• The Korean Journal of Pain
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• 제22권2호
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• pp.167-170
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• 2009

Pharmacological management is the first choice for treatment of the trigeminal neuralgia patients; however, if this mode of treatment fails a minimally invasive procedure should be performed. One of the most commonly used procedures is conventional radiofrequency lesioning of the Gasserian ganglion. Despite its popularity and success rate, this technique has disadvantages such as diminished corneal reflex, masseter weakness, numbness and anesthesia dolorosa. As a result, many studies have been conducted in an attempt to find a better method of treating trigeminal neuralgia. We report here a case of a trigeminal neuralgia patient that was treated with pulsed radiofrequency lesioning of the supraorbital and supratrochlear nerve due to pain in the frontal head that was refractory to the pharmacological treatments. Following the procedure, the Visual Analogue Scale score for pain decreased to 1-2/10 and the pain relief persisted for 7 months. These results indicate that pulsed radiofrequency treatment of the peripheral nerve may be useful for trigeminal neuralgia patients that do not respond to pharmacological treatments.

• The Korean Journal of Pain
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• 제27권3호
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• pp.260-265
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• 2014

Background: To evaluate the results of conventional radiofrequency thermorhizotomy (CRT) for trigeminal neuralgia (TN) in patients with failed medical management. Methods: Patients with Trigeminal neuralgia who were referred to us for 'limited intervention' during the time frame July-2011 to Jan-2013 were enrolled for this study. CRT was administered by the Sweet technique. Pain relief was evaluated by the principle investigator. Results: Eighteen patients were enrolled and completed a mean follow-up of 18.0 months. Pain relief was observed in 14 of 18 (77.8%) patients on the post-operative day, 14 of 18 (77.8%) at 1-month follow-up, 14 of 17 (82.4%) at 3-months follow-up, 12 of 15 (80%) at 6-months follow-up, 7 of 11 (63.6%) at 1-year follow-up and 2 of 6 (33.3%) 1.5 years of follow-up. Four patients required a repeat cycle of CRT; two at six months of follow-up and two at one year of follow-up. One patient was transferred for surgical intervention at six months of follow-up. Side-effects included facial hypoesthesia (n = 6); nausea/vomiting (n = 2), diminished corneal reflex (n = 13) and difficulty in chewing (n = 11). Severity of adverse effects gradually diminished and none of the patients who are beyond 6 months of follow-up have any functional limitation. Conclusions: CRT is an effective method of pain relief for patients with Trigeminal neuralgia. Successful outcome (excellent or good) can be expected in 66.7% of patients after first cycle of CRF. The incidence and severity of adverse effects is less and the procedure is better tolerated by the patients.

• Journal of Oral Medicine and Pain
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• 제40권1호
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• pp.35-40
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• 2015

Purpose: This study aims to assess the psychological characteristics of patients with iatrogenic damage of the trigeminal nerve using Symptom Checklist-90-Revised (SCL-90-R). Methods: A total of 22 patients who visited the clinic of Department of Oral Medicine, School of Dentistry, Chosun University were evaluated in the months from December 2012 to December 2014. Patients were included in the study if they presented with reported sensory changes due to iatrogenic trigeminal nerve injury. A total of 37 control group who has no symptoms of pain and sensory change were included in the study. All participants filled out the SCL-90-R instrument to assess psychosocial symptoms. Results: The T-scores of most of the SCL-90-R symptom dimensions were within normal range (less than 55) in the patients and the control group. The patients group showed higher T-scores of SCL-90-R than those of the control group, with statistically significance of somatization, anxiety, psychoticism, and positive symptoms distress. Female patients group had higher Tscores of SCL-90-R than those of male patients group, but there was no statistical difference, except for the positive symptom global index. The chronic patients group showed higher Tscores of SCL-90-R than those of the acute patients group, but there was no statistical difference, except for the Positive symptom global index. Conclusions: According to the psychological assessment of iatrogenic trigeminal nerve injury patients using SCL-90-R, the patients group, as compared to the control group shows a significantly higher score for somatization, anxiety, and psychoticism. Therefore, assessment of psychological state would be considered to treat patients with iatrogenic trigeminal nerve injury.

• The Korean Journal of Physiology and Pharmacology
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• 제22권3호
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• pp.331-341
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• 2018

The aim of the present study was to examine the effects of preemptive analgesia on the development of trigeminal neuropathic pain. For this purpose, mechanical allodynia was evaluated in male Sprague-Dawley rats using chronic constriction injury of the infraorbital nerve (CCI-ION) and perineural application of 2% QX-314 to the infraorbital nerve. CCI-ION produced severe mechanical allodynia, which was maintained until postoperative day (POD) 30. An immediate single application of 2% QX-314 to the infraorbital nerve following CCI-ION significantly reduced neuropathic mechanical allodynia. Immediate double application of QX-314 produced a greater attenuation of mechanical allodynia than a single application of QX-314. Immediate double application of 2% QX-314 reduced the CCI-ION-induced upregulation of GFAP and p-p38 expression in the trigeminal ganglion. The upregulated p-p38 expression was co-localized with NeuN, a neuronal cell marker. We also investigated the role of voltage-gated sodium channels (Navs) in the antinociception produced by preemptive application of QX-314 through analysis of the changes in Nav expression in the trigeminal ganglion following CCI-ION. Preemptive application of QX-314 significantly reduced the upregulation of Nav1.3, 1.7, and 1.9 produced by CCI-ION. These results suggest that long-lasting blockade of the transmission of pain signaling inhibits the development of neuropathic pain through the regulation of Nav isoform expression in the trigeminal ganglion. Importantly, these results provide a potential preemptive therapeutic strategy for the treatment of neuropathic pain after nerve injury.

• 방사선산업학회지
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• 제12권4호
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• pp.337-341
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• 2018

Sector block is not used for Gamma Knife surgery in patients with generalized trigeminal neuralgia but sector block is used to reduce the dose reaching the brain stem when the trigeminal ganglgia and the 'Brain stem', radiation sensitive tissue, are adjacent. In the Gamma Knife surgical plan of this study, a surgical plan was established using a Leksell Gamma Plan 11. 1.0 (Elekta Instrument AB, Sweden) with one patient (Block unused, Brain stem dose No volume over 12 Gy, Case 1) who did not need a sector block and four patients (Block unused, Brain stem dose 12 Gy or more, Case 2~5) with a sector block. Magnetic resonance images were obtained by MPRAGE T1 and CISS Respectively. When the trigeminal ganglion is in close proximity to the brain stem, the brain stem volume is decreased when the sector block is used, while the treatment time was increased. In conclusion, This Study evaluates the usefulness of the Sector block in brain stem through Gamma Knife surgery in trigeminal neuralgia, which is considered to be the most important factor for the Gamma Knife surgery.

• Korean Journal of Radiology
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• 제23권8호
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• pp.821-827
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• 2022

Objective: To determine the anatomical characteristics of the petrous ridge and trigeminal nerve in trigeminal neuralgia (TN) without neurovascular compression (NVC). Materials and Methods: From May 2017 to March 2021, 66 patients (49 female and 17 male; mean age ± standard deviation [SD], 56.8 ± 13.3 years) with TN without NVC and 57 controls (46 female and 11 male; 52.0 ± 15.6 years) were enrolled. The angle of the petrous ridge (APR) and angle of the trigeminal nerve (ATN) were measured using magnetic resonance imaging with a high-resolution three-dimensional T2 sequence. Data on the symptomatic side were compared with those on the asymptomatic side in patients and with the mean measurements of the bilateral sides in controls. Receiver operating characteristic (ROC) analysis was conducted to evaluate the performance of APR and ATN in distinguishing TN patients from controls. Results: In TN patients without NVC, the mean ± standard deviation (SD) of APR on the symptomatic side (98.40° ± 19.75°) was significantly smaller than that of the asymptomatic side (105.59° ± 22.45°, p = 0.019) and controls (108.44° ± 15.98°, p = 0.003). The mean ATN ± SD on the symptomatic side (144.41° ± 8.92°) was significantly smaller than that of the asymptomatic side (149.67° ± 8.09°, p = 0.003) and controls (150.45° ± 8.48°, p = 0.001). The area under the ROC curve for distinguishing TN patients from controls was 0.673 (95% confidence interval [CI]: 0.579-0.758) for APR and 0.700 (CI: 0.607-0.782) for ATN. The sensitivity and specificity using the diagnostic cutoff yielding the highest Youden index were 81.8% (54/66) and 49.1% (28/57), respectively, for APR (with a cutoff score of 94.30°) and 65.2% (43/66) and 66.7% (38/57), respectively, for ATN (cutoff score, 148.25°). Conclusion: In patients with TN without NVC, APR and ATN were smaller than those in controls, which may explain the potential cause of TN and provide additional information for diagnosis.

• Journal of Korean Neurosurgical Society
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• 제29권5호
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• pp.650-658
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• 2000

Objective : To evaluate the role of Gamma Knife radiosurgery in essential and tumor-related(secondary) trigeminal neuralgia, outcomes of radiosurgery and microsurgery were compared each other. Methods : Five patients with essential trigeminal neuralgia underwent stereotactic radiosurgical treatment with Leksell Gamma Knife and twenty five patients were treated with microsurgery during the same period(1994. 1-1997. 6). A 4-mm collimator was used and REZ or proximal portion of trigeminal nerve was targeted with maximal dose of 60-72Gy. The mean follow-up after radiosurgery was 39.4 months and that after microsurgery was 47.9 months. Results : At the last follow-up, four patients(80%) had excellent(pain free) or good(50-90% pain relief) outcomes, one(20%) had poor control after radiosurgical treatment. Twenty-three patients(92%) had excellent or good outcomes and two(8%) had poor results after microsurgery. Postoperative complications occurred in ten(40%) with microsurgery, but there were no complications in patients with Gamma Knife radiosurgery. Six patients with secondary trigeminal neuralgia received radiosurgical treatment directed at their tumors, and three patients were surgically treated. Three of six(50%) patients treated with Gamma Knife had pain relief while two of three patients with surgical treatment showed immediate pain relief. Post-treatment complications were developed in two of six radiosurgical patients and in one of three surgical patients. Conclusion : Gamma Knife stereotactic radiosurgery may be considered as a useful and alternative option for the treatment of essential and secondary trigeminal neuralgia owing to of its safety and less complications. The preliminary results obtained in our series appear encouraging, although the outcome is not so good as that of surgery.

• Journal of Dental Anesthesia and Pain Medicine
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• 제24권4호
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• pp.227-243
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• 2024

This study aimed to evaluate pain assessment strategies and factors associated with outcomes after microvascular decompression for the treatment of primary trigeminal neuralgia in adults. We conducted a systematic review and meta-analysis of English, Spanish, and French literature. We searched three databases, PubMed, Ovid, and EBSCO, from 2010 to 2022 and selected studies including patients with primary trigeminal neuralgia, clear pain assessment, and pain outcomes. Population means and standard deviations were calculated. Studies that included factors associated with postoperative outcomes were included in the meta-analysis. A total of 995 studies involving 5673 patients with primary trigeminal neuralgia following microvascular decompression were included. Patients with arteries compressing the trigeminal nerve demonstrated optimal outcomes following microvascular decompression (odds ratio [OR]= 0.39; 95% confidence interval [CI] = 0.19-0.80; X² = 46.31; Dof = 15; I² = 68%; P = < 0.0001). Conversely, when comparing arterial vs venous compression of the trigeminal nerve (OR = 2.72; 95% CI = 1.16-6.38; X² = 23.23; Dof = 10; I² = 57%; P = 0.01), venous compression demonstrated poor outcomes after microvascular decompression. Additionally, when comparing single-vessel vs multiple-vessel compression (OR = 2.72; 95% CI = 1.18-6.25; X² = 21.17; Dof = 9; I² = 57%; P = 0.01), patients demonstrated unfavorable outcomes after microvascular decompression. This systematic review and meta-analysis evaluated factors associated with outcomes following microvascular decompression (MVD) for primary trigeminal neuralgia (PTN). Although MVD is an optimal treatment strategy for PTN, a gap exists in interpreting the results when considering the lack of evidence for most pain assessment strategies.

• Journal of Korean Neurosurgical Society
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• 제29권9호
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• pp.1228-1232
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• 2000

목 적 : 본 연구는 삼차신경통에 대한 감마나이프 방사선 수술을 한 경우에 있어서 그 장기추적 결과를 분석하고자 하였다. 방 법 : 총 증례수는 11례였고 신경근 입구부(nerve root entry zone)에 수술의 목표점으로 최대량 67~85Gy를 조사하였다. 4mm collimator를 사용하였고 목표점은 뇌교의 표면으로부터 1~6mm 원위부 신경근에 위치하였다. 초기 3례에 있어서는 신경근과 뇌교가 만나는 접합부를 방사선수술의 목표점으로 삼았다. 이들 증례에서는 뇌교에 56 혹은 60Gy가 조사되었다. 후반 8례에서는 목표점을 다소 신경근의 원위부로 이동하여 뇌교의 가장자리가 최대량의 20% 이하로 조사되도록 계획하였다. 결 과 : 평균추적 기간은 25개월(13~50개월)이었다. 통증감소의 시작시점은 수술후 일주일내에서부터 길게는 5개월째였다. 통증의 치료결과는 삼례에서 완전소실, 3례에서 현격히 감소(80~90%)하였고 4례에서는 의미있게 감소하였다. 단 한례에서 최종추적결과 수술전과 같은 정도의 통증재발이 있었다. 전례에서 감마나이프 방사선수술과 관련된 의미있는 정도의 부작용은 관찰되지않았다. 결 론 : 장기추적 결과 감마나이프 방사선 수술이 삼차신경통의 치료에 효과적임이 관찰되었고 향후 이 질환에 대한 일차적 치료법으로 정하기 위하여 좀더 많은 치료경험이 필요할 것으로 사료된다.

• Restorative Dentistry and Endodontics
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• 제25권2호
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• pp.225-234
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• 2000

The purpose of this study was to investigate the distribution and fluorescene intensity of vasoactive intestinal polypeptide(VIP) immunoreactive cells in rat trigeminal ganglion after inferior alveolar nerve axotomy. The animals were divided into normal and two experimental groups. The experimental animals were sacrificed at 14th and 28th day after inferior alveolar nerve axotomy. The trigeminal ganglion was removed and immersed in the 4% paraformaldehyde-0.2% picric acid in 0.1M phosphate buffer. Serial frozon sections about $16{\mu}m$ in thickness were cut with a cryostat. The immunofluorescence staining was performed. The rabbit anti-VIP(1 : 8,000) was used as primary antibody and fluorescene isothiocynate(FITC)-conjugated anti-rabbit IgG(1 : 80) as secondary antibody. The slides were observed under confocal laser scanning microscope. Three-dimensional images were constructed from 9 serial images(each $1{\mu}m$ in thickness) made by automatic optical sectioning. Unprocessed optical sections were obtained and stored on a optical disk. Color picture were printed by a video copy processor. The results were as follows; 1. The appearance of VIP immunoreactive cells in the mandibular part of trigeminal ganglion was 8.79${\pm}$1.99% in normal group and 39.16${\pm}$5.62% in 14 days, 16.25${\pm}$2.39% in 28 days after inferior alveolar nerve axotomy groups. 2. The relative fluorescence intensity of VIP immunoreactive cell bodies in the mandibular part of trigeminal ganglion was 134.40${\pm}$10.39 in normal group and 192.88${\pm}$14.06 in 14 days, 143.10${\pm}$5.02 in 28 days after nerve axotomy groups. Therefore, the relative fluorescence intensity of 14 days after nerve axotomy group was 43.3% higher than intensity of normal group. 3. In optical single section analysis of VIP immunoreactive cell bodies, white cell bodies(moderate fluorescence intensity) were the most abundant in normal and 28 days after nerve axotomy groups. Whereas, in 14 days after nerve axotomy group, red cell bodies(high fluorescence intensity) were the most abundant. 4. In optical serial section analysis of VIP immunoreactive cell bodies, red cell bodies(high fluorescence intensity) were observed in a part of the 9 sections of normal and 24 days after nerve axotomy groups. Whereas, red cell bodies were observed in all of the 9 sections of 14 days after nerve axotomy group. 5. The results indicates that number and fluorescence intensity of VIP immunoreactive cells were increased in the mandibular part of trigeminal ganglion following inferior alveolar nerve axotomy.