations of the German Society of Migraine and Headache]

[Article in German]

Paulus W, Evers S, May A, Steude U, Wolowski A, Pfaffenrath V; German Society of Migraine and Headache.

Abteilung Klinische Neurophysiologie der Universitat Gottingen.

Trigeminal neuralgia and postherpetic neuralgia are the most relevant neuralgiform facial pain syndromes. Trigeminal neuralgia is characterized by lancinating intensive pain attacks of very short duration, triggered by external cues,whereas postherpetic neuralgia consists predominantly of long-lasting burning pain. Sodium channel blocking drugs are first choice in treatment of trigeminal neuralgia, operative procedures encompass microvascular decompression, thermocoagulation and percutaneous retrogasserian glycerol rhizotomy. In the acute stage postherpetic neuralgia is treated antivirally and analgesically, in the chronic stage by tricyclic antidepressive substances. Other pain syndromes described encompass the Tolosa-Hunt-syndrome, cervicogenic headache, craniomandibular dysfunction syndrome, atypical facial pain and rarer syndromes. Therapeutic recommendations are based on evidence based medicine criteria (EBM).

Publication Types:

* Review
* Review, Academic

PMID: 12579391 

33: Javadpour M, Eldridge PR, Varma TR, Miles JB, Nurmikko TJ. 
No Abstract -  Microvascular decompression for trigeminal neuralgia in patients over 70 years of age.
Neurology. 2003 Feb 11;60(3):520. No Abstract -  available.
PMID: 12578946 [PubMed - indexed for MEDLINE]

34: Chang FL, Huang GS, Cherng CH, Ho ST, Wong CS. 
No Abstract -  Repeated peripheral nerve blocks by the co-administration of ketamine, morphine, and bupivacaine attenuate trigeminal neuralgia.
Can J Anaesth. 2003 Feb;50(2):201-2. No Abstract -  available.
PMID: 12560318 [PubMed - in process]

35: Mursch K, Schafer M, Steinhoff BJ, Behnke-Mursch J. 
Abstract -  Trigeminal evoked potentials and sensory deficits in atypical facial pain--a comparison with results in trigeminal neuralgia.
Funct Neurol. 2002 Jul-Sep;17(3):133-6.
PMID: 12549718 [PubMed - indexed for MEDLINE]

36: Taki W, Matsushima S, Hori K, Mouri G, Ishida F. 
Abstract -  Repositioning of the vertebral artery with titanium bone fixation plate for trigeminal neuralgia.
Acta Neurochir (Wien). 2003 Jan;145(1):55-61.
PMID: 12545263 [PubMed - indexed for MEDLINE]

Repositioning of the vertebral artery with titanium bone fixation plate for trigeminal neuralgia.

Taki W, Matsushima S, Hori K, Mouri G, Ishida F.

Department of Neurosurgery, Mie University School of Medicine, Tsu City, Mie Prefecture, Japan.

BACKGROUND: Trigeminal neuralgia is usually treated by the padding method using Teflon felt. However this can not be done in certain cases in whom a large tortuous vertebrobasilar artery compresses the fifth nerve. The transposition method using the sling may be an alternative method. But this method is not an easy procedure and requires a relatively large craniotomy. Two cases were treated by a new and simpler effective technique. CLINICAL PRESENTATION: Two cases of the trigeminal neruralgia were treated. The first case was a 71 year-old male and the second case was a 63 year-old male. The history of the medical treatments were similar and both cases had had trigeminal nerve blocks and were prescribed carbamazepin. However, the pain control was insufficient in both cases. In both cases, three dimensional computerized tomography showed the large tortuous right vertebral artery ran just behind the clivus and compressed the right trigeminal nerve. In the second case past history showed a recent hypertensive cerebellar hemorrhage. TECHNIQUE AND RESULTS: A right suboccipital craniotomy were performed in both cases. In both cases, the right vertebral artery compressed the trigeminal nerve in a rostral direction. The sling technique with nylon sutures was tried in both cases but failed during surgery. Then, the bone fixation stainless plate was cut to 10 cm in length and pre-shaped with pliers. After being shaped, the distal end of the plate was inserted between the vertebral artery and fifth nerve and the proximal end of the plate was fixed to the skull by screw. The fifth nerve was completely isolated from the artery as they were in direct contact. After surgery, the pain disappeared completely during the follow-up of one and a half year in the first case and 9 months in the second case. CONCLUSION: The plate can be bent and curved with plier to suit each individual case. This technique is easily applied even when the slings or other isolation technique is not available and appeared to achieve the mechanically stronger reposition and fixation of a very large and tortuous artery away from the trigeminal nerve.

PMID: 12545263

37: Liu B, Zhu X, Liang J, Yin M, Lu Q, Yuan H. 
Abstract -  [Improved retrosigmoid approach operation in the treatment of trigeminal neuralgia]
Lin Chuang Er Bi Yan Hou Ke Za Zhi. 2001 Sep;15(9):407-8. Chinese.
PMID: 12541891 [PubMed - in process]

38: Wang XW, Fu XJ, Dong SY. 
Abstract -  [The retrosigmiod approach surgery of trigeminal never]
Lin Chuang Er Bi Yan Hou Ke Za Zhi. 2000 Mar;14(3):116-7. Chinese.
PMID: 12541412 [PubMed - in process]

39: Chen Z, Zhao Z, Li M, Yang Y. 
Abstract -  [Clinical significance of trigeminal neuralgia treated using radiofrequency thermocoagulation (RFT) with different approaches]
Hua Xi Kou Qiang Yi Xue Za Zhi. 2001 Aug;19(4):240-2. Chinese.
PMID: 12539731 [PubMed - indexed for MEDLINE]

40: Liu JB, Wu HJ, Zhu ZF. 
Abstract -  [Evaluation of clinical therapeutic efficacy by injecting adriamycin to the nerve in primary trigeminal neuralgia]
Hunan Yi Ke Da Xue Xue Bao. 2001 Apr 28;26(2):163-4. Chinese.
PMID: 12536657 [PubMed - indexed for MEDLINE]

41: Frese A, Evers S, May A. 
No Abstract -  Autonomic activation in experimental trigeminal pain.
Cephalalgia. 2003 Feb;23(1):67-8. No Abstract -  available.
PMID: 12534584 [PubMed - indexed for MEDLINE]

42: Kaup AO, Mathew NT, Levyman C, Kailasam J, Meadors LA, Villarreal SS. 
Abstract -  'Side locked' migraine and trigeminal autonomic cephalgias: evidence for clinical overlap.
Cephalalgia. 2003 Feb;23(1):43-9. Review.
PMID: 12534580 [PubMed - indexed for MEDLINE]

43: Boes CJ, Matharu MS, Goadsby PJ. 
Abstract -  The paroxysmal hemicrania-tic syndrome.
Cephalalgia. 2003 Feb;23(1):24-8.
PMID: 12534576 [PubMed - indexed for MEDLINE]

44: Bonicalzi V, Canavero S. 
Abstract -  A case of trigeminal-vagal neuralgia relieved by peripheral self-stimulation.
Acta Neurol Belg. 2002 Dec;102(4):188-90.
PMID: 12534247 [PubMed - indexed for MEDLINE]

45: Bogucki J, Czernicki Z. 
Abstract -  [The effectiveness of microvascular decompression in various types of vascular compression in patients with trigeminal neuralgia]
Neurol Neurochir Pol. 2002 Sep-Oct;36(5):937-46. Polish.
PMID: 12523118 [PubMed - indexed for MEDLINE]

46: Song S, Zheng X, Wen S, Huang J, Ding D. 
Abstract -  Change of serum soluble intercellular adhesion molecule and basic fibroblast grouth factor in patients with acute cerebral infarction and its clinical significance.
Zhonghua Yi Xue Za Zhi. 2002 Nov 10;82(21):1447-9.
PMID: 12509902 [PubMed - in process]

47: Born JD. 
Abstract -  [Trigeminal neuralgia and hemifacial spasm. Vessel-nerve antagonism]
Bull Mem Acad R Med Belg. 2002;157(3-4):178-86; discussion 186-8. French.
PMID: 12508714 [PubMed - indexed for MEDLINE]

48: Vaughan P, Hampshire A, Soanes T, Kemeny A, Radatz M, Rowe J, Walton L. 
Abstract -  The clinical application of plugging patterns for the Leksell gamma knife.
J Neurosurg. 2002 Dec;97(5 Suppl):579-81.
PMID: 12507100 [PubMed - indexed for MEDLINE]

The clinical application of plugging patterns for the Leksell gamma knife.

Vaughan P, Hampshire A, Soanes T, Kemeny A, Radatz M, Rowe J, Walton L.

National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield, England.

OBJECT: In this report the authors explore the use of standardized plugging templates in formulating stereotactic radiosurgery dose plans for the Leksell gamma knife. METHODS: Unplugged gamma knife dose plans previously used in the treatment of patients with trigeminal neuralgia (TN) and vestibular schwannoma (VS) were studied. Standardized plugging templates were then superimposed on these plans, and their effects on the conformity index of tumors and the transposition of the radiation field from the brainstem to the cerebrospinal fluid spaces for the trigeminal cases were examined. CONCLUSIONS: The standardized plugging templates significantly increased the conformity indices in cases of VS plans and for TN. Plugging significantly reduced the brainstem exposure to radiation while at the same time not altering the length of the trigeminal nerve being treated. Standardized plugging templates may therefore be a useful tool in optimizing dose plans.

