Percutaneous trigeminal tractotomy for trigeminal neuralgia: Postoperative MRI findings

Gurbani, Saumya; Brandman, David M.; Reeves, Christopher; Boulis, Nicholas M.; Weinberg, Brent D.

doi:10.1111/jon.12925

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…Available postoperative MRI data in our patients do not allow us to draw definitive conclusions about long-term postoperative outcomes of the surgery since not all patients had neuroimaging completed. Gurbani et al [34] after analyzing the postoperative images of 4 patients who underwent transcutaneous nucleotractotomy, concluded that the ablation zone when performing this procedure according to the standard method corresponds to the anatomical location of the nucleus and tract of the trigeminal nerve. The availability of visualization techniques for the spinal nucleus of the trigeminal nerve will make it possible to identify individual differences in the electrode location during destruction [35].…”

Section: Resultsmentioning

confidence: 99%

Open and Percutaneous Trigeminal Nucleotractotomy: A Case Series and Literature Review

Anisimov,

Rzaev,

Moysak

et al. 2023

Stereotact Funct Neurosurg

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Introduction: Nucleotractotomy is an efficient surgical technique that provides a high pain relief rate for specific clinical indications. There are two main approaches for performing this operation: an open and percutaneous technique. Methods: In the Federal Center of Neurosurgery (Novosibirsk, Russia) from 2016 to 2022, 13 trigeminal nucleotractotomies (7 open and 6 percutaneous) were performed in 12 patients (5 women and 7 men). The indications for surgery were deafferentation pain and chronic drug-resistant pain syndrome caused by malignancy in the facial region. A neurological examination was done on each patient 1 day before the surgery, right after the surgery, and at the follow-up (examinations were done after 1, 6, and 12 months, or when the patient independently applied to our hospital). In the early postoperative period, patients underwent brain MRI. Results: The average pain intensity score before nucleotractotomy on the 11-point (0–10) visual analog scale (VAS) was 9.3. The effectiveness of open interventions was somewhat higher; the average VAS score in the early postoperative period for the open technique was 1.57, in the group of patients who underwent percutaneous nucleotractotomy were 2.66. Complete regression of the pain syndrome was achieved in 6 patients; in 5 patients, the pain in the face decreased by more than 50%. One case had an unsatisfactory outcome. In the open-surgery group in the early postoperative period, according to MRI, the average length of the visualized area of signal change was longer (21.5 mm, the average diameter was 3.75 mm) than in a percutaneous nucleotractotomy group (16 mm, the average diameter was 3.75 mm). During the postoperative period (average follow-up 40 months), the pain recurred in 3 patients (30%): 2 patients after percutaneous nucleotractotomy (3 and 18 months after surgery) and in 1 patient 4 months after the open surgery. The mean VAS score at the last follow-up was 2.6. Conclusion: Trigeminal nucleotractotomy is an effective approach to the treatment of intractable facial pain. Our experience suggests this technique is highly effective in patients with drug-resistant pain caused by craniofacial tumors and deafferentation conditions after treating trigeminal neuralgia.

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Section: Resultsmentioning

confidence: 99%

Open and Percutaneous Trigeminal Nucleotractotomy: A Case Series and Literature Review

Anisimov,

Rzaev,

Moysak

et al. 2023

Stereotact Funct Neurosurg

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“…The patient returned to baseline pain levels at 1 month post-tractotomy [14]. Anisimov et al presented a case with minimal pain reduction (VAS reduction from 10 to 8) after percutaneous nucleotractotomy for deafferentiation pain following a surgical attempt to treat trigeminal neuralgia [15]. While Kanpolat et al reported an 80% success rate based on VAS scores in their series of failure trigeminal neuralgia patients, the long-term outcomes were not specified.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography-guided trigeminal tractotomy-nucleotomy for refractory chronic craniofacial pain: a case report

Genc,

Aydoseli

2024

Egypt J Neurosurg

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Background Refractory chronic craniofacial pain is a debilitating condition with limited treatment options. This case report presents the use of percutaneous computed tomography-guided trigeminal tractotomy-nucleotomy under general anesthesia in a patient with refractory trigeminal neuralgia and post-treatment anesthesia dolorosa. This case report expands the use of TR-NC to include treatment-resistant post-treatment anesthesia dolorosa and introduces real-time verification under anesthesia, potentially broadening access and improving precision, while highlighting the need for further research on long-term efficacy and patient selection for this promising technique. Case presentation A 50-year-old woman with 12 years of chronic facial pain in the opthalmic and maxillary trigeminal branches despite multiple surgical and medical interventions underwent computed tomography-guided trigeminal tractotomy-nucleotomy under general anesthesia. Initial pain relief was significant, but symptoms gradually returned within 12 months. Transient mild ataxia was the only complication. Conclusion This case suggests trigeminal tractotomy-nucleotomy under general anesthesia with real-time verification may be a valuable option for patients with refractory post-treatment anesthesia dolorosa. However, the transient nature of pain relief necessitates further investigation of long-term outcomes and optimal patient selection.

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“…Три пациента отметили улучшение в виде купирования болевого синдрома. Опасность данной процедуры обусловлена тем, что оперативное вмешательство проводится на стволе головного мозга, что требует технического оснащения и высокой квалификации хирурга [52].…”

Section: хирургическое лечениеunclassified

Trigeminal neuralgia at the present stage: Pathophysiology, classification, diagnosis and treatment (literature review)

Zhurkin,

Semenov,

Shurygina

et al. 2024

Acta biomedica scientifica

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The incidence of trigeminal neuralgia (TN) is 4–5 cases per 100,000 population per year, and the prevalence is about 20–50 cases per 100,000 population. According to the modern classification, the following types of TN are distinguished: classical, symptomatic and idiopathic. The cause of classical TN is a neurovascular conflict, of symptomatic TN – neoplasms in the petroclival area, vascular anomalies, multiple sclerosis, etc. In the absence of a reliable etiological factor, TN is considered idiopathic. TN