Chinese expert consensus on minimally invasive interventional treatment of trigeminal neuralgia

Abstract

Background and purposeTrigeminal neuralgia is a common condition that is associated with severe pain, which seriously affects the quality of life of patients. When the efficacy of drugs is not satisfactory or adverse drug reactions cannot be tolerated, minimally invasive interventional therapy has become an important treatment because of its simple operation, low risk, high repeatability and low cost. In recent years, minimally invasive interventional treatments, such as radiofrequency thermocoagulation (RF) of the trigeminal nerve and percutaneous microcompression (PMC), have been widely used in the clinic to relieve severe pain in many patients, however, some related problems remain to be addressed. The Pain Association of the Chinese Medical Association organizes and compiles the consensus of Chinese experts to standardize the development of minimally invasive interventional treatment of trigeminal neuralgia to provide a basis for its clinical promotion and application.Materials and methodsThe Pain Association of the Chinese Medical Association organizes the Chinese experts to compile a consensus. With reference to the evidence-based medicine (OCEBM) system and the actual situation of the profession, the Consensus Development Committee adopts the nominal group method to adjust the recommended level.ResultsPrecise imaging positioning and guidance are the keys to ensuring the efficacy and safety of the procedures. RF and PMC are the most widely performed and effective treatments among minimally invasive interventional treatments for trigeminal neuralgia.ConclusionsThe pain degree of trigeminal neuralgia is severe, and a variety of minimally invasive intervention methods can effectively improve symptoms. Radiofrequency and percutaneous microcompression may be the first choice for minimally invasive interventional therapy.

Altered trends of local brain function in classical trigeminal neuralgia patients after a single trigger pain

“…Neurovascular compression (NVC) on the trigeminal nerve root [ 4 , 7 ] was hypothesized to be the etiology of CTN, which may relate to ectopic impulses caused by demyelination and regeneration of trigeminal nerve after compression [ 12 ]. But some healthy controls (HCs) and the unaffected side of CTN also have NVC [ 13 ], so the NVC may be only one of the important factors of CTN.…”

Alteration of brain network centrality in CTN patients after a single triggering pain

“…According to the etiology of TN, it is classified into three subtypes, which are classical trigeminal neuralgia (CTN), secondary trigeminal neuralgia (STN) and idiopathic trigeminal neuralgia (ITN) ( Olesen, 2018 ). CTN is a common chronic facial neurogenic disease, characterized by paroxysmal, electric shock-like pain along the trigeminal nerve branches area ( Cruccu et al, 2020 ; Fan et al, 2022a ). This pain is often triggered by non-noxious stimuli, including talking and chewing ( Cruccu et al, 2020 ), and the pain duration often seconds to a few minutes ( Shankar Kikkeri and Nagalli, 2022 ), while a small number of patients present sustainable pain ( Di Stefano et al, 2020 ), and in the pain interval, often, there is no pain attack ( Wang et al, 2017a ).…”

Brain entropy changes in classical trigeminal neuralgia

“…Classical trigeminal neuralgia (CTN) is a prevalent and debilitating chronic neuropathic facial pain disorder (1). This condition is characterized by sudden and intense facial pain episodes, often triggered by seemingly harmless activities like eating, talking, or teeth brushing (2,3). CTN significantly impacts the quality of life and daily functioning of those affected, highlighting the need for a deeper comprehension of its underlying pathological mechanisms, however, its precise pathological mechanisms remain elusive (4,5).…”