PMID: 12507100

49: Shetter AG, Rogers CL, Ponce F, Fiedler JA, Smith K, Speiser BL. 
Abstract -  Gamma knife radiosurgery for recurrent trigeminal neuralgia.
J Neurosurg. 2002 Dec;97(5 Suppl):536-8.
PMID: 12507092 [PubMed - indexed for MEDLINE]

Gamma knife radiosurgery for recurrent trigeminal neuralgia.

Shetter AG, Rogers CL, Ponce F, Fiedler JA, Smith K, Speiser BL.

Department of Radiation Oncology, Foundation for Cancer Research and Education, Arizona Oncology Services, Phoenix, Arizona 85013, USA.

OBJECT: Pain may fail to respond or may recur after initial gamma knife radiosurgery (GKS) for trigeminal neuralgia (TN). The authors examined their experience with performing a second GKS procedure in these patients. METHODS: Twenty-nine patients underwent repeated GKS for TN at our institution between March 1997 and March 2002. Questionnaires were mailed to patients to assess the degree of their pain relief and the extent of facial numbness. Nineteen patients responded. All patients underwent repeated GKS involving a single 4-mm isocenter directed at the trigeminal nerve as it exited the brainstem (mean maximum dose 23.2 Gy). At a mean follow up of 13.5 months after the second procedure, 10 patients (53%) were pain free and medication free. Four patients (21%) were pain free but elected to continue medication in reduced dose, and two patients (11%) had incomplete but satisfactory pain control and were still taking medication. There was new-onset facial numbness in eight patients (42%), rated as tolerable in all instances. CONCLUSIONS: Patients with facial numbness had a greater likelihood of being pain free than those with no sensory loss. The authors observed no cases of corneal anesthesia, keratitis, or deafferentation pain.

PMID: 12507092

50: Chang JW, Choi JY, Yoon Y, Park YG, Chung SS. 
Abstract -  Unusual causes of trigeminal neuralgia treated by gamma knife radiosurgery. Report of two cases.
J Neurosurg. 2002 Dec;97(5 Suppl):533-5.
PMID: 12507091 [PubMed - indexed for MEDLINE]

51: Rogers CL, Shetter AG, Ponce FA, Fiedler JA, Smith KA, Speiser BL. 
Abstract -  Gamma knife radiosurgery for trigeminal neuralgia associated with multiple sclerosis.
J Neurosurg. 2002 Dec;97(5 Suppl):529-32.
PMID: 12507090 [PubMed - indexed for MEDLINE]

Gamma knife radiosurgery for trigeminal neuralgia associated with multiple sclerosis.

Rogers CL, Shetter AG, Ponce FA, Fiedler JA, Smith KA, Speiser BL.

St. Joseph's Hospital and Barrow Neurological Institute, Department of Radiation Oncology Foundation for Cancer Research and Education, Arizona Oncology Services, Phoenix, Arizona 85013, USA.

OBJECT: The authors assessed the efficacy and complications from gamma knife radiosurgery (GKS) for multiple sclerosis (MS)-associated trigeminal neuralgia (TN). METHODS: There were 15 patients with MS-associated TN (MS-TN). Treatment involved three sequential protocols, 70 to 90-Gy maximum dose, using a single 4-mm isocenter targeting the ipsilateral trigeminal nerve at its junction with the pons with the 50% isodose. Pain was appraised by each patient by using Barrow Neurological Institute (BNI) Scores I through IV: I, no pain; II, occasional pain not requiring medication; IIIa, no pain but continued medication; IIIb, some pain, controlled with medication; IV, some pain, not controlled with medication; and V, severe pain/no pain relief. With a mean follow up of 17 months (range 6-38 months), 12 (80%) of 15 patients experienced pain relief. Three patients (20%) reported no relief (BNI Score V). For responders, the mean latency from treatment to the onset of pain relief was 13 days (range 1-61 days). Maximal relief was achieved after a mean latency of 56 days (range 1-157 days). Five patients underwent a second GKS after a mean interval of 534 days (range 231-946 days). The mean maximum dose at this second treatment was 48 Gy. The target was unchanged from the first treatment. All five patients who underwent repeated GKS improved. Complications were limited to delayed facial hypesthesias. Two (13%) of 15 patients experienced onset of numbness after the first GKS, as well as two of five patients following a second GKS. The patients found this mild and not bothersome. Each patient who developed hypesthesias also experienced complete pain relief. CONCLUSIONS: Gamma knife radiosurgery is an effective treatment for MS-TN. Radiosurgery carries an acceptable small risk of mild facial hypesthesias, and hypesthesia appears predictive of a favorable outcome.

Publication Types:

* Clinical Trial

PMID: 12507090

52: Matsuda S, Serizawa T, Sato M, Ono J. 
Abstract -  Gamma knife radiosurgery for trigeminal neuralgia: the dry-eye complication.
J Neurosurg. 2002 Dec;97(5 Suppl):525-8.
PMID: 12507089 [PubMed - indexed for MEDLINE]

Gamma knife radiosurgery for trigeminal neuralgia: the dry-eye complication.

Matsuda S, Serizawa T, Sato M, Ono J.

Department of Neurology, Chiba Cardiovascular Center, Ichihara, Chiba, Japan.

OBJECT: The purpose of this paper is to report a unique complication of gamma knife radiosurgery (GKS) for trigeminal neuralgia (TN). The nature of this complication and its related factors are discussed. METHODS: Forty-one medically refractory patients with TN were treated with GKS. All patients received 80 Gy to the proximal trigeminal nerve root, using a 4-mm collimator and a single isocenter. Follow up consisted of three monthly outpatient sessions after GKS. Improvement, recurrence, complications, and changes in magnetic resonance imaging were recorded. To evaluate the factors behind the complications, a subgroup of 33 patients was assessed in whom the follow-up duration was more than 9 months. The follow-up duration was 3 to 36 months (mean 13 months). The results were excellent in 20 patients, good in 11, and fair in seven. No patient had a poor result. Three patients suffered recurrences. Seven patients suffered complications 9 to 24 months after GKS. All seven patients complained of facial numbness and hypesthesia was recorded. Three of them also complained of "dry eye" with diminution or absence of corneal reflex but no other abnormalities of the cornea and conjunctiva were found on ophthalmological examination. In these three patients, hypesthesia of the first division of the trigeminal nerve area had been found before their "dry eye" symptoms appeared. The irradiated volume on the brainstem was significantly related to this complication. CONCLUSIONS: The dry eye symptom seems to be a special form of sensory disturbance. An overdose of radiation to the brainstem may play an important role in the manifestation of this complication.

PMID: 12507089

53: Viktorov VA, Domanskii VL. 
Abstract -  [Equipment for electrostimulation of the nervous and muscular systems: investigations, design, and application]
Med Tekh. 2002 Nov-Dec;(6):4-6. Russian.
PMID: 12506735 [PubMed - indexed for MEDLINE]

54: Kondziolka D, Flickinger JC, Lunsford LD. 
No Abstract -  Energy sources in the posterior fossa: the role of radiosurgery.
Clin Neurosurg. 2002;49:548-61. Review. No Abstract -  available.
PMID: 12506569 [PubMed - indexed for MEDLINE]

55: Rowe JG, Radatz MW, Walton L, Kemeny AA. 
Abstract -  Changing utilization of stereotactic radiosurgery in the UK: the Sheffield experience.
Br J Neurosurg. 2002 Oct;16(5):477-82.
PMID: 12498492 [PubMed - indexed for MEDLINE]

56: Wakamoto H, Miyazaki H, Orii M, Ishiyama N, Akiyama K, Konohana I. 
Abstract -  [Aseptic meningitis as a complication caused by an allergic reaction after microvascular decompression: two case reports]
No Shinkei Geka. 2002 Dec;30(12):1331-5. Japanese.
PMID: 12491585 [PubMed - indexed for MEDLINE]

57: Eriksson M, Ben-Menachem E, Andersen O. 
Abstract -  Epileptic seizures, cranial neuralgias and paroxysmal symptoms in remitting and progressive multiple sclerosis.
Mult Scler. 2002 Dec;8(6):495-9.
PMID: 12474990 [PubMed - indexed for MEDLINE]

58: Deseure K, Koek W, Colpaert FC, Adriaensen H. 
Abstract -  The 5-HT(1A) receptor agonist F 13640 attenuates mechanical allodynia in a rat model of trigeminal neuropathic pain.
Eur J Pharmacol. 2002 Dec 5;456(1-3):51-7.
PMID: 12450569 [PubMed - indexed for MEDLINE]

The 5-HT(1A) receptor agonist F 13640 attenuates mechanical allodynia in a rat model of trigeminal neuropathic pain.

Deseure K, Koek W, Colpaert FC, Adriaensen H.

Laboratory of Anesthesiology S4, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium.

