Guidelines for the management of trigeminal neuralgia

Chong, M.S.; Bahra, Anish; Zakrzewska, Joanna M.

doi:10.3949/ccjm.90a.22052

Cited by 15 publications

(12 citation statements)

References 20 publications

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“…However, several months later, these axonal myelin sheaths regenerate, which may explain why TN patients successfully treated with PBC experience recurrence of pain without permanent sensory de cits [11]. TN often affects the V2 and V3 branches of the trigeminal nerve, with the right side of the face more prone to TN than the left, and a higher incidence in females than males, especially after the age of 40 [3,12]. Among patients treated with PBC, the immediate postoperative pain relief rate exceeds 90% [13,14]Meckel's cave is at before the balloon is in ated, and a pear-shaped balloon indicates su cient pressure, thereby forming a small protrusion from the trigeminal nerve ori ce.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Correlation between Percutaneous Balloon Compression Treatment Frequency and Facial Numbness in Trigeminal Neuralgia

Wang,

Zhang,

Jiang

et al. 2024

Preprint

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Percutaneous balloon compression (PBC) offers substantial immediate relief from the severe pain associated with trigeminal neuralgia (TN). To investigate the effect of compression Frequency during balloon compression on facial numbness in patients with primary trigeminal neuralgia, we conducted a nested case–control study. A retrospective analysis was performed on clinical data from 150 TN patients treated with PBC from October 2017 to May 2022. Of these, 60 patients underwent a single PBC compression, while the remaining 90 underwent two compressions. The Barrow Neurological Institute Pain Intensity (BNI-P) score was employed to measure the severity of pain. The Barrow Neurological Institute facial numbness score (BNI-N) was used to assess the degree of postoperative pain relief and facial numbness. At time point T1, the BNI-P scores for the “two compressions” group were significantly lower than those for the “single compression” group (P < 0.05). From T2 to T5, no significant differences in BNI-P scores were observed between the groups. For the BNI-N score, there was no notable difference between the groups at T0, while from T1 to T4, the “double compressions” group exhibited significantly lower BNI-N scores than the “single compression” group (P < 0.05). At T5, no significant difference in BNI-N scores was observed between the groups. The application of two compressions in PBC is a safe and effective surgical method that not only maintains the efficacy of the procedure but also significantly reduces the degree and duration of postoperative facial numbness.

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Section: Discussionmentioning

confidence: 99%

Analysis of the Correlation between Percutaneous Balloon Compression Treatment Frequency and Facial Numbness in Trigeminal Neuralgia

Wang,

Zhang,

Jiang

et al. 2024

Preprint

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“…It is unclear from the included studies which patients may best benefit from using BTX injections. There is weak evidence that BTX further reduces pain intensity when used as an adjunct to the commonly used anti-epileptic drugs [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Is Botulinum Toxin Effective in Treating Orofacial Neuropathic Pain Disorders? A Systematic Review

Val,

Delcanho,

Ferrari

et al. 2023

Toxins

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Background: The aim of this paper is to provide a systematic review of the literature regarding the clinical use of botulinum toxin (BTX) to treat various orofacial neuropathic pain disorders (NP). Methods: A comprehensive literature search was conducted using Medline, Web of Science, and the Cochrane Library databases. Only randomized clinical trials (RCT) published between 2003 and the end of June 2023, investigating the use of BTX to treat NP, were selected. PICO guidelines were used to select and tabulate the articles. Results: A total of 6 RCTs were selected. Five articles used BTX injections to treat classical trigeminal neuralgia, and one to treat post-herpetic neuralgia. A total of 795 patients received BTX injections. The selected studies utilised different doses and methods of injections and doses. All the selected studies concluded superiority of BTX injections over placebo for reducing pain levels, and 5 out 6 of them highlighted an improvement in the patient’s quality of life. Most of the studies reported transient and mild side effects. Conclusion: There is evidence of the efficacy of BTX injections in orofacial pain management. However, improved study protocols are required to provide direction for the clinical use of BTX to treat various orofacial neuropathic pain disorders.

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“…The hospital charts of these patients were reviewed to extract demographic data and baseline clinical characteristics. All GLOA series were embedded in a multimodal interdisciplinary therapy concept as described in the actual guidelines [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

Ganglionic Local Opioid Analgesia at the Superior Cervical Ganglion: MRI-Verified Solution Spread

Neuwersch-Sommeregger,

Köstenberger,

Sandner-Kiesling

et al. 2024

Pain Ther

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Introduction Ganglionic local opioid analgesia (GLOA) at the superior cervical ganglion (SCG) is performed for pain control and is known to be an effective procedure. In this study, we evaluated the spread of the injectate in the area of the SCG. Our expectation was that there would be a correlation between the area and volume of the injectate spread and post-procedural outcome measures. Methods This was a retrospective blinded review of magnetic resonance imaging (MRI) scans. Assessors evaluated the anatomical area of fluid spread, the furthermost spread from midline, any hampered spread and contact of contrast fluid with other structures. The efficacy of GLOA and complications were estimated. Results The main solution spread reached from the C1 to C3 vertebrae. The furthest spread in the lateral and sagittal planes was 21.2 and 15.2 mm, respectively. The furthest craniocaudal spread was 63.5 mm. In 53.3% and 33% of interventions, the solution was found in the parapharyngeal space and in its “medial compartment,” respectively. A correlation was found between pain relief and both solution spread and volume of solution spread. No hampered spread was recorded. A negative correlation between pain reduction and number of GLOA was observed. Higher pre-procedural pain intensity was correlated with higher pain reduction. We estimated pain relief in 93% of procedures correctly. No correlation between post-procedural Numerical Rating Scale (NRS) scores and different needle approaches was found. Conclusion For the transoral blocking technique, a strict laterodorsal needle direction is recommended to prevent possible block failures. A total volume of 2 ml injected into the parapharyngeal space and its “medial compartment” is recommended. Higher volumes may lead to uncontrolled distribution patterns. Trial registration Clinicaltrials.gov identifier NCT05257655; date of registration 2022-02-25; patient enrollment date from 2023-01-09 to 2023-08-31.

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Guidelines for the management of trigeminal neuralgia

Cited by 15 publications

References 20 publications

Analysis of the Correlation between Percutaneous Balloon Compression Treatment Frequency and Facial Numbness in Trigeminal Neuralgia

Analysis of the Correlation between Percutaneous Balloon Compression Treatment Frequency and Facial Numbness in Trigeminal Neuralgia

Is Botulinum Toxin Effective in Treating Orofacial Neuropathic Pain Disorders? A Systematic Review

Ganglionic Local Opioid Analgesia at the Superior Cervical Ganglion: MRI-Verified Solution Spread

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