Trigeminal neuralgia: definition and classification

Eller, Jorge L.; Raslan, Ahmed M.; Burchiel, Kim J.

doi:10.3171/foc.2005.18.5.4

Cited by 211 publications

(143 citation statements)

References 19 publications

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“…Nonetheless, patients have also reported, to a lesser degree, sharp pain as typical-TN (Eller et al, 2005). For those patients, the mild to severe pain is usually constant, with a characteristic after-sensation.…”

Section: Atypical Trigeminal Neuralgia (Atypical-tn)mentioning

confidence: 99%

“…Hence, injuries at the medial and anterior parts of the ganglion mostly lead to pain in V1, caudal and lateral injuries produce pain at V3, and intermediate injuries pain in V2 (Cusick, 1981;Bullitt et al, 1986;Nomura et al, 1994;Borsook et al, 2003;Eller et al, 2005). Conversely, lesions closer to and beyond the REZ will obey central pain somatotopy, which resembles the onionskin pattern.…”

Section: Trigeminal Ganglion and Rootmentioning

confidence: 99%

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The Role of Sensory Fiber Demography in Trigeminal and Postherpetic Neuralgias

DaSilva

DosSantos

2011

J Dent Res

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A supplemental appendix to this article is published electronically only at http://jdr.sagepub.com/supplemental. AbstrActIn this study, we systematically investigated fiber demography, based on function and distribution, from the periphery to their destinations in the various central (sub) nuclei in the trigeminal brainstem nuclear sensory complex. Conventional and novel compelling information is provided, demonstrating that the ratio and somatotopy of types A and C sensory fibers at the site of a lesion can elucidate important puzzles in TNP disorders. For instance, we explain how of a major shift in the fibers' direction and ratio at the level of the trigeminal root entry zone (REZ) influences the pathophysiology of preand typical trigeminal neuralgia. As a result, there is a high A/C ratio of oral and peri-oral fibers in the supero-medial region of the REZ, which is mostly susceptible to vascular compression. However, this A/C ratio varies considerably at lower proportions in other areas along the peripheral trigeminal pathway, where an injury (viral, vessel compression, or trauma) can lead to a broader spectrum of fiber involvement and, consequently, pain outcome. In summary, we explain how fiber demography can influence pain quality, location, temporal features, progress, and treatment prognosis of TNP in those patients who develop it.

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Section: Atypical Trigeminal Neuralgia (Atypical-tn)mentioning

confidence: 99%

Section: Trigeminal Ganglion and Rootmentioning

confidence: 99%

The Role of Sensory Fiber Demography in Trigeminal and Postherpetic Neuralgias

DaSilva

DosSantos

2011

J Dent Res

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“…10 Evaluation of the type of TN was made according to the classifications proposed by Eller et al 7 and comprised idiopathic TN1 and TN2. TN1 is described as typically sharp, shooting, electrical shock like, with pain-free intervals between attacks that is present for more than 50% of the time; TN2 is described as an ach-ing, throbbing, or burning pain that is present for more than 50% of the time and is constant in nature (constant background pain being the most significant attribute).…”

Section: Society Definitionmentioning

confidence: 99%

Long-term safety and efficacy of Gamma Knife surgery in classical trigeminal neuralgia: a 497-patient historical cohort study