The effects of acute intraperitoneal injections of the 5-HT(1A) receptor agonists F 13640 [(3-chloro-4-fluoro-phenyl)-[4-fluoro-4-[[(5-methyl-pyridin-2-ylmethyl)-amino]-methyl]piperidin-1-yl]-methadone] and F 13714 [3-chloro-4-fluorophenyl-(4-fluoro-4-[[(5-methyl-6-methylamino-pyridin-2-ylmethyl)-amino]-methyl]-piperidin-1-yl-methanone] were studied in comparison with those of baclofen and morphine on responsiveness to von Frey hair stimulation after chronic constriction injury to the rat's infraorbital nerve (IoN-CCI). Following IoN-CCI, an ipsilateral hyperresponsiveness developed that remained stable in control rats throughout the period of drug testing. F 13640, F 13714, baclofen and morphine dose-dependently decreased the hyperresponsiveness; normalization of the response occurred at doses 0.63, 0.04, 5 and 10 mg/kg, respectively. Confirming earlier data, baclofen's effects further validate IoN-CCI as a model of trigeminal neuralgia. The effects of F 13640 and F 13714 are initial evidence that 5-HT(1A) receptor agonists produce profound analgesia in the IoN-CCI model. The present data extend recent evidence that high-efficacy 5-HT(1A) receptor activation constitutes a new mechanism of central analgesia the spectrum of which may also encompass trigeminal neuropathic pain.

PMID: 12450569

59: Link MJ, Cohen PL, Breneman JC, Tew JM Jr. 
Abstract -  Malignant squamous degeneration of a cerebellopontine angle epidermoid tumor. Case report.
J Neurosurg. 2002 Nov;97(5):1237-43. Review.
PMID: 12450053 [PubMed - indexed for MEDLINE]

60: Devulder JE. 
Abstract -  Postherpetic ophthalmic neuralgia.
Bull Soc Belge Ophtalmol. 2002;(285):19-23. Review.
PMID: 12442339 [PubMed - indexed for MEDLINE]

Postherpetic ophthalmic neuralgia.

Devulder JE.

Ghent University Hospital, Department of Anesthesia-Section Pain Clinic, B-9000 Ghent, Belgium.

Postherpetic ophthalmic neuralgia is the final stage of a varicella zoster infection. Many years after chickenpox infection, patients can develop herpes zoster in one or more specific dermatomal regions. The ophthalmic branch of the trigeminal nerve and the thoracic nerves are most commonly affected. Younger patients are less prone to postherpetic neuralgia than the older. Patients with a depression in cell-mediated immunity are more susceptible to develop postherpetic pain. Postherpetic ophthalmic neuralgia is a neuropathic pain and can be treated by anticonvulsants and tricyclic antidepressants. Neurodestructive procedures are not recommended as they enhance destruction and neuropathic pain. Sympathetic nerve blocks can be helpful. Neurostimulation is the last therapeutic resort.

Publication Types:

* Review
* Review, Tutorial

PMID: 12442339


61: Cabaleiro J. 
No Abstract -  Assessing and treating neuropathic pain.
Home Healthc Nurse. 2002 Nov;20(11):718-23; quiz 724. No Abstract -  available.
PMID: 12442041 [PubMed - indexed for MEDLINE]

62: Takeda M, Ikeda M, Tanimoto T, Lipski J, Matsumoto S. 
Abstract -  Changes of the excitability of rat trigeminal root ganglion neurons evoked by alpha(2)-adrenoreceptors.
Neuroscience. 2002;115(3):731-41.
PMID: 12435412 [PubMed - indexed for MEDLINE]

63: Scardina GA, Mazzullo M, Messina P. 
Abstract -  [Early diagnosis of progressive systemic sclerosis: the role of oro-facial phenomena]
Minerva Stomatol. 2002 Jul-Aug;51(7-8):311-7. Review. Italian.
PMID: 12434126 [PubMed - indexed for MEDLINE]

64: Vitek L, Tettenborn B. 
No Abstract -  Cavernous angioma in the brachium pontis presenting with trigeminal neuralgia: a case report.
Eur Neurol. 2002;48(4):226-8. No Abstract -  available.
PMID: 12422074 [PubMed - indexed for MEDLINE]

65: Volvoikar P, Patil S, Dinkar A. 
Abstract -  Tooth exfoliation, osteonecrosis and neuralgia following herpes zoster of trigeminal nerve.
Indian J Dent Res. 2002 Jan-Mar;13(1):11-4. Review.
PMID: 12420562 [PubMed - indexed for MEDLINE]

66: Micheli F, Scorticati MC, Raina G. 
Abstract -  Beneficial effects of botulinum toxin type a for patients with painful tic convulsif.
Clin Neuropharmacol. 2002 Sep-Oct;25(5):260-2.
PMID: 12410057 [PubMed - indexed for MEDLINE]

Beneficial effects of botulinum toxin type a for patients with painful tic convulsif.

Micheli F, Scorticati MC, Raina G.

Programa de Parkinson y Movimientos Anormales, Instituto de Neurociencias, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina.

Botulinum toxin is a well-known therapy for patients with diverse movement disorders. Its application has been extended to other disorders. Here, we document the case of a 70-year-old man with hemifacial spasm associated to trigeminal neuralgia secondary to an ectatic basilar artery. He was treated with botulinum toxin type A, 2.5 mouse units over five sites at the orbicularis oculi and one over the buccinator muscle. After botulinum toxin injections, relief was gained not only from twitching but also from pain. When the effects of the toxin vanished, spasms and pain recurred. Further infiltrations were given every 12 weeks following the same response pattern. This observation further validates the increasing role of botulinum toxin in pain management.

PMID: 12410057


67: Dufour SK. 
Abstract -  An unusual case of stabbing eye pain: a case report and review of trigeminal neuralgia.
Optometry. 2002 Oct;73(10):626-34. Review.
PMID: 12408549 [PubMed - indexed for MEDLINE]

68: Edwards RJ, Clarke Y, Renowden SA, Coakham HB. 
Abstract -  Trigeminal neuralgia caused by microarteriovenous malformations of the trigeminal nerve root entry zone: symptomatic relief following complete excision of the lesion with nerve root preservation.
J Neurosurg. 2002 Oct;97(4):874-80.
PMID: 12405376 [PubMed - indexed for MEDLINE]

69: Galer BS. 
No Abstract -  Effectiveness and safety of lidocaine patch 5%.
J Fam Pract. 2002 Oct;51(10):867-8; author reply 868. No Abstract -  available.
PMID: 12401158 [PubMed - indexed for MEDLINE]

70: Huang H. 
No Abstract -  Combined use of the points shenmai and zhaohai for treatment of craniofacial diseases.
J Tradit Chin Med. 2002 Sep;22(3):221-3. No Abstract -  available.
PMID: 12400435 [PubMed - indexed for MEDLINE]

71: Arias M, Iglesias A, Vila O, Brasa J, Conde C. 
Abstract -  MR imaging findings of neurosarcoidosis of the gasserian ganglion: an unusual presentation.
Eur Radiol. 2002 Nov;12(11):2723-5.
PMID: 12386763 [PubMed - indexed for MEDLINE]

72: Unger F, Walch C, Schrottner O, Eustacchio S, Sutter B, Pendl G. 
Abstract -  Cranial nerve preservation after radiosurgery of vestibular schwannomas.
Acta Neurochir Suppl. 2002;84:77-83.
PMID: 12379008 [PubMed - indexed for MEDLINE]

73: Kondo A. 
Abstract -  Microvascular decompression surgery for trigeminal neuralgia.
Stereotact Funct Neurosurg. 2001;77(1-4):187-9.
PMID: 12378075 [PubMed - indexed for MEDLINE]

Microvascular decompression surgery for trigeminal neuralgia.

Kondo A.

Department of Neurosurgery, Shiroyama Hospital, Furuiti, Habikino City, Osaka, Japan.

Long-term follow-up data were analyzed to evaluate the surgical results of microvascular decompression (MVD). Among 1,324 patients with trigeminal neuralgia (TGN), who underwent MVD between 1976 and 2000, a consecutive 281 patients were followed and studied for 5-20 years as of the year of 1997. When the data were analyzed and compared in two groups (A: 1976-1986, B: 1987-1991), the postoperative cure rate increased from 92.9 to 96.7%, satisfaction rate with the results of MVD increased from 80.3 to 82.5%, incomplete cure rate decreased from 7.1 to 3.3%, and recurrence rate decreased from 10.2 to 6.5%. Advances in surgical techniques may have increased the success rate in Group B. Copyright 2002 S. Karger AG, Basel

PMID: 12378075

74: Ecker AD, Smith JE. 
Abstract -  Are latent, immediate-early genes of herpes simplex virus-1 essential in causing trigeminal neuralgia?
Med Hypotheses. 2002 Nov;59(5):603-6.
PMID: 12376087 [PubMed - in process]

75: Karapantzos I, Kehl R, Mpouras N, Markmann HU, Huber I. 
Abstract -  [Rare site of an adenoid cystic carcinoma in the nasopharynx]
HNO. 2002 Aug;50(8):758-61. German.
PMID: 12243033 [PubMed - indexed for MEDLINE]
76: Tronnier VM, Rasche D, Hamer J, Kunze S. 
Abstract -  [Neurosurgical therapy of facial neuralgias]
Schmerz. 2002 Sep;16(5):404-11. German.
PMID: 12235505 [PubMed - indexed for MEDLINE]

[Neurosurgical therapy of facial neuralgias]

[Article in German]

Tronnier VM, Rasche D, Hamer J, Kunze S.

Neurochirurgische Universitatsklinik Heidelberg, Germany.

