Trigeminal neuralgia; difficulties during surgery without proir MRI screening

A retrospective study of 40 cases of Trigeminal Neuralgia who were treated surgically [by MVD, micro-vascular decompression]. Department of Neurosurgery Quaid-l-Azam Medical College/Bahawal Victoria Hospital Bahawalpur during four [4] year period from January 2003 to December 2006 These patients were resistant to medical treatment so MVD was performed. Methods Total number of patients is [40] forty. In 10 patients CT scan brain and especially for posterior fossa was performed before surgery to rule out any suspected tumour pathology. In the remaining 30 cases no MRI or CT scanning of brain was done before surgery and diagnosis of Trigeminal Neuralgia was made on clinical grounds. Posterior fossa was opened by standard right or left retro-mastoid approach depending upon the side of pain. In 27 out of 40 cases the superior cerebellar artery [SCA] was the offending vessel. In 5 cases, only the vein was the cause of pain. In 2 cases, vein and artery, both were the offending vessels. In 2 cases, only arachnoidal adhesions were the cause of pain. And in 4 cases, after opening the posterior fossa it was found that cause of pain is a tumour of trigeminal nerve [3 cases] or meningioma [1 case] of cerebellopontine angle. From these operative findings of tumours in the posterior fossa in cases of Trigeminal Neuralgia, it is concluded that all the patients suffering from Trigeminal Neuralgia should be screened with MRI prior to surgery to rule out any tumour pathology as a cause of Trigeminal Neuralgia, so that proper preparations be made before surgical intervention

Psychological evaluation and cope with trigeminal neuralgia and temporomandibular disorder / Avaliação psicológica e enfrentamento na neuralgia trigeminal e disfunção temporomandibular

OBJECTIVE: To determine the psychological aspects of orofacial pain in trigeminal neuralgia (TN) and temporomandibular disorder (TMD), and associated factors of coping as limitations in daily activities and feelings about the treatment and about the pain. METHOD: 30 patients were evaluated (15 with TN and 15 with TMD) using a semi-directed interview and the Hospital Anxiety Depression (HAD) scale. RESULTS: TN patients knew more about their diagnosis (p<0.001). Most of the patients with TN considered their disease severe (87 percent), in opposite to TMD (p=0.004); both groups had a high level of limitations in daily activities, and the most helpful factors to overcome pain were the proposed treatment followed by religiosity (p<0.04). Means of HAD scores were 10.9 for anxiety (moderate) and 11.67 for depression (mild), and were not statistically different between TMD and NT (p=0.20). CONCLUSION: TN and TMD had similar scores of anxiety and depression, therefore patients consider TN more severe than TMD. Even with higher limitations, patients with TN cope better with their disease then patients with TMD.

OBJETIVO: Comparar aspectos psicológicos de dor orofacial entre neuralgia trigeminal (NT) e disfunção temporomandibular (DTM), e repercussões em atividades diárias, enfrentamento a representação da dor. MÉTODO: 30 pacientes foram avaliados (15 com NT, 15 com DTM) utilizando entrevista semi-dirigida e a Escala Hospitalar de Ansiedade e Depressão (HAD). RESULTADOS: Pacientes com NT sabiam melhor sobre seu diagnóstico (p<0,001). A maioria destes considerou sua doença grave (87 por cento), em oposição a pacientes com DTM (p=0,004); ambos tiveram um alto nível de limitações durante atividades diárias, e o tratamento seguido da religiosidade foram considerados os aspectos mais positivos para superação da dor (p<0,04). Não houve diferença estatística entre os grupos quanto a HAD (p=0,20), sendo a média dos índices foi 10,9 para ansiedade (moderada) e 11,67 para depressão (leve). CONCLUSÃO: Tanto pacientes com NT como pacientes com DTM apresentaram níveis semelhantes de ansiedade e depressão, entretanto pacientes com NT consideram sua doença mais grave do que os outros doentes. Mesmo com alto grau de limitações, seu enfrentamento da doença é melhor do que o enfrentamento de doentes com DTM.

Treatment of atypical trigeminal neuralgia with microvascular decompression.

AIM: To explore the methods for achieving pain relief in patients with atypical trigeminal neuralgia (TN) using microvascular decompression (MVD). STUDY DESIGN AND SETTINGS: Retrospective study of 26 patients treated during the years 2000 to 2004. MATERIALS AND METHODS: Twenty-six patients in whom vascular compression of the trigeminal nerve was identified by high definition magnetic resonance tomographic angiography (MRTA) were treated with MVD for atypical TN in our department. Clinical presentations, surgical findings and clinical outcomes were analyzed retrospectively. RESULTS: In this study, single trigeminal division was involved in only 2 patients (8%) and two or three divisions in the other 24 patients (92%). Of prime importance is the fact that in 46.2% of the patients, several conflicting vessels were found in association. Location of the conflicts around the circumference of the trigeminal root was supero-medial to the root in 53.5%, supero-lateral in 30.8% and inferior in 15.7%. MVD for atypical TN resulted in complete pain relief in 50% of the patients with complete decompression, partial pain relief in 30.8% and poor pain relief or pain recurrence in 19.2% of the patients without complete decompression postoperatively. CONCLUSIONS: Complete decompression of the entire trigeminal root plays an important role in achieving pain relief in patients with atypical TN with MVD.

