Microvascular Decompression for Trigeminal Neuralgia

Sade, Burak; Lee, Joung H.

doi:10.1016/j.nec.2014.06.007

Cited by 22 publications

(11 citation statements)

References 21 publications

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“…127,178 Indications and details on the surgical procedures employed for TN treatment have been reviewed by others and are outside the scope of this review. 127,[179][180][181][182] Despite these avenues, there remains a critical need for new therapies, and this requires an indepth understanding of the underlying pathways and molecular mechanisms of TN.…”

Section: Pharmacological Alternatives To Cbzmentioning

confidence: 99%

Trigeminal neuralgia: An overview from pathophysiology to pharmacological treatments

2020

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The trigeminal nerve (V) is the fifth and largest of all cranial nerves, and it is responsible for detecting sensory stimuli that arise from the craniofacial area. The nerve is divided into three branches: ophthalmic (V1), maxillary (V2), and mandibular (V3); their cell bodies are located in the trigeminal ganglia and they make connections with second-order neurons in the trigeminal brainstem sensory nuclear complex. Ascending projections via the trigeminothalamic tract transmit information to the thalamus and other brain regions responsible for interpreting sensory information. One of the most common forms of craniofacial pain is trigeminal neuralgia. Trigeminal neuralgia is characterized by sudden, brief, and excruciating facial pain attacks in one or more of the V branches, leading to a severe reduction in the quality of life of affected patients. Trigeminal neuralgia etiology can be classified into idiopathic, classic, and secondary. Classic trigeminal neuralgia is associated with neurovascular compression in the trigeminal root entry zone, which can lead to demyelination and a dysregulation of voltage-gated sodium channel expression in the membrane. These alterations may be responsible for pain attacks in trigeminal neuralgia patients. The antiepileptic drugs carbamazepine and oxcarbazepine are the first-line pharmacological treatment for trigeminal neuralgia. Their mechanism of action is a modulation of voltage-gated sodium channels, leading to a decrease in neuronal activity. Although carbamazepine and oxcarbazepine are the first-line treatment, other drugs may be useful for pain control in trigeminal neuralgia. Among them, the anticonvulsants gabapentin, pregabalin, lamotrigine and phenytoin, baclofen, and botulinum toxin type A can be coadministered with carbamazepine or oxcarbazepine for a synergistic approach. New pharmacological alternatives are being explored such as the active metabolite of oxcarbazepine, eslicarbazepine, and the new Nav1.7 blocker vixotrigine. The pharmacological profiles of these drugs are addressed in this review.

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Section: Pharmacological Alternatives To Cbzmentioning

confidence: 99%

Trigeminal neuralgia: An overview from pathophysiology to pharmacological treatments

2020

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“…Similar reports showed can reach same objectives with less complicated patient positioning and small craniotomies, such as that reported by Broggi et al . in his paper presenting a similar technique[11217] However, the use of circular Dacron guarantees the attachment to nerve and avoids another surgery for repositioning in case the prosthesis falls. [19]…”

Section: Resultsmentioning

confidence: 99%

“…[913] Pharmacological treatment is the first line of the treatment, however, surgery is proposed when treatment evolves with intolerance to drugs, persistent pain, or patient choice. [281617]…”

Section: Introductionmentioning

confidence: 99%

Surgical variation of microvascular decompression for trigeminal neuralgia: A technical note and anatomical study

Silva

et al. 2016

Surg Neurol Int

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Background:In this article, the authors described their experience in microvascular decompression for trigeminal neuralgia.Methods:The microvascular decompression technique used in the authors’ institution is described in a step by step manner with some illustrative cases as well as a cadaver dissection to highlight the differences with other previously described techniques.Results:Since 2013, 107 patients were operated in the Neurosurgery Division of the University of São Paulo using the described technique, with a shorter operative time and avoiding cerebellar retractor compared with classic techniques.Conclusion:Our modified microvascular decompression technique for trigeminal neuralgia can be used with safety and efficiency for treating trigeminal neuralgia.

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“…It is based on the theory of arterial compression leading to a demyelinating lesion. This allows for the ephaptic neuronal transmission seen in trigeminal neuralgia [11,12]. It may be that in the case of the optic nerve, demyelination leads to a visual deficit (as in optic neuritis secondary to multiple sclerosis) and that physical dampening of the arterial pulsations with felt and not necessarily "decompression" interrupts the pathophysiological mechanism underlying the visual loss.…”

Section: Discussionmentioning

confidence: 99%

Microvascular Decompression of the Optic Nerve

McDougall¹

2016

SOJN

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Symptomatic compression of the optic apparatus by a tortuous internal carotid artery (ICA) is rare. We report a patient with visual decline due to optic nerve compression by the ICA. The patient presented with a visual field deficit and standard work-up revealed no discernible cause. Magnetic resonance imaging (MRI) demonstrated distortion of the optic nerve by the ICA. The optic nerve was decompressed with resultant clinical improvement. Optic nerve compression by the ICA may be considered a diagnosis of exclusion. Here, microvascular decompression led to improvement in visual function.

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Microvascular Decompression for Trigeminal Neuralgia

Cited by 22 publications

References 21 publications

Trigeminal neuralgia: An overview from pathophysiology to pharmacological treatments

Trigeminal neuralgia: An overview from pathophysiology to pharmacological treatments

Surgical variation of microvascular decompression for trigeminal neuralgia: A technical note and anatomical study

Microvascular Decompression of the Optic Nerve

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