Régis

Tuleasca

Resseguier

et al. 2016

JNS

143

126

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OBJectiVe Gamma Knife surgery (GKS) is one of the surgical alternatives for the treatment of drug-resistant trigeminal neuralgia (TN). This study aims to evaluate the safety and efficacy of GKS in a large population of patients with TN with very long-term clinical follow-up. methOdS Between July 1992 and November 2010, 737 patients presenting with TN were treated using GKS. Data were collected prospectively and were further retrospectively evaluated at Timone University Hospital. The frequency and severity of pain, as well as trigeminal nerve function, were evaluated before GKS and regularly thereafter. Radiosurgery using the Gamma Knife (model B, C, 4C, or Perfexion) was performed with the help of both MR and CT targeting. A single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 7.6 mm (range 4-14 mm) anterior to the emergence of the nerve (retrogasserian target). A median maximum dose of 85 Gy (range 70-90 Gy) was prescribed. reSultS The safety and efficacy are reported for 497 patients with medically refractory classical TN who were never previously treated by GKS and had a follow-up of at least 1 year. The median age in this series was 68.3 years (range 28.1-93.2 years). The median follow-up period was 43.8 months (range 12-174.4 months). Overall, 456 patients (91.75%) were initially pain free in a median time of 10 days (range 1-180 days). Their actuarial probabilities of remaining pain free without medication at 3, 5, 7, and 10 years were 71.8%, 64.9%, 59.7%, and 45.3%, respectively. One hundred fifty-seven patients (34.4%) who were initially pain free experienced at least 1 recurrence, with a median delay of onset of 24 months (range 0.6-150.1 months). However, the actuarial rate of maintaining pain relief without further surgery was 67.8% at 10 years. The hypesthesia actuarial rate at 5 years was 20.4% and at 7 years reached 21.1%, but remained stable until 14 years with a median delay of onset of 12 months (range 1-65 months). Very bothersome facial hypesthesia was reported in only 3 patients (0.6%). cONcluSiONS Retrogasserian GKS proved to be safe and effective in the long term and in a very large number of patients. Even if the probability of long-lasting effects may be modest compared with microvascular decompression, the rarity of complications prompts discussion of using GKS as the pragmatic surgical first- or second-intention alternative for classical TN. However, a randomized trial, or at least a case-matched control study, would be required to compare with microvascular decompression.http://thejns.org/doi/abs/10.3171/2015.2.JNS142144

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“…We have proposed a classification scheme that defines classic symptoms (electric shock-like, lancinating) as Type 1 TN, and more that 50% constant symptoms (aching, throbbing, or burning) as Type 2 TN. 3,7 It is likely that this and other pain characteristics are predictive of postoperative outcome. The purpose of this study is to identify the preoperative characteristics of TN (type of pain, trigger points, pain-free intervals, response to AEDs, and memorable onset) more likely to be associated with immediate and long-term pain relief after MVD.…”

mentioning

confidence: 99%

“…Patients report a wide spectrum of symptoms, from episodic lancinating pain to constant burning pain. 3,4,7,13 Classic characteristics of TN such as presence of trigger points, memorable onset of pain, pain-free intervals lasting weeks to years, and response to AEDs are absent in many patients. For some, pain is maximal at onset, while others report progression over time.…”

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confidence: 99%

Predictors of long-term success after microvascular decompression for trigeminal neuralgia

Miller

Magill

Acar

et al. 2009

JNS

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Object. Microvascular decompression (MVD) is an effective treatment for trigeminal neuralgia (TN). However, many patients do not experience complete pain relief, and relapse can occur even after an initial excellent result. This study was designed to identify characteristics associated with improved long-term outcome after MVD.Methods. One hundred seventy-nine consecutive patients who had undergone MVD for TN at the authors' institution were contacted, and 95 were enrolled in the study. Patients provided information about preoperative pain characteristics including preponderance of shock-like (Type 1 TN) or constant (Type 2 TN) pain, preoperative duration, trigger points, anticonvulsant therapy response, memorable onset, and pain-free intervals. Three groups were defined based on outcome: 1) excellent, pain relief without medication; 2) good, mild or intermittent pain controlled with low-dose medication; and 3) poor, severe persistent pain or need for additional surgical treatment.Results. Type of TN pain (Type 1 TN vs Type 2 TN) was the only significant predictor of outcome after MVD. Results were excellent, good, and poor for Type 1 TN versus Type 2 TN patients in 60 versus 25%, 24 versus 39%, and 16 versus 36%, respectively. Among patients with each TN type, there was a significant trend toward better outcome with greater proportional contribution of Type 1 TN (lancinating) symptoms (p < 0.05).Conclusions. Pain relief after MVD is strongly correlated with the lancinating pain component, and therefore type of TN pain is the best predictor of long-term outcome after MVD. Application of this information should be helpful in the selection of TN patients likely to benefit from MVD. (DOI: 10.3171/2008.9.17660) Key WorDS • facial pain • microvascular decompression • trigeminal neuralgiaAbbreviations used in this paper: AED = anticonvulsant drug; MVD = microvascular decompression; TN = trigeminal neuralgia.

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Trigeminal neuralgia: definition and classification

Cited by 211 publications

References 19 publications

The Role of Sensory Fiber Demography in Trigeminal and Postherpetic Neuralgias

The Role of Sensory Fiber Demography in Trigeminal and Postherpetic Neuralgias

Long-term safety and efficacy of Gamma Knife surgery in classical trigeminal neuralgia: a 497-patient historical cohort study

Predictors of long-term success after microvascular decompression for trigeminal neuralgia

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