INTRODUCTION: Neuralgias of the face, especially trigeminal neuralgia and glossopharyngeal neuralgia are indications for surgical interventions after failed medical therapy. In contrast to other forms of headache or atypical facial pain, where surgical measures are considered to be contraindicated, percutaneous procedures or microvascular decompression are able to produce immediate and longstanding pain relief. Careful preoperative evaluation is essential to confirm the clinical diagnosis and to rule out other causes as multiple sclerosis or tumors afflicting the cranial nerves. The following study will summarize the common surgical techniques and their role considering a mechanism-based therapy as well as document long-term results of these measures. METHODS: Between 1977 and 1997 316 thermo-controlled radiofrequency trigeminal rhizotomies (TK) and 379 microvascular decompressions (MVD) were performed in our hospital to treat trigeminal neuralgia; additional 6 MVDs for glossopharyngeal neuralgia and one MVD of the intermediate facial nerve were carried out. Questionnaires were sent out to all patients still living in 1981, 1982, 1992 and 1998. For all other patients, interviews with relatives or the general practitioners were conducted. A retrospective analysis of postoperative pain relief was performed using Kaplan-Meier curves at the latest follow-up. Additionally 80 patients underwent careful quantitative sensory testing with Von-Frey-hairs. RESULTS: 225 patients who underwent microvascular decompression and 206 with radiofrequency trigeminal rhizotomies were further analyzed. There was a 50% risk for pain recurrence two years after radiofrequency rhizotomy. On the other hand 64% of patients who underwent microvascular decompression remained painfree 20 years postoperatively. Patients with microvascular decompression without sensory deficit were painfree significantly longer than patients with postoperative hypesthesia. DISCUSSION: Etiology and pathogenesis of facial neuralgias are far from understood despite several hypotheses. Based on current models there is no explanation for the immediate pain relief especially after microvascular decompression. Some authors even discuss surgical trauma as the only cause for postoperative pain relief.

PMID: 12235505

77: Sommer C. 
Abstract -  [Pharmacotherapy of orofacial pain]
Schmerz. 2002 Sep;16(5):381-8. Review. German.
PMID: 12235502 [PubMed - indexed for MEDLINE]

78: Akimoto H, Nagaoka T, Nariai T, Takada Y, Ohno K, Yoshino N. 
Abstract -  Preoperative evaluation of neurovascular compression in patients with trigeminal neuralgia by use of three-dimensional reconstruction from two types of high-resolution magnetic resonance imaging.
Neurosurgery. 2002 Oct;51(4):956-61; discussion 961-2.
PMID: 12234403 [PubMed - indexed for MEDLINE]

79: Zakrzewska JM. 
No Abstract -  Trigeminal neuralgia.
Clin Evid. 2002 Jun;(7):1221-31. Review. No Abstract -  available.
PMID: 12230739 [PubMed - indexed for MEDLINE]

80: Chaudhary P, Baumann T. 
Abstract -  Expression of VPAC2 receptor and PAC1 receptor splice variants in the trigeminal ganglion of the adult rat.
Brain Res Mol Brain Res. 2002 Aug 15;104(2):137-42.
PMID: 12225867 [PubMed - indexed for MEDLINE]

81: Unger F, Walch C, Papaefthymiou G, Eustacchio S, Feichtinger K, Quehenberger F, Pendl G. 
Abstract -  Long term results of radiosurgery for vestibular schwannomas.
Zentralbl Neurochir. 2002;63(2):52-8.
PMID: 12224030 [PubMed - indexed for MEDLINE]

82: Gregoire A, Clair C, Delabrousse E, Aubry R, Boulahdour Z, Kastler B. 
Abstract -  [CT guided neurolysis of the sphenopalatine ganglion for management of refractory trigeminal neuralgia]
J Radiol. 2002 Sep;83(9 Pt 1):1082-4. French.
PMID: 12223918 [PubMed - indexed for MEDLINE]

83: Fiske J, Griffiths J, Thompson S. 
Abstract -  Multiple sclerosis and oral care.
Dent Update. 2002 Jul-Aug;29(6):273-83. Review.
PMID: 12222018 [PubMed - indexed for MEDLINE]

84: Backonja MM. 
Abstract -  Use of anticonvulsants for treatment of neuropathic pain.
Neurology. 2002 Sep 10;59(5 Suppl 2):S14-7. Review.
PMID: 12221151 [PubMed - indexed for MEDLINE]

Use of anticonvulsants for treatment of neuropathic pain.

Backonja MM.

Department of Neurology, University of Wisconsin Hospital and Clinics, Room H6/574, 600 Highland Avenue, Madison, WI 53792-5132, USA.

Emerging evidence from animal models of neuropathic pain suggests that many pathophysiologic and biochemical changes occur in the peripheral and central nervous system. Similarities between the pathophysiologic phenomena observed in some epilepsy models and in neuropathic pain models justify the use of anticonvulsants in the symptomatic management of neuropathic pain. Positive results from laboratory and clinical trials further support such use. Carbamazepine was the first of this class of drugs to be studied in clinical trials and has been longest in use for treatment of neuropathic pain. Clinical trial data support its use in treating trigeminal neuralgia, but data for treatment of painful diabetic neuropathy are less convincing. Use of newer anticonvulsants has marked a new era in the treatment of neuropathic pain. Gabapentin has demonstrated efficacy, specifically in painful diabetic neuropathy and postherpetic neuralgia. Lamotrigine has been reported to be effective in relieving pain from trigeminal neuralgia refractory to other treatments, HIV neuropathy, and central post-stroke pain. Results from clinical trials of phenytoin are equivocal. Zonisamide's mechanisms of action suggest that it would be effective in controlling neuropathic pain symptoms. Other anticonvulsants, including lorazepam, valproate, topiramate, and tiagabine, have also been under investigation. Anecdotal experience provides support for studies with oxcarbazepine and levetiracetam for treating neuropathic pain. Evidence supporting the efficacy of anticonvulsants in treatment of such pain is evolving. Additional clinical trials should provide information that will better define their role in neuropathic pain.

Publication Types:

* Review
* Review, Tutorial

PMID: 12221151

85: Freudenstein D, Wagner A, Gurvit O, Bartz D, Duffner F. 
Abstract -  Simultaneous virtual representation of both vascular and neural tissue within the subarachnoid space of the basal cistern--technical note.
Med Sci Monit. 2002 Sep;8(9):MT153-8.
PMID: 12218952 [PubMed - indexed for MEDLINE]

86: Uchino A, Sawada A, Hirakawa N, Totoki T, Kudo S. 
Abstract -  Congenital absence of the internal carotid artery diagnosed during investigation of trigeminal neuralgia.
Eur Radiol. 2002 Sep;12(9):2339-42.
PMID: 12195492 [PubMed - indexed for MEDLINE]

87: Hung CM, Kang HM, Shen CH, Yang TC, Wu CC, Ho WM. 
Abstract -  Contralateral neurologic deficits following microvascular decompression surgery--a case report.
Acta Anaesthesiol Sin. 2002 Jun;40(2):91-5.
PMID: 12194397 [PubMed - indexed for MEDLINE]

88: Smith RR, Lavassani A, Zachow S, Wahl D, Mandybur G, Patrick B. 
No Abstract -  The gamma knife for relief of trigeminal neuralgia.
J Miss State Med Assoc. 2002 Jul;43(7):205-7. No Abstract -  available.
PMID: 12189910 [PubMed - indexed for MEDLINE]

89: Pollock BE, Phuong LK, Gorman DA, Foote RL, Stafford SL. 
Abstract -  Stereotactic radiosurgery for idiopathic trigeminal neuralgia.
J Neurosurg. 2002 Aug;97(2):347-53.
PMID: 12186463 [PubMed - indexed for MEDLINE]

Stereotactic radiosurgery for idiopathic trigeminal neuralgia.

Pollock BE, Phuong LK, Gorman DA, Foote RL, Stafford SL.

Department of Neurological Surgery, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.

OBJECT: Each year a greater number of patients with trigeminal neuralgia (TN) undergo radiosurgery, including a large number of patients who are candidates for microvascular decompression (MVD). METHODS: The case characteristics and outcomes of 117 consecutive patients who underwent radiosurgery were retrieved from a prospectively maintained database. The mean patient age was 67.8 years; and the majority (58%) of patients had undergone surgery previously. The dependent variable for all analyses of facial pain was complete pain relief without medication (excellent outcome). Median follow-up duration was 26 months (range 1-48 months). The actuarial rate of achieving and maintaining an excellent outcome was 57% and 55% at 1 and 3 years, respectively, after radiosurgery. A greater percentage of patients who had not previously undergone surgery achieved and maintained excellent outcomes (67% at 1 and 3 years) than that of patients who had undergone prior surgery (51% and 47% at 1 and 3 years, respectively; relative risk [RR] = 1.77, 95% confidence interval [CI] 1.01-3.13, p = 0.04). New persistent trigeminal dysfunction was noted in 43 patients (37%). Tolerable numbness or paresthesias occurred in 29 patients (25%), whereas bothersome dysesthesias developed in 14 patients (12%). Only a radiation dose of 90 Gy correlated with new trigeminal deficits or dysesthesias (RR = 3.10, 95% CI 1.64-5.81, p < 0.001). Excellent outcomes in patients with new trigeminal dysfunction were achieved and maintained at rates of 76% and 74% at 1 and 3 years, respectively, after radiosurgery, compared with respective rates of 46% and 42% in patients who did not experience postradiosurgery trigeminal dysfunction (RR = 4.53, 95% CI 2.03-9.95, p < 0.01). CONCLUSIONS: Radiosurgical treatment provides complete pain relief for the majority of patients with idiopathic TN. There is a strong correlation between the development of new facial sensory loss and achievement and maintenance of pain relief after this procedure. Because the long-term results of radiosurgery still remain unknown, MVD should continue to be the primary operation for medically fit patients with TN.

