Microvascular Decompression Treatment for Trigeminal Neuralgia

Chakravarthi, P. Srinivas; Ghanta, Rajesh K; Kattimani, Vivekanand

doi:10.1097/scs.0b013e31821a07b7

Cited by 46 publications

(34 citation statements)

References 18 publications

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“…3 The pathophysiologic mechanisms of trigeminal neuralgia are not fully understood, but fortunately valuable pharmacological and surgical treatments have been developed. Most patients improve with oral medications including carbamazepine, 4 but in some cases, invasive procedures including neurovascular decompression, 5 gamma knife stereotactic radiosurgery, 6 percutaneous radiofrequency thermocoagulation, and partial sensory rhizotomy 7 may be required. Unfortunately, some patients continue to have persistent or recurrent painful attacks even despite multiple operations.…”

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confidence: 99%

Acute Treatment of Trigeminal Neuralgia With Onabotulinum Toxin A

Zúñiga¹,

Piedimonte²,

Díaz³

et al. 2013

Clinical Neuropharmacology

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A double-blind, randomized, placebo-controlled study of patients with essential trigeminal neuralgia and treatment with a single injection of onabotulinum toxin A (BTX) was carried out. The efficacy, safety, and tolerability of either 1 mL 0.9% saline plus 50 U of BTX or only 1 mL of 0.9% saline injected subcutaneously in the affected area were evaluated. Cases with involvement of the third branch of the trigeminal nerve also received intramuscularly either 10 U of BTX or matching placebo in the masseter muscle, ipsilateral to the pain location. Pain was assessed with the visual analog scale (VAS). Twenty subjects were administered BTX, and 16 subjects received placebo. Two months after the intervention, a trend to statistical significance was observed for the VAS mean values in subjects treated with BTX and those who received placebo (VAS 4.9 vs 6.63, t test, P = 0.07). Three months after the injection, significant differences were observed in the average VAS score for subjects treated with BTX and those treated with placebo (VAS 4.75 vs 6.94, respectively; t test, P = 0.01). Onabotulinum toxin A was well tolerated and seems to be a safe and useful therapy for patients with essential trigeminal neuralgia.

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confidence: 99%

Acute Treatment of Trigeminal Neuralgia With Onabotulinum Toxin A

Zúñiga¹,

Piedimonte²,

Díaz³

et al. 2013

Clinical Neuropharmacology

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“…[4–7] Micro-vascular decompression (MVD) is a well-known surgical treatment for TN. [89] Radiosurgery for TN has been performed either as a frame based or as a frameless radiosurgery. Frame based is an invasive method while frameless is a noninvasive method.…”

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confidence: 99%

Dosimetric analysis of trigeminal nerve, brain stem doses in CyberKnife radiosurgery of trigeminal neuralgia

Sudahar¹,

Kurup²,

Murali³

et al. 2012

J Med Phys

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CyberKnife radiosurgery treatment of Trigeminal neuralgia (TN) is performed as a non-invasive image guided procedure. The prescription dose for TN is very high. The brainstem is the adjacent critical organ at risk (OAR) which is prone to receive the very high target dose of TN. The present study is to analyze the dose distribution inside the tiny trigeminal nerve target and also to analyze the dose fall off in the brain stem. Seven TN cases treated between November 2010 and January 2012 were taken for this study retrospectively. The treatment plans were analyzed for target dose conformity, homogeneity and dose coverage. In the brainstem the volume doses D1%, D2% were taken for analyzing the higher doses in the brain stem. The dose fall off was analyzed in terms of D5% and D10%. The mean value of maximum dose within the trigeminal nerve target was 73.5±2.1Gy (P=0.0007) and the minimum dose was 50.0±4.1Gy (P=0.1315). The mean conformity index was 2.19 and the probable reason could be the smallest CyberKnife collimator of 5mm used in the treatment plan. The mean D1%, of the brainstem was 10.5± 2.1Gy (P=0.5316) and the mean value of the maximum point dose within the brainstem was 35.6±3.8Gy. This shows the degree of dose fall off within the brainstem. Though the results of the present study are showing superior sparing of brain stem and reasonable of target coverage, it is necessary to execute the treatment plan with greater accuracy in CyberKnife as the immobilization is noninvasive and frameless.

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“…Surprisingly, the vascular conflict hypothesis is not discussed in this paper. Kakizawa et al noted a 49% rate of vascular contact trigeminal nerves in a magnetic resonance imaging (MRI) study of 220 nerves; the superior cerebellar artery was the most frequent cause of compression (67.5%) (3). In the literature, we have also found descriptions of the venous conflict hypothesis.…”

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confidence: 99%

“…The transverse pontine vein could be a causative factor of venous origin in the pathogenesis of trigeminal neuralgia (5). To complete the vascular conflict hypothesis, regardless of the MRI results (normal or vascular conflict), 40 patients with trigeminal neuralgia underwent microvascular decompression surgery (3), 92.5% of whom were pain-free and did not require any medical treatment. These results demonstrate vascular conflict empiracally and must be seriously explored.…”

mentioning

confidence: 99%