Chemical destruction of Gasserian ganglion by either alcohol or phenol has remained a popular form of treatment for tic pain. However, control of the lesion size is inaccurate and various complications have often resulted. With advent of radiofrequency generator, percutaneous coagulation of the Gasserian ganglion is now possible, and the need for open surgery or chemical destruction have been drastically reduced. We treated 3 cases of trigeminal neuralgia with the radiofrequency current. Modified Hartel's anterior appaorch for the injection of the Gasserian ganglion is utilized and the radiofrequency lesions were made in the second branches of the trigeminal nerve selectively preserving the touch sensation in our patients. We reviewed the literature and described the technical procedures.
Humans ; Phenol ; Sensation ; Tics ; Trigeminal Ganglion ; Trigeminal Nerve ; Trigeminal Neuralgia*

The infrared (IR) receptors in the pit organ of crotaline snakes are very sensitive to temperature. The sensitivity to IR radiation is much greater in crotaline snakes than in boid snakes because they have a thermosensitive membrane suspended in a pair of pits that comprise the pit organ. The vasculature of the pit membrane, which is located near IR-sensitive terminal nerve masses, the IR receptors, supplies the blood necessary to provide cooling and the energy and oxygen that the IR receptors require. The ophthalmic and maxillary branches of the trigeminal nerve innervate the pit membrane. In crotaline snakes, the trigeminal ganglion (TG) is divided into the ophthalmic and maxillomandibular ganglia; a prominent septum further separates the two divisions of the maxillomandibular ganglion. The TG neurons in the ophthalmic ganglion and the maxillary division of the maxillomandibular ganglion relay IR sensation to the brain. This article reviews the IR-sensitive pit organ and trigeminal sensory system structures in crotaline snakes.
Brain ; Crotalid Venoms ; Equipment and Supplies ; Ganglion Cysts ; Membranes ; Neurons ; Oxygen ; Sensation ; Snakes ; Trigeminal Ganglion ; Trigeminal Nerve

The radiofrequency has been used for percutaneous cordotomy in patient having intractable pain. Recently the use of this radiofrequency has been extended to include other neurosurgical procedures, which in the past were done with chemical agents or mechanical methods etc. We treated one case of trigeminal neuralgia with the radiofrequency. The gasserian ganglion was punctured through the foramen ovale using a modified Hartel technique and the radiofrequency lesion was made in the second and third branches of the right trigeminal nerve selectively. The postoperative result was satisfactory. We reviewed the literature and described the technical procedures and complications.
Cordotomy ; Foramen Ovale ; Humans ; Neurosurgical Procedures ; Pain, Intractable ; Trigeminal Ganglion ; Trigeminal Nerve ; Trigeminal Neuralgia*

Trigeminal neuralgia is characterized by recurrent episodes of intense lancinating pain affecting the face localized to the sensory supply areas of the trigeminal nerve. There is a lack of certainty regarding the etiology and pathophysiology of trigeminal neuralgia. The diagnosis of idiopathic typical trigeminal neuralgia requires the absence of clinically evident neurological deficit. Treatment must be individualized to each patient. Various trigeminal neural blockades can be options when medical therapy fails to relieve pain. Neural blockades include peripheral nerve branch blocks and intracranial nerve root or ganglion blocks such as RF thermocoagulation, percutaneous balloon compression and glycerol rhizolysis. Neural blockade with local anesthetics produces temporary effects, but neural blockade with neurolytics like alcohol lasts longer, around one or two years. They are very useful for patients with poor general condition or high risk. RF rhizotomy and balloon compression of trigeminal ganglion are relatively more invasive treatment options, but have more cost effectiveness with less serious complications compared to other surgical procedures. The continuous improvement of neural block techniques is necessary for better treatment of trigeminal neuralgia.
Anesthetics, Local ; Cost-Benefit Analysis ; Electrocoagulation ; Ganglion Cysts ; Glycerol ; Humans ; Peripheral Nerves ; Rhizotomy ; Trigeminal Ganglion ; Trigeminal Nerve ; Trigeminal Neuralgia

It is well known that trigeminal nerve injury causes hyperexcitability in trigeminal ganglion neurons, which become sensitized. Long after trigeminal nerve damage, trigeminal spinal subnucleus caudalis and upper cervical spinal cord (C1/C2) nociceptive neurons become hyperactive and are sensitized, resulting in persistent orofacial pain. Communication between neurons and non-neuronal cells is believed to be involved in these mechanisms. In this article, the authors highlight several lines of evidence that neuron-glial cell and neuron macrophage communication have essential roles in persistent orofacial pain mechanisms associated with trigeminal nerve injury and/or orofacial inflammation.
Cell Communication ; Cervical Cord ; Facial Pain ; Inflammation ; Macrophages ; Neurons ; Nociceptors ; Trigeminal Ganglion ; Trigeminal Nerve ; Trigeminal Nerve Injuries ; Trigeminal Nucleus, Spinal

OBJECTIVE: The objective is to describe the relationship of anatomical landmark required for the middle fossa approach to preservation of hearing. METHODS: Dissection of 16 fixed human cadaveric heads was performed. we identified a rhomboid-shaped middle fossa landmarks that serve as a guide to minimize cochlea injury. The points of this construct are as follows ; 1) the junction of the greater superficial petrosal nerve and the trigeminal nerve ; 2) the lateral edge of the porus trigemius ; 3) the intersection of the petrous ridge and arcuate eminence ; and 4) the intersection of the lines extended along the axes of the greater superficial petrosal nerve and arcuate eminence. Mean, minimum, and maximum measurements of all distances were determined. RESULTS: The average cochlea-geniculate ganglion distance measured in the dissected specimens was 3.0+/-0.8mm with a range of 1.2 to 4.1mm. The average cochlea-petrous carotid genu distance was 2.9+/-0.9mm with a range of 1.2 to 4.0mm. The average cochlea-internal acoustic meatus distance measured in the dissected specimens was 9.0+/-0.5mm with a range of 7.8-10.9mm. The average cochlea-mandibular nerve distance measured was 9.4+/-0.4mm with a range of 7.6-11.3mm. CONCLUSION: The middle fossa approach requires special knowledge of the anantomy to reduce the risk of damage to cochlea. It is important that the surgeon understand the surgical anantomy. The present study describes the simple geometric construct that proposes to assist in locating the cochlea.
Acoustics ; Cadaver ; Cochlea ; Ganglion Cysts ; Head ; Hearing ; Humans ; Trigeminal Nerve

No abstract available.
Animals ; Immunohistochemistry ; Ion Channels ; Neurons ; Rats ; Trigeminal Ganglion

The deleted in colorectal cancer (DCC) protein mediates attractant responses to netrin during axonogenesis. In the rat trigeminal ganglia (TG), axons must extend toward and grow into the trigeminal nerve to innervate target tissues such as dental pulp. Our present study aimed to investigate the expression of DCC in the TG. Four developmental timepoints were assessed in the experiments: postnatal days 0, 7 and 10 and adulthood. RT-PCR and western blotting revealed that the expression of DCC mRNA and protein does not significantly change throughout development. Immunohistochemistry demonstrated that DCC expression in the TG was detectable in the perikarya region of the ganglion cells during development. Nerve injury at 3 and 5 days after the mandibular nerve had been cut did not induce altered expression of DCC mRNA in the TG. Moreover, DCC-positive cell bodies also showed similar immunoreactive patterns after a nerve cut injury. The results of this study suggest that DCC constitutively participates in an axonogenesis attractant in ways other than expression regulation.
Animals ; Axons ; Blotting, Western ; Colorectal Neoplasms ; Dental Pulp ; Ganglion Cysts ; Immunohistochemistry ; Mandibular Nerve ; Rats ; RNA, Messenger ; Trigeminal Ganglion ; Trigeminal Nerve

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.
Anesthesia ; Head ; Humans ; Hypesthesia ; Peripheral Nerves ; Pulsed Radiofrequency Treatment ; Reflex ; Trigeminal Ganglion ; Trigeminal Neuralgia

Neurinomas of the trigeminal nerve are relatively rare tumors that are arising from the gasserian ganglion or trigeminal nerve root and constitute 0.2% of all brain tumors. Although the most common clinical feature is the signs of trigeminal nerve involvement, the symptoms and signs are so variable that middle fossa syndrome, symptoms and signs of cerebellopontine angle tumor, cerebellar and brain stem compression may be developed sequentially through the extension of tumor. Radiological studies such as plain skull x-ray, angiogram and pneumoencephalogram are known to be helpful, but now the CT scan gives the early detection of the small tumors as well as the definite diagnostic clues and anatomical location. The profusely and beautifully illustrated one hundred thirty one cases that have been found from the literature are reviewed. Authors present four cases of neurinoma of the trigeminal nerve operated during recent one year with the analysis of clinical features, comparing with the cases reviewed from the literature.
Brain Neoplasms ; Brain Stem ; Neurilemmoma* ; Neuroma, Acoustic ; Skull ; Tomography, X-Ray Computed ; Trigeminal Ganglion ; Trigeminal Nerve*