Avaliação funcional mandibular e sensitiva orofacial de doentes com neuralgia trigeminal tratados com compressão do gânglio trigeminal com balão / Sensitive and functional evaluation of the orofacial region of patients with trigeminal neuralgia treated with balloon compression

Esse trabalho teve como objetivos avaliar as características odontológicas, verificar a ocorrência de complicações sensitivas orofaciais e determinar os aspectos funcionais mandibulares de 105 doentes com neuralgia idiopática do trigêmeo (NIT) submetidos 'a compressão radiculo-ganglionar com balão inflável. Foram realizadas 5 avaliações para cada doente: uma pré-cirúrgica e 4 pós-cirúrgicas (7, 30, 120 e 210 dias). Ocorreu comprometimento sensitivo mais intenso no território dos ramos maxilar e mandibular do nervo trigêmeo (p < 0,001) e poucas anormalidades no território do ramo oftálmico (p = 0,1815). As qualidades sensitivas calor, frio, tato, e dor foram afetadas. As queixas subjetivas de dormência foram mais frequentes do que as objetivadas durante o exame de sensibilidade facial (p < 0,001). foi elevada a ocorrência de disfunção oclusal (62,9%); 42,6% dos doentes apresentaram queixas espontâneas relacionadas à mastigação; houve intensificação da dor miofascial na musculatura mastigatória após a cirurgia (p < 0,001), que retornou aos valores iniciais após os 210 dias; a mobilidade mandibular também agravou-se (p < 0,001). Os autores concluiram que o procedimento é eficaz e seguro quando aplicado em doentes com NIT envolvendo o ramo oftálmico. Entretanto, recidiva é frequente e as complicações sensitivas e ou motoras orofaciais poderiam comprometer a qualidade de vida e dificultar a reabilitação funcional dos doentes.

The aim of this study was to determine dental characteristics, abnormalities in masticatory function and ocurrence of orofacial sensorial complications in 105 patients with trigeminal neuralgia treated with radiculo-ganglionar compression of the trigeminal ganglion with balloon. The patients were evaluated in the pre-operative period and in 4 post-operative evaluations (7, 30, 120 and 210 days). Sensory deficits were more severe in the area innervated by the maxillary and the mandibular trigeminal branches (p < 0.001); the ophthalmic branch presented abnormalities in few cases. The sensory qualities heat, cold, tactile and pain were affected. Subjective numbness was more frequent than sensory abnormalities findings at the post-operative sensitive evaluation (p < 0.001). Dental occlusion abnormalities were observed in 62.9% of the patients and 42.6% of patients' complaints were spontaneous masticatory difficulties. During the post-operative period, myofascial pain of the masticatory muscles was statistically significant (p < 0.001), but normalized after 210 days in average. It also compromised the jaw mobility (p < 0.001). It was concluded that this procedure is safe for patients with idiopathic trigeminal neuralgia involving the ophthalmic branch; however, sensory and motor complications of the method can affect the quality of life and rehabilitation of the patient.

Bloqueo del ganglio de Gasser / Gasserian ganglion block

El presente artículo está referido al Bloqueo del Ganglio de Gasser como técnica terapéutica, para tratar el dolor de origen crónico, considerado en pacientes con neuralgia trigeminal, Ca de cara y Globo ocular técnica a ser utilizada cuando se han agotado esquemas terapéuticos convencionales para tratamientos de dolor crónico oncológico y no oncológico. Varias condiciones terapéuticas deben optarse previa su realización. Se contará con disponibilidad de recursos humanos y técnicos aptos para su realización, considerando la expectativa de vida, en los grupos de pacientes en los que se considera su práctica.

Diangóstico diferencial del dolor orofacial III. Asociado a desórdenes neuropáticos / Differential diagnosis of orofacial pain III. Associated with neuropathic disorders

Este es el último de tres artículos que tienen como propósito presentar una revisión de la literatura sobre las condiciones que se han considerado para el establecimiento del diagnóstico diferencial del dolor orofacial (DOF). En este artículo se discuten los desórdenes neuropáticos de tipo episódico (neuralgia trigeminal, neuralgia glosofaríngea, neuralgia occipital) y continuo (neuritis, neuralgia postherpética, dolor por deaferentación y los dolores atípicos). A través de estos tres artículos, las principales características clínicas de las diferentes condiciones de DOF han sido presentadas. Esas características se usan para realizar una comparación sistemática con los hallazgos clínicos del paciente, lo cual proveerá las bases para establecer el correcto diagnóstico diferencial. Por lo tanto, independiente de conocer el tratamiento, el clínico debe estar familiarizado con la mayor cantidad posible de características clínicas de las diferentes condiciones de DOF

Cluster-tic syndrome: report of five new cases

The so-called short lasting primary headaches include heterogenic entities that can be divided between those without pronounced autonomic activation and those where this activation is evident, which includes the cluster-tic syndrome. We report five new cases with age closer to the trigeminal neuralgia's one, and concomitance of cluster headache and trigeminal neuralgia, which is less frequent in the literature. We also discuss briefly the pathophysiology of these clinical entities, suggesting that the trigeminus nerve is a common pathway of pain manifestation.