PMID: 12186463

90: Wrobel-Wisniewska G, Kasprzak P, Zawirski M. 
Abstract -  [Sixteen-year experience in the treatment of trigeminal neuralgia by percutaneous retrogasserian thermorhizotomy]
Neurol Neurochir Pol. 2002 May-Jun;36(3):471-9. Polish.
PMID: 12185803 [PubMed - indexed for MEDLINE]

91: De Ridder D, Moller A, Verlooy J, Cornelissen M, De Ridder L. 
Abstract -  Is the root entry/exit zone important in microvascular compression syndromes?
Neurosurgery. 2002 Aug;51(2):427-33; discussion 433-4.
PMID: 12182781 [PubMed - indexed for MEDLINE]

92: Wang CJ, Howng SL. 
Abstract -  Trigeminal neuralgia caused by nasopharyngeal carcinoma with skull base invasion--a case report.
Kaohsiung J Med Sci. 2001 Dec;17(12):630-2.
PMID: 12168498 [PubMed - indexed for MEDLINE]

93: Theodosopoulos PV, Marco E, Applebury C, Lamborn KR, Wilson CB. 
Abstract -  Predictive model for pain recurrence after posterior fossa surgery for trigeminal neuralgia.
Arch Neurol. 2002 Aug;59(8):1297-302.
PMID: 12164727 [PubMed - indexed for MEDLINE]

Predictive model for pain recurrence after posterior fossa surgery for trigeminal neuralgia.

Theodosopoulos PV, Marco E, Applebury C, Lamborn KR, Wilson CB.

Department of Neurological Surgery, The University of California-San Francisco, 505 Parnassus St, Room M787, Campus Box 0112, San Francisco, CA 94143-0112, USA.

BACKGROUND: Surgical exploration of the posterior fossa is the definitive treatment for trigeminal neuralgia refractory to medication, but predictors of its success in effecting long-term pain relief have not been established. OBJECTIVE: To develop a model that allows stratification of patients' risk of postoperative recurrence of pain based on pretreatment factors. METHODS: We reviewed the records of 420 consecutive patients who underwent posterior fossa exploration by one of us (C.B.W.) for the treatment of idiopathic trigeminal neuralgia. The primary outcome measure was recurrence of trigeminal pain. The predictive value of preoperative and intraoperative factors was evaluated. Multivariate analysis revealed the statistically significant predictors of pain recurrence, permitting creation of a risk model for recurrence of pain. RESULTS: After surgery, trigeminal pain had lessened in 98% of patients and completely resolved in 87%. There were no perioperative deaths. After a mean follow-up of 56.3 months, 93% of patients reported significant pain improvement and 72% continued to have no pain. The estimated likelihood of pain recurrence at 8 years was 34%. Significant predictors of eventual recurrence of pain were age younger than 53 years at the time of surgery, symptoms lasting longer than 11(1/2) years, female sex, and pain on the left side in men. These factors were weighted and incorporated into a risk model that revealed 4-year pain-free survival of 89% +/- 4% for the low-risk group, 80% +/- 4% for the moderate-risk group, and 58% +/- 6% for the high-risk group (data are mean +/- SD). CONCLUSIONS: We developed a predictive model that stratifies the risk for eventual recurrence of pain after posterior fossa exploration for trigeminal neuralgia. This information may be useful in counseling patients regarding treatment.

PMID: 12164727

94: Watanabe J, Mizunuma N, Aruga A, Oguchi M, Hatake K. 
No Abstract -  Trigeminal neuralgia caused by lymphomatous compression at oval foramen.
Eur J Haematol. 2002 May;68(5):323. No Abstract -  available.
PMID: 12144542 [PubMed - indexed for MEDLINE]

95: Ranganath HN. 
No Abstract -  Treatment of trigeminal neuralgia: letter to editor.
Neurol India. 2002 Jun;50(2):231. No Abstract -  available.
PMID: 12134205 [PubMed - indexed for MEDLINE]

96: Wehrmann J. 
No Abstract -  [Comment on the contribution by RE Schopf et a.: "Neurotrophic ulcer as a late sequela of trigeminal exharesis"]
Hautarzt. 2002 Jun;53(6):438. German. No Abstract -  available.
PMID: 12132303 [PubMed - indexed for MEDLINE]

97: Zakrzewska JM. 
No Abstract -  Facial pain: neurological and non-neurological.
J Neurol Neurosurg Psychiatry. 2002 Jun;72 Suppl 2:ii27-ii32. Review. No Abstract -  available.
PMID: 12122200 [PubMed - indexed for MEDLINE]

98: Boes CJ, Capobianco DJ, Matharu MS, Goadsby PJ. 
Abstract -  Wilfred Harris' early description of cluster headache.
Cephalalgia. 2002 May;22(4):320-6.
PMID: 12100097 [PubMed - indexed for MEDLINE]

99: Pareja JA, Baron M, Gili P, Yanguela J, Caminero AB, Dobato JL, Barriga FJ, Vela L, Sanchez-del-Rio M. 
Abstract -  Objective assessment of autonomic signs during triggered first division trigeminal neuralgia.
Cephalalgia. 2002 May;22(4):251-5.
PMID: 12100085 [PubMed - indexed for MEDLINE]

100: Lindena G, Diener HC, Hildebrandt J, Klinger R, Maier C, Schops P, Tronnier V. 
Abstract -  [Guidelines in pain treatment--methodical quality of guidelines for treatment of pain patients]
Schmerz. 2002 Jun;16(3):194-204. German.
PMID: 12077679 [PubMed - indexed for MEDLINE]

101: Cha ST, Eby JB, Katzen JT, Shahinian HK. 
Abstract Trigeminocardiac reflex: a unique case of recurrent asystole during bilateral trigeminal sensory root rhizotomy.
J Craniomaxillofac Surg. 2002 Apr;30(2):108-11.
PMID: 12069514 [PubMed - indexed for MEDLINE]

102: Vaideanu D, Fraser K, Deady JP. 
No Abstract - Just another corneal abrasion?
Lancet. 2002 Jun 1;359(9321):1916. No Abstract - available.
PMID: 12057555 [PubMed - indexed for MEDLINE]

103: Pradel W, Hlawitschka M, Eckelt U, Herzog R, Koch K. 
Abstract - Cryosurgical treatment of genuine trigeminal neuralgia.
Br J Oral Maxillofac Surg. 2002 Jun;40(3):244-7.
PMID: 12054718 [PubMed - indexed for MEDLINE]

Cryosurgical treatment of genuine trigeminal neuralgia.

Pradel W, Hlawitschka M, Eckelt U, Herzog R, Koch K.

Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, Dresden, Germany.

A newly developed cryoprobe for peripheral nerves allows surgeons to freeze branches of the trigeminal nerve at the infraorbital or the mandibular foramen without exposing the nerve or damaging the surrounding tissue. The probe has an outer diameter of 2.7mm, and a vacuum-insulated shaft to protect the adjacent tissue. It is designed to be inserted transmucosally. The cryoprobe was used in 19 patients to freeze the infraorbital nerve or the inferior alveolar nerve. At 4-8 months after cryotherapy sensation in the areas innervated by the treated nerve had returned, but pain was absent for at least 6 months. The pain recurred in 13 out of 19 patients within 6-12 months. However, it was possible to repeat the cryotherapy as the procedure was not stressful. Cryosurgery widens the range of methods available to treat trigeminal neuralgia. Copyright 2002 The British Association of Oral and Maxillofacial Surgeons.

PMID: 12054718

104: Kerns RD, Kassirer M, Otis J. 
Abstract Pain in multiple sclerosis: a biopsychosocial perspective.
J Rehabil Res Dev. 2002 Mar-Apr;39(2):225-32. Review.
PMID: 12051466 [PubMed - indexed for MEDLINE]

105: Regis J. 
No Abstract - High-dose trigeminal neuralgia radiosurgery associated with increased risk of trigeminal nerve dysfunction.
Neurosurgery. 2002 Jun;50(6):1401-2; author reply 1402-3. No abstract available.
PMID: 12051192 [PubMed - indexed for MEDLINE]

106: Umino M, Kohase H, Ideguchi S, Sakurai N. 
Abstract - Long-term pain control in trigeminal neuralgia with local anesthetics using an indwelling catheter in the mandibular nerve.
Clin J Pain. 2002 May-Jun;18(3):196-9.
PMID: 12048422 [PubMed - indexed for MEDLINE]

Long-term pain control in trigeminal neuralgia with local anesthetics using an indwelling catheter in the mandibular nerve.

Umino M, Kohase H, Ideguchi S, Sakurai N.

Section of Anesthesiology and Clinical Physiology, Department of Oral Restitution, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.

OBJECTIVE: The authors sought to determine the usefulness of long-term continuous trigeminal nerve block with local anesthetics using an indwelling catheter in a patient with trigeminal neuralgia. DESIGN: The study design included pain control in a patient with trigeminal neuralgia until the time of neurosurgical operation. SETTING: The study was conducted in the Dental Hospital of Tokyo Medical and Dental University. PATIENT: The patient was a 78-year-old woman with trigeminal neuralgia in the right maxillary region. Her pain could not be controlled by carbamazepine and was unbearable. INTERVENTION: The authors estimated the patient's pain intensity, quality, and locality using a visual analog scale to determine the effectiveness of continuous nerve block. OUTCOME MEASURES: Visual analog scores were measured during treatment. The treatment term was divided into three periods according to the difference of the catheter location and injection protocol (premandibular nerve block, infuser injection, and patient-controlled analgesia [PCA] pump injection). The authors also examined the patient's general condition and blood concentration of drugs. RESULTS: The visual analog values were 44.8 +/- 3.6, 26.7 +/- 3.5, and 11.9 +/- 3.1 mm in each period, respectively. The value in the PCA pump infusion period was significantly lower than that in the other periods. No side effects of the local anesthetics were observed on the patient's systemic condition. CONCLUSIONS: The authors controlled trigeminal neuralgia pain by blocking the mandibular nerve with local anesthetics administered through an indwelling catheter. Because the continuous nerve block with local anesthetics is reversible and only mildly toxic, this method is beneficial for pain control in patients with trigeminal neuralgia scheduled to undergo microvascular decompression.

