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PostPosted: 22 Apr 2013 01:12 
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Trigeminal Neuralgia

Trigeminal neuralgia (TGN) is a disorder of the fifth cranial (trigeminal) nerve that causes severe piercing pain which is episodic affecting an area supplied by one or more branches of the nerve .It usually affects one half of the face but occasionally affects both sides. Women are more often affected than men. The mean annual incidence is stated to be 4 per 100 000 population.

Treatment usually starts with medication –anti-convulsant drugs, carbamazepine or gabapentin. If medication causes side effects or does not control the pain surgical intervention maybe necessary.

The neurosurgical procedures available are 1) injection of glycerol in to the trigeminal ganglion, 2) radiofrequency thermocoagulation of the nerve, 3)balloon compression of the nerve.

Surgical procedure that might be considered is microvascular decompression of the vessel pressing on the nerve. All surgical procedures do carry a certain amount of risk.

Treatment that should be considered for older patients or patients who are not suitable for surgery isGamma knife radiosurgery. This involves precisely aiming a beam of radiation at the trigeminal nerve to destroy it. This is considered to be safe and does not need insertion of a needle or even an incision and no anaesthetic is required.

In the Journal of Neurosurgery 2005 March, Sheehan J, Pan HC, Stroila M, Steiner L. report that in a study where 151 cases of TN were treated with Gamma Knife Surgery, pain relief was noted in 44% of patients. Some improvement was seen at 3 years in 70% of patients. They conclude that although GKS is not as effective as MVD it is a good option for those not suitable for surgery.

Brisman R. from The Columbia University Medical Center, New York reporting in Stereotact Funct Neurosurg. 2007 concludes that MVD is more likely than GKS to result in complete pain relief.

A You tube presentation of "Gama Knife" surgery - http://youtu.be/GXTxBd1AZYU


Last edited by Badri on 24 Mar 2019 20:00, edited 3 times in total.

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PostPosted: 25 Apr 2013 19:00 
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Hi Badri
Thank you for bringing up the discussion and treatment of Trigeminal Neuralgia! As we know it is a symptom than a diagnosis!
Recently I had a 50 years old gentleman with trigeminal neuralgia and MRI confirmed that he had ACC at the base of the skull infiltrating the trigeminal nerve. He promptly underwent the base of skull surgery at a very reputed centre with excellent prognosis as it was diagnosed in time.
''Adenoid cystic carcinomas are malignant epithelial neoplasms that arise from the salivary glands. These carcinomas can involve the nasopharynx, lacrimal glands, lung, trachea, mammary gland, and skin. The tumors are characterized by an insidious, aggressive, and invasive local growth. Distant metastases are common. Perineural spread along the trigeminal nerve and its branches renders the skull base and cavernous sinus susceptible to tumor invasion. Thus, there can be bony (skull base), meningeal, neural, and parenchymal involvement as a result of contiguous or perineural spread via the foramina of the skull base. The reported incidence of intracranial involvement ranges between 3 and 22%''
So I feel that we should be aware of such a condition when we are treating such clients!


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PostPosted: 28 Apr 2013 14:27 
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Thank you Jay,

You have brought out an important point when we make a diagnosis. Basic tests must be done first to rule out other possible conditions before you arrive at a definitive diagnosis.


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PostPosted: 24 Mar 2019 20:21 
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Results of Gama Knife surgery in Trigeminal Neuralgia was discussed in J Radiat Oncol. 2014; Published online 2013 Nov 20.

Thirty-six consecutive patients with medically intractable TN were reviewed. The incidence of early pain relief was high (80.5 %) and relief was noted in an average of 1.6 months after treatment. At minimum follow-up of 3 years, 67 % were pain free (BNI I) and 75 % had good treatment outcome. At a mean last follow-up of 69 months, 32 % were free from any pain and 63 % were free from severe pain. Bothersome post treatment facial numbness was reported in 11 % of the patients. A statistically significant correlation was found between age and recurrence of any pain with age >70 predicting a more favorable outcome after radiosurgery.

In conclusion they report that the success rate of GKRS for treatment of medically intractable TN declines over time with 32 % reporting ideal outcome and 63 % reporting good outcome. Patients older than age 70 are good candidates for radiosurgery. This data should help in setting realistic expectations for weighing the various available treatment options.


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