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

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.
Follow-Up Studies ; Humans ; Hypesthesia ; Incidence ; Mastication ; Reflex ; Research Personnel ; Trigeminal Ganglion ; Trigeminal Neuralgia*

A consecutive series of 16 patients with trigeminal neurinoma have been managed surgically at seoul National University Hospital duriny the last nine years. Five patients had tumors confined to the middle fossa arising from the trigeminal ganglion, four had posterior fossa tumors arising from the trigeminal root, and seven had "dumbbell" lesions extending above and below the tentorium. In four patients, tumor had also invaded cavernous sinus. A two stage operation was done in two cases with "dumbbell"-shaped tumors. A total tumor excision was achieved in ten patients ; all remain free of recurrence 4 to 77 months after surgery. A subtotal tumor excision was performed in six cases. There were no operative deaths nor major morbidity. Trigeminal nerve dysfunction persisted or was aggravated in ten cases. Six patients had preserved or improved the trigeminal function after treatment. Selection of the appropriate surgical approaches to the various types of tumor location and growth pattern was important for successful operations.
Cavernous Sinus ; Humans ; Infratentorial Neoplasms ; Neurilemmoma* ; Recurrence ; Seoul ; Trigeminal Ganglion ; Trigeminal Nerve