PMID: 12048422

107: Black DF, Dodick DW. 
Abstract - Two cases of medically and surgically intractable SUNCT: a reason for caution and an argument for a central mechanism.
Cephalalgia. 2002 Apr;22(3):201-4.
PMID: 12047459 [PubMed - indexed for MEDLINE]

108: Shenouda EF, Coakham HB. 
Abstract - Episodic facial palsy due to epithelial cyst of the cerebellopontine angle: case report and review of the literature.
Br J Neurosurg. 2002 Apr;16(2):177-81. Review.
PMID: 12046740 [PubMed - indexed for MEDLINE]

109: Benoliel R, Eliav E, Tal M. 
Abstract - Strain-dependent modification of neuropathic pain behaviour in the rat hindpaw by a priming painful trigeminal nerve injury.
Pain. 2002 Jun;97(3):203-12.
PMID: 12044617 [PubMed - indexed for MEDLINE]

110: Pareja JA, Caminero AB, Sjaastad O. 
Abstract - SUNCT Syndrome: diagnosis and treatment.
CNS Drugs. 2002;16(6):373-83. Review.
PMID: 12027784 [PubMed - indexed for MEDLINE]

111: Das B, Saha SP. 
Abstract - Trigeminal neuralgia: current concepts and management.
J Indian Med Assoc. 2001 Dec;99(12):704-9. Review.
PMID: 12022221 [PubMed - indexed for MEDLINE]

Trigeminal neuralgia: current concepts and management.

Das B, Saha SP.

Bangur Institute of Neurology, Kolkata.

Trigeminal neuralgia is the most frequent cranial neuralgia, the incidence being 1 per 1,000,00 persons per year. It presents with stabbing pain often in the distribution of the mandibular and maxillary divisions of the trigeminal nerve. An accurate history of pain is important in the diagnosis of trigeminal neuralgia. A patient with tic douloureux and no neurological abnormality on clinical examination does not need diagnostic tests. The available options for management of trigeminal neuralgia are: Pharmacotherapy, destructive procedures and non-destructive procedures. The pharmacotherapy includes (i) monotherapy with one anticonvulsant, (ii) combined therapy with more than one anticonvulsant, (iii) add-on therapy with newer drugs and (iv) polytherapy with anticonvulsant + add-on drugs + antidepressants/anxiolytics. Destructive procedures include (i) non-surgical methods--injections along trigeminal pathways, percutaneous trigeminal radiofrequency thermocoagulation and (ii) surgical methods--trigeminal branch avulsion or peripheral neurectomy, avulsion of trigeminal nerve, trigeminal tractotomy, radiosurgery. Though various modalities of treatment are available for the management of trigeminal neuralgia, pharmacotherapy with carbamazepine still remains the first line of treatment. The alternative approach followed at most centres is percuatenous Gasserian rhizolysis (chemical/radiofrequency thermal) or microvascular decompression.

Publication Types:

* Review
* Review, Tutorial

PMID: 12022221

112: Brisman R, Khandji AG, Mooij RB. 
Abstract - Trigeminal Nerve-Blood Vessel Relationship as Revealed by High-resolution Magnetic Resonance Imaging and Its Effect on Pain Relief after Gamma Knife Radiosurgery for Trigeminal Neuralgia.
Neurosurgery. 2002 Jun;50(6):1261-6, discussion 1266-7.
PMID: 12015844 [PubMed - indexed for MEDLINE]

Trigeminal Nerve-Blood Vessel Relationship as Revealed by High-resolution Magnetic Resonance Imaging and Its Effect on Pain Relief after Gamma Knife Radiosurgery for Trigeminal Neuralgia.

Brisman R, Khandji AG, Mooij RB.

Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York Presbyterian Hospital, Columbia Presbyterian Medical Center, New York, New York 10032-2699, USA.

OBJECTIVE: Blood vessel (BV) compression of the trigeminal nerve (Cranial Nerve [CN] V) is a common cause of trigeminal neuralgia (TN). High-resolution magnetic resonance imaging scans obtained during gamma knife radiosurgery (GKRS) in patients with TN may be used to analyze the BV-CN V relationship. Follow-up data from a large series of patients treated with GKRS for TN were used to provide information regarding the BV-CN V relationship and pain relief. METHODS: T1-weighted, axial 1-mm-thick volume acquisition magnetic resonance imaging scans were obtained through the area of CN V at its exit from the brainstem after injection of 15 ml of gadolinium. The BV-CN V relationship on the symptomatic side that was treated with GKRS was categorized into the following groups: Group 1 (no close relationship), Group 2 (BV close to CN V but not touching it), and Groups 3 and higher (BV-CN V contact). RESULTS: A total of 181 symptomatic nerves were studied in 179 patients with TN who were treated with GKRS. In BV-CN V Groups 1, 2, and 3 and higher, respectively, were 43 sides (24%), 31 sides (17%), and 107 sides (59%). In 100 sides where there was no surgical procedure before GKRS, 50% or greater pain relief was more likely in those with BV-CN V contact (51 [88%] of 58 sides) than in those without BV-CN V (29 [69%] of 42 sides) (P = 0.024). BV-CN V contact was observed more often in men (55 [69%] of 80 sides) than in women (52 [52%] of 101 sides) (P = 0.023) and more often in patients who had unilateral TN (104 [62%] of 169 patients) rather than bilateral TN (2 [20%] of 10 patients) (P = 0.016). CONCLUSION: In patients who have not undergone previous surgery for TN, BV-CN V contact revealed by high-resolution magnetic resonance imaging may indicate a particularly favorable response to GKRS.

PMID: 12015844

113: Shigeno T, Kumai J, Endo M, Oya S, Hotta S. 
Abstract - Snare technique of vascular transposition for microvascular decompression--technical note.
Neurol Med Chir (Tokyo). 2002 Apr;42(4):184-9; discussion 190.
PMID: 12013673 [PubMed - indexed for MEDLINE]

114: Desai K, Nadkarni T, Bhayani R, Goel A. 
Abstract - Cerebellopontine angle epidermoid tumor presenting with 'tic convulsif' and tinnitus--case report.
Neurol Med Chir (Tokyo). 2002 Apr;42(4):162-5.
PMID: 12013668 [PubMed - indexed for MEDLINE]

115: Zheng LG, Xu DS, Kang CS, Zhang ZY, Li YH, Zhang YP, Liu D, Jia Q. 
Abstract - Stereotactic radiosurgery for primary trigeminal neuralgia using the Leksell Gamma unit.
Stereotact Funct Neurosurg. 2001;76(1):29-35.
PMID: 12007276 [PubMed - indexed for MEDLINE]

Stereotactic radiosurgery for primary trigeminal neuralgia using the Leksell Gamma unit.

Zheng LG, Xu DS, Kang CS, Zhang ZY, Li YH, Zhang YP, Liu D, Jia Q.

Gamma Knife Center, Department of Neurosurgery, Second Hospital of the Tianjin Medical University, People's Republic of China.

OBJECTIVE: Previous papers have reported Gamma Knife radiosurgery to be a safe, effective method for primary trigeminal neuralgia. Since November 1996, we have treated primary trigeminal neuralgia using the Leksell Gamma Knife at the Tianjin Medical University. The present study reports clinical results of Gamma Knife radiosurgery in the treatment of trigeminal neuralgia in 80 cases. METHODS: The mean patient age was 67 years (range 32-92), the mean duration of facial pain was 7.6 years (range 1.5-29). The male:female ratio was 31:49. The right side of the face was involved in 45 patients (56.25%) and the left side in 30 cases (37.5%), with bilateral involvement in 5 cases (6.25%). Under local anesthesia, all patients underwent stereotactic MRI to identify the trigeminal nerve. A single isocenter, using a 4-mm collimator, was positioned at the sensory root of the trigeminal nerve entry zone of the pons, 4-6 mm from the brainstem surface, so that no more than the 20% isodose was administered to the brainstem. The maximum dose was between 70 and 90 Gy, with a mean of 75.6 Gy. For bilateral trigeminal neuralgia, two separate matrices were employed, and bilateral Gamma Knife radiosurgery was performed on the same day. RESULTS: Follow-up ranged from 12 to 43 months (mean 23.7 months). Neurological evaluation indicated excellent response in 42 cases (52.5%), good response in 25 cases (31.25%), effective response in 8 cases (10%), so the total pain control rate was 93.75%. The latency from Gamma Knife surgery to pain relief ranged from 1 to 120 days (mean 22 days). Among the 75 patients 7 with pain control experienced pain recurrence 5-26 months after being completely free from pain. A second Gamma Knife radiosurgery was performed in 7 recurrent cases and 5 patients with treatment failure. A maximal dose ranging from 70 to 80 Gy was given (mean 74.2 Gy). After a mean follow-up of 18 months (8-33 months), 9 patients achieved excellent results, and 2 had good results. The latency interval to pain relief ranged from 1 to 120 days (mean 15 days). Nine patients developed new facial numbness, while no other complication appeared in the remainder of the patients. CONCLUSIONS: Gamma Knife radiosurgery is a safe and effective method in the treatment of trigeminal neuralgia once diagnosis is established. Copyright 2002 S. Karger AG, Basel

PMID: 12007276


116: Konzelman JL Jr, Herman WW, Comer RW. 
Abstract - Enigmatic pain referred to the teeth and jaws.
Gen Dent. 2001 Mar-Apr;49(2):182-6; quiz 187-8.
PMID: 12004699 [PubMed - indexed for MEDLINE]

117: Shankland WE 2nd. 
Abstract - Differential diagnosis of two disorders that produce common orofacial pain symptoms.
Gen Dent. 2001 Mar-Apr;49(2):150-5. Review.
PMID: 12004693 [PubMed - indexed for MEDLINE]

Differential diagnosis of two disorders that produce common orofacial pain symptoms.

Shankland WE 2nd.

Severe orofacial pain often is diagnosed as trigeminal neuralgia, with little distinction made as to which type--typical or atypical. In addition, osteonecrosis of the jaws quite often produces symptoms which mimic trigeminal neuralgia. Unless diagnosed correctly, a patient suffering from a condition of "dead bone" may be referred for unnecessary neurosurgery. The general dentist often is the one doctor who can make the proper diagnosis and guide the patient toward the proper treatment.

Publication Types:

* Review
* Review, Tutorial

PMID: 12004693

118: [No authors listed] 
No Abstract - Trigeminal neuralgia in dentistry.
Dent Implantol Update. 2000 Feb;11(2):15. No abstract available.
PMID: 11992935 [PubMed - indexed for MEDLINE]

119: Lopes PG, Castro ES Jr, Lopes LH. 
Abstract - Trigeminal neuralgia in children: two case reports.
Pediatr Neurol. 2002 Apr;26(4):309-10.
PMID: 11992761 [PubMed - indexed for MEDLINE]

120: Yamada K, Miyamoto S, Takayama M, Nagata I, Hashimoto N, Ikada Y, Kikuchi H. 
Abstract - Clinical application of a new bioabsorbable artificial dura mater.
J Neurosurg. 2002 Apr;96(4):731-5.
PMID: 11990814 [PubMed - indexed for MEDLINE]

121: Kolasa P, Palka Z, Wegrzyn Z. Related Articles, Links
Abstract [Retrospective assessment of bilateral trigeminal neuralgia treatment]
Neurol Neurochir Pol. 2001 Nov-Dec;35(6):1063-9. Polish.
PMID: 11987702 [PubMed - indexed for MEDLINE]

122: Gupta V, Singh AK, Kumar S, Sinha S. Related Articles, Links
Abstract Familial trigeminal neuralgia.
Neurol India. 2002 Mar;50(1):87-9. Review.
PMID: 11960159 [PubMed - indexed for MEDLINE]

123: Chen JF, Lee ST, Lui TN, Wu CT. Related Articles, Links
Abstract Percutaneous trigeminal ganglion compression for the treatment of trigeminal neuralgia: report of two cases.
Chang Gung Med J. 2002 Feb;25(2):122-7.
PMID: 11952272 [PubMed - indexed for MEDLINE]

124: Andrychowski J, Czernicki Z. Related Articles, Links
Abstract [Application of the insulating material teflon--pladgets (Genzyme-USA) during the microvascular decompression]
Neurol Neurochir Pol. 2001;35 Suppl 5:26-9. Polish.
PMID: 11935676 [PubMed - indexed for MEDLINE]

125: Holsheimer J. Related Articles, Links
Abstract Electrical stimulation of the trigeminal tract in chronic, intractable facial neuralgia.
Arch Physiol Biochem. 2001 Oct;109(4):304-8.
PMID: 11935364 [PubMed - indexed for MEDLINE]

Electrical stimulation of the trigeminal tract in chronic, intractable facial neuralgia.

Holsheimer J.

Institute for Biomedical Technology, University of Twente, Enschede, The Netherlands.

In this paper the treatment of patients with chronic, intractable trigeminal neuralgia by invasive electrical stimulation of the Gasserion ganglion is reviewed. Two different surgical techniques are employed in this treatment. Most frequently, a method similar to the traditional technique for percutaneous glycerol and radiofrequency trigeminal rhizolysis is used: a small percutaneous stimulation electrode is advanced under fluoroscopic control through a thin needle via the foramen ovale to the Gasserian cistern. Some neurosurgeons use an open surgical technique by which the Gasserian ganglion is approached subtemporally and extradurally, and the bipolar pad electrode is sutured to the dura. When percutaneous test stimulation is successful (at least 50% pain relief) the electrode is internalized and connected to a subcutaneous pulse generator or RF-receiver. Data from 8 clinical studies, including 267 patients have been reviewed. Of all 233 patients with medication-resistant atypical trigeminal neuralgia 48% had at least 50% long term pain relief. The result of test stimulation is a good predictor of the long term effect, because 83% of all patients with successful test stimulation had at least 50% long term relief, and 70% had at least 75% long term relief. Patients generally preferred this invasive method over TENS. The success rate in patients with postherpetic trigeminal neuralgia was very low (less than 10%). It is suggested that the likelihood of pain relief by electrical stimulation is inversely related to the degree of sensory loss. It is concluded that invasive stimulation of the Gasserian ganglion is a promising treatment modality for patients with chronic, intractable, atypical trigeminal neuralgia.

PMID: 11935364

126: Jarrahy R, Eby JB, Cha ST, Shahinian HK. Related Articles, Links
Abstract Fully endoscopic vascular decompression of the trigeminal nerve.
Minim Invasive Neurosurg. 2002 Mar;45(1):32-5.
PMID: 11932822 [PubMed - indexed for MEDLINE]

Fully endoscopic vascular decompression of the trigeminal nerve.

Jarrahy R, Eby JB, Cha ST, Shahinian HK.

Division of Skull Base Surgery, Cedars-Sinai Medical Center, 8635 West Third Street, Los Angeles, CA 90048, USA.

Microvascular decompression of the trigeminal nerve is an accepted and effective means of treating patients with trigeminal neuralgia in whom compression of the nerve by a vascular structure is implicated in the pathogenesis of the disease. The current standard technique uses the binocular operating microscope for all intra-operative visualization. Posterior fossa endoscopy has demonstrated that the endoscope provides more comprehensive views of the anatomy of the cerebellopontine angle than does the operating microscope. To date, endoscopy has only been used to supplement microscopy in cranial nerve decompression surgery. In this report, we describe our completely endoscopic surgical technique as we present the case of a patient with trigeminal neuralgia who underwent successful vascular decompression by this approach. Using this technique the offending vessel was separated from the nerve with minimal brain retraction or dissection of surrounding structures. This report represents the first documented case where the endoscope was used as the exclusive imaging modality for decompression of the trigeminal nerve. From our experience we conclude that the endoscope's superior visualization more accurately identifies neurovascular conflicts, and provides a comprehensive evaluation of the completeness of the decompression. Additionally, this new method minimizes the risks of brain retraction and extensive dissection often required for microscopic exposure. From this study we conclude that completely endoscopic vascular decompression represents the next step forward in the safe and effective surgical treatment of trigeminal neuralgia.

PMID: 11932822

127: Hannerz J, Linderoth B. Related Articles, Links
Abstract Neurosurgical treatment of short-lasting, unilateral, neuralgiform hemicrania with conjunctival injection and tearing.
Br J Neurosurg. 2002 Feb;16(1):55-8.
PMID: 11926467 [PubMed - indexed for MEDLINE]

128: Korinth MC, Moller-Hartmann W, Gilsbach JM. Related Articles, Links
Abstract Microvascular decompression of a developmental venous anomaly in the cerebellopontine angle causing trigeminal neuralgia.
Br J Neurosurg. 2002 Feb;16(1):52-5.
PMID: 11926466 [PubMed - indexed for MEDLINE]

129: el Amrani M, Massiou H, Bousser MG. Related Articles, Links
Abstract [Idiopathic SUNCT (short lasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, sweating and rhinorrhea) syndrome: 2 new cases]
Rev Neurol (Paris). 2001 Dec;157(12):1519-24. French.
PMID: 11924448 [PubMed - indexed for MEDLINE]

130: Ishikawa M, Nishi S, Aoki T, Takase T, Wada E, Ohwaki H, Katsuki T, Fukuda H. Related Articles, Links
Abstract Operative findings in cases of trigeminal neuralgia without vascular compression: proposal of a different mechanism.
J Clin Neurosci. 2002 Mar;9(2):200-4.
PMID: 11922717 [PubMed - indexed for MEDLINE]

Operative findings in cases of trigeminal neuralgia without vascular compression: proposal of a different mechanism.

Ishikawa M, Nishi S, Aoki T, Takase T, Wada E, Ohwaki H, Katsuki T, Fukuda H.

Department of Neurosurgery, Kitano Hospital, Osaka, Japan.

Trigeminal neuralgia is known to be caused by vascular compression at the trigeminal root entry zone (REZ) and microvascular decompression provides good outcome in most of cases. However, in some cases, no vascular compression was observed at the REZ. Over the last 2(1/2) years, the first author operated on 53 cases of trigeminal neuralgia with microvascular decompression and encountered nine cases where no offending vessels were noted at or near the REZ. They were divided into two groups: five cases involving an initial operation and four cases involving a second operation. In the former, arachnoid thickening, angulation or torsion of the root axis were common findings. Dissection of thick arachnoid around the root along the whole length reversed the root to be straight and flaccid. Complete pain relief was noted in four of five cases. In one case of atypical pain, constant facial pain remained. In the latter four cases, where the first operations were done more than 4 years before, thick granulation was noted around REZ without new offending vessels in two cases. In the remaining two cases, where no offending vessels were noted in the first operation, thick adhesion of a distal portion of the root with dura on the pyramidal bone was noted. Meticulous dissection of t he whole length of the root was done and complete pain relief was obtained. Delayed but complete pain relief in these nine cases was noted. Based on operative findings, arachnoid thickening or granulomatous adhesion between the root and surrounding structures can cause an abnormal course of the trigeminal nerve root, which causes root angulation and/or torsion. They can also cause pulsatile movement of the trigeminal nerve root. This tethering effect can promote abnormal root stretching force, especially at REZ, which might promote hyperexitability of the nerve.This speculative mechanism suggests that it is important to make the root free along the entire length, especially at its distal portion in cases with no offending vessels. Copyright 2002, Elsevier Science Ltd. All rights reserved.

PMID: 11922717

131: Peterson AM, Williams RL, Fukui MB, Meltzer CC. Related Articles, Links
Abstract Venous angioma adjacent to the root entry zone of the trigeminal nerve: implications for management of trigeminal neuralgia.
Neuroradiology. 2002 Apr;44(4):342-6.
PMID: 11914813 [PubMed - indexed for MEDLINE]

132: Kissani N, Belaidi H, Ouazzani R, Chkili T. Related Articles, Links
No abstract [Flat angioma and idiopathic facial neuralgia. Association or coincidence?]
Ann Dermatol Venereol. 2001 Dec;128(12):1350-1. French. No abstract available.
PMID: 11908144 [PubMed - indexed for MEDLINE]

133: Rozen TD. Related Articles, Links
Abstract Antiepileptic drugs in the management of cluster headache and trigeminal neuralgia.
Headache. 2001 Nov-Dec;41 Suppl 1:S25-32. Review.
PMID: 11903537 [PubMed - indexed for MEDLINE]

Antiepileptic drugs in the management of cluster headache and trigeminal neuralgia.

Rozen TD.

Department of Neurology, Jefferson Medical College, Thomas Jefferson University Hospital, Jefferson Headache Center, Philadelphia, PA, USA.

Cluster headache and trigeminal neuralgia are relatively rare but debilitating neurologic conditions. Although they are clinically and diagnostically distinct from migraine, many of the same pharmacologic agents are used in their management. For many patients, the attacks are so frequent and severe that abortive therapy is often ineffective; therefore, chronic preventive therapy is necessary for adequate pain control. Cluster headache and trigeminal neuralgia have several distinguishing clinical features. Cluster headache is predominantly a male disorder; trigeminal neuralgia is more prevalent in women. Individuals with cluster headaches often develop their first attack before age 25; most patients with trigeminal neuralgia are between age 50 and 70. Cluster headaches are strongly associated with tobacco smoking and triggered by alcohol consumption; trigeminal neuralgia can be triggered by such stimuli as shaving and toothbrushing. Although the pain in both disorders is excruciating, cluster headache pain is episodic and unilateral, typically surrounds the eye, and lasts 15 to 180 minutes; the pain of trigeminal neuralgia lasts just seconds and is usually limited to the tissues overlying the maxillary and mandibular divisions of the trigeminal nerve. Cluster headache is unique because of its associated autonomic symptoms. Although the pathophysiology of cluster headache and trigeminal neuralgia are not completely understood, both appear to have central primary processes, and these findings have prompted investigations of the effectiveness of the newer antiepileptic drugs for cluster headache prevention and for the treatment of trigeminal neuralgia. The traditional antiepileptic drugs phenytoin and carbamazepine have been used for the treatment of trigeminal neuralgia for a number of years, and while they are effective, they can sometimes cause central nervous system effects such as drowsiness, ataxia, somnolence, and diplopia. Reports of studies in small numbers of patients or individual case studies indicate that the newer antiepileptic drugs are effective in providing pain relief for trigeminal neuralgia and cluster headache sufferers, with fewer central nervous system side effects. Divalproex has been shown to provide effective pain control and to reduce cluster headache frequency by more than half in episodic and chronic cluster headache sufferers. Topiramate demonstrated efficacy in a study of 15 patients, with a mean time to induction of cluster headache remission of 1.4 weeks (range, 1 day to 3 weeks). In the treatment of trigeminal neuralgia, gabapentin has been shown to be effective in an open-label study. When added to an existing but ineffective regimen of carbamazepine or phenytoin, lamotrigine provided improved pain relief; it also may work as monotherapy. Topiramate provided a sustained analgesic effect when administered to patients with trigeminal neuralgia. The newer antiepileptic drugs show considerable promise in the management of cluster headache and trigeminal neuralgia.

Publication Types:

* Review
* Review, Tutorial

PMID: 11903537

134: Kowacs PA, Piovesan EJ, Tatsui CE, Lange MC, Werneck LC, Vincent M. Related Articles, Links
No abstract Symptomatic trigeminal-autonomic cephalalgia evolving to trigeminal neuralgia: report of a case associated with dual pathology.
Cephalalgia. 2001 Nov;21(9):917-20. No abstract available.
PMID: 11903287 [PubMed - indexed for MEDLINE]

135: Schapiro RT. Related Articles, Links
Abstract Management of spasticity, pain, and paroxysmal phenomena in multiple sclerosis.
Curr Neurol Neurosci Rep. 2001 May;1(3):299-302. Review.
PMID: 11898533 [PubMed - indexed for MEDLINE]

136: Jawahar A, Smith DR, Willis BK, Ampil F, Delaune A, Datta R, Nanda A. Related Articles, Links
Abstract First 100 cases of gamma knife radiosurgery in Louisiana: analysis of demographics and early results.
J La State Med Soc. 2002 Jan-Feb;154(1):31-6.
PMID: 11892881 [PubMed - indexed for MEDLINE]

137: Jensen TS. Related Articles, Links
Abstract Anticonvulsants in neuropathic pain: rationale and clinical evidence.
Eur J Pain. 2002;6 Suppl A:61-8. Review.
PMID: 11888243 [PubMed - indexed for MEDLINE]

138: Devor M, Govrin-Lippmann R, Rappaport ZH, Tasker RR, Dostrovsky JO. Related Articles, Links
Abstract Cranial root injury in glossopharyngeal neuralgia: electron microscopic observations. Case report.
J Neurosurg. 2002 Mar;96(3):603-6.
PMID: 11883848 [PubMed - indexed for MEDLINE]

139: Devor M, Govrin-Lippmann R, Rappaport ZH. Related Articles, Links
Abstract Mechanism of trigeminal neuralgia: an ultrastructural analysis of trigeminal root specimens obtained during microvascular decompression surgery.
J Neurosurg. 2002 Mar;96(3):532-43.
PMID: 11883839 [PubMed - indexed for MEDLINE]

140: Tyler-Kabara EC, Kassam AB, Horowitz MH, Urgo L, Hadjipanayis C, Levy EI, Chang YF. Related Articles, Links
Abstract Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression.
J Neurosurg. 2002 Mar;96(3):527-31.
PMID: 11883838 [PubMed - indexed for MEDLINE]

[See Also, Comment in:* J Neurosurg. 2003 Mar;98(3):647; author reply 647-8.]

Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression.

Tyler-Kabara EC, Kassam AB, Horowitz MH, Urgo L, Hadjipanayis C, Levy EI, Chang YF.

Department of Neurosurgery, Center for Cranial Nerve Disorders, University of Pittsburgh Medical Center, Pennsylvania 15213-2582, USA.

OBJECT: Microvascular decompression (MVD) has become one of the primary treatments for typical trigeminal neuralgia (TN). Not all patients with facial pain, however, suffer from the typical form of this disease; many patients who present for surgical intervention actually have atypical TN. The authors compare the results of MVD performed for typical and atypical TN at their institution. METHODS: The results of 2675 MVDs in 2264 patients were reviewed using information obtained from the department database. The authors examined immediate postoperative relief in 2003 patients with typical and 672 with atypical TN, and long-term follow-up results in patients for whom more than 5 years of follow-up data were available (969 with typical and 219 with atypical TN). Outcomes were divided into three categories: excellent, pain relief without medication; good, mild or intermittent pain controlled with low-dose medication; and poor, no or poor pain relief with large amounts of medication. The results for typical and atypical TN were compared and patient history and pain characteristics were evaluated for possible predictive factors. CONCLUSIONS: In this study, MVD for typical TN resulted in complete postoperative pain relief in 80% of patients, compared with 47% with complete relief in those with atypical TN. Significant pain relief was achieved after 97% of MVDs in patients with typical TN and after 87% of these procedures for atypical TN. When patients were followed for more than 5 years, the long-term pain relief after MVD for those with typical TN was excellent in 73% and good in an additional 7%, for an overall significant pain relief in 80% of patients. In contrast, following MVD for atypical TN, the long-term results were excellent in only 35% of cases and good in an additional 16%, for overall significant pain relief in only 51%. Memorable onset and trigger points were predictive of better postoperative pain relief in both atypical and typical TN. Preoperative sensory loss was a negative predictor for good long-term results following MVD for atypical TN.

PMID: 11883838

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