Hemifacial Spasm ; etiology ; surgery ; Humans ; Trigeminal Neuralgia ; etiology ; surgery

OBJECTIVE: To evaluate the feasibility of surface tractotomy of trigeminal nerve sensory root (STS) for the treatment of trigeminal neuralgia (TN). METHOD: Seven patients with TN were operated on using the STS. The six patients were followed up for 4.8-9.8 years. The trigeminal nerve root (TNR) obtained from 30 cadavers were performed microanatomical research using paraffin embedding and hematoxylin-eosin staining technique. RESULT: Clinically, the patients' symptoms, such as face ache, disappeared after the surface nerve fiber bundles of trigeminal nerve sensory root (TNSR) were cut off. Only one patient died of brainstem bleeding on postoperative day 18. Histological examination: The common type of sensory root fibers were arranged parallel for 3-6 mm at its exit of brainstem, and then the glial myelin transformed to Schwann cells. The axon bifurcated from outer layer to middle region, and gradually formed the tiny nerve fiber bundles in the surface layer and the giant nerve fiber bundles in the center of the root. CONCLUSION TN can be radical cured by STS without lesioning of nerve functions. Therefore,this new approach is an effective, advanced surgical technique for TN treatment.
Aged ; Denervation ; methods ; Female ; Humans ; Male ; Middle Aged ; Trigeminal Nerve ; surgery ; Trigeminal Neuralgia ; surgery

OBJECTIVE: To investigate curative effect and importance of radiofrequency thermocoagulation onsemilunar ganglion of aged patients with recurrent trigeminal neuralgia. METHOD: 112 cases with recurrent trigeminal neuralgia were performed with radiofrequency thermocoagulation on semilunar ganglion by puncture through skin under local anesthesia. RESULT: The maintaining effective duration in 112 cases was 7.3 ± 1.3 years after primary therapy. After the first thermocoagulation, 89.28% (100/112) patients got the relief from pain immediately, 8 (7.14%) cases also recieved the same effect after twice treatment. However two cases (2.6%) had no effects. The total effective rate was 98.21%. During five follow-up years, VAS scores, dose of carbamazepine and satisfaction were better than those before the treatment. The effective rate was still over 57.5% within three years after the treatment. The recurrent risk increased obviously from 40 months after the treatment by Kaplan-Meier method. CONCLUSION Semilunar ganglion of radiofrequency thermocoagulation was an ideal option for old-age patients with trigeminal neuralgia. It can be performed repeatedly.
Aged ; Electrocoagulation ; Humans ; Recurrence ; Treatment Outcome ; Trigeminal Ganglion ; surgery ; Trigeminal Neuralgia ; surgery

OBJECTIVE: The microvascular decompression(MVD) for trigeminal neuralgia(TN) is known as an effective surgical technique. But the failed MVD cases have been reported in long term follow-up studies. This study is to evaluate the efficacy of MVD through our operative techniques, offending vessels in operative field, failed cases with the review of the literatures. METHODS: We analyzed total 63 cases of TN which underwent MVD from 1955 to 2003 according to characters of pain, operative findings, operative results related to causative vessel compression and operative method, progonotic factor. Statistical analysis was performed using paired t-test with SPSS Ver 11.0. RESULTS: In TN, the most common offending vessel was superior cerebellar artery(45.0%). In compression group of nerve root by offending vessel, the cure rate was 91.7%. However, the cure rate of the contact group was 64.7% and the cure rate of the negative group was 37.5%. There was no statistical significance between the degree of compression by vessel and the operative result(p=0.076). In 51 cases with MVD only, the cure rate was 84.3% and in 3 cases with PSR only, 42.8% and in 2 cases with PSR(partial sensory rhizotomy) with MVD, 50.0%. TN recurred in 7 cases within the follow-up period and reoperations(PSR) were added in 2 cases of them. CONCLUSION: This study shows that MVD provided a high rate of success with a minor risk of complications, which has been regarded as the most safe and effective procedure for trigeminal neuralgia. Additional MVD in recurred TN by severe adhesion of teflon showed poor outcome. But, revisional operation(PSR) in recurred TN showed relatively good outcome. PSR should be considered for treatment of recurrent TN after MVD.
Follow-Up Studies ; Microvascular Decompression Surgery* ; Polytetrafluoroethylene ; Trigeminal Neuralgia*

OBJECTIVE: Gamma knife radiosurgery (GKRS) is the least invasive surgical option for patients with trigeminal neuralgia (TN). However, the indications and long term outcomes of GKRS are still controversial. Additionally, a series with uniform long-term follow-up data for all patients has been lacking. In the present study, the authors analyzed long-term outcomes in a series of patients with TN who underwent a single GKRS treatment followed by a minimum follow-up of 60 months. METHODS: From 1994 to 2009, 40 consecutive patients with typical, intractable TN received GKRS. Among these, 22 patients were followed for >60 months. The mean maximum radiation dose was 77.1 Gy (65.2-83.6 Gy), and the 4 mm collimator was used to target the radiation to the root entry zone. RESULTS: The mean age was 61.5 years (25-84 years). The mean follow-up period was 92.2 months (60-144 months). According to the pain intensity scale in the last follow-up, 6 cases were grades I-II (pain-free with or without medication; 27.3%) and 7 cases were grade IV-V (<50% pain relief with medication or no pain relief; 31.8%). There was 1 case (facial dysesthesia) with post-operative complications (4.54%). CONCLUSION: The long-term results of GKRS for TN are not as satisfactory as those of microvascular decompression and other conventional modalities, but GKRS is a safe, effective and minimally invasive technique which might be considered a first-line therapy for a limited group of patients for whom a more invasive kind of treatment is unsuitable.
Follow-Up Studies ; Humans ; Microvascular Decompression Surgery ; Radiosurgery ; Trigeminal Neuralgia

A 66-year-old man presented with typical trigeminal neuralgia (TN). Magnetic resonance angiography (MRA) revealed a primitive trigeminal artery (PTA) that came into contact with the trigeminal nerve. Based on MRA, we performed microvascular decompression (MVD). In the operational field, we confirmed the PTA location and performed MVD successfully. Postoperatively, the patient's pain subsided without any complications.
Aged ; Arteries* ; Humans ; Magnetic Resonance Angiography ; Microvascular Decompression Surgery ; Trigeminal Nerve ; Trigeminal Neuralgia*

A 66-year-old man presented with typical trigeminal neuralgia (TN). Magnetic resonance angiography (MRA) revealed a primitive trigeminal artery (PTA) that came into contact with the trigeminal nerve. Based on MRA, we performed microvascular decompression (MVD). In the operational field, we confirmed the PTA location and performed MVD successfully. Postoperatively, the patient's pain subsided without any complications.
Aged ; Arteries* ; Humans ; Magnetic Resonance Angiography ; Microvascular Decompression Surgery ; Trigeminal Nerve ; Trigeminal Neuralgia*

Manipulation of the sensory branches of the trigeminal nerve is known to cause autonomic changes, such as bradycardia or asystole, known as the trigemino-cardiac reflex. In this case, the patient underwent microvascular decompression due to trigeminal neuralgia and developed sudden bradycardia, followed by abrupt asystole with a concurrent fall in the systolic blood pressure. There was spontaneous return of cardiac rhythm and blood pressure, but two more episodes of sinus bradycardia occurred during the surgery.
Blood Pressure ; Bradycardia ; Heart Arrest* ; Humans ; Microvascular Decompression Surgery* ; Reflex, Trigeminocardiac ; Trigeminal Nerve ; Trigeminal Neuralgia*

The authors report two cases of trigeminal neuralgia caused by epidermoid tumor in the cerebellopontine angle. The one case showed that trigeminal nerve was displaced superiorly by the tumor and was adhesed to the superior cerebellar artery. The other case showed that tumor mass encircled the facial, acoustic nerves as well as trigeminal nerve entirely and after removal of the tumor petrosal vein was found at the root entry zone of the trigeminal nerve. Interestingly these two cases were devoid of neurologic deficit. We tried microvascular decompression as well as removal of tumor and were satisfied with its result. We reviewed the literature and discussed these cases in point of mechanisms of trigeminal neuralgia.
Arteries ; Cerebellopontine Angle* ; Cochlear Nerve ; Microvascular Decompression Surgery ; Neurologic Manifestations ; Trigeminal Nerve ; Trigeminal Neuralgia* ; Veins

OBJECTIVES: Trigeminal neuralgia (TN) is undurable paroxysmal pain in the distribution of the fifth cranial nerve. Invasive treatment modalities for TN include microvascular decompression (MVD) and percutaneous procedures, such as, radiofrequency rhizotomy (RFR). Gamma Knife radiosurgery (GKRS) is a considerable option for patients with pain recurrence after an initial procedure. This study was undertaken to analyze the effects of gamma knife radiosurgery in recurrent TN after other procedures. METHODS: Eleven recurrent TN patients after other procedures underwent GKRS in our hospital from September 2004 to August 2016. Seven patients had previously undergone MVD alone, two underwent MVD with partial sensory rhizotomy (PSR), and two underwent RFR. Mean patient age was 60.5 years. We retrospectively analyzed patient's characteristics, clinical results, sites, and divisions of pain. Outcomes were evaluated using the Visual Analog Scales (VAS) score. RESULTS: Right sides were more prevalent than left sides (7:4). The most common distribution of pain was V1 + V2 division (n = 5) following V2 + V3 (n = 3), V2 (n = 2), and V1 + V2 + V3 (n = 1) division. Median GKRS dose was 80 Gy and the mean interval between the prior treatment and GKRS was 74.45 months. The final outcomes of subsequent GKRS were satisfactory in most cases, and at 12 months postoperatively ten patients (90.0%) had a VAS score of ≤ 3. CONCLUSIONS: In this study, the clinical result of GKRS was satisfactory. Invasive procedures, such as, MVD, RFR are initially effective in TN patients, but GKRS provides a safe and satisfactory treatment modality for those who recurred after prior invasive treatments.
Humans ; Microvascular Decompression Surgery ; Radiosurgery ; Recurrence ; Retrospective Studies ; Rhizotomy ; Trigeminal Nerve ; Trigeminal Neuralgia ; Visual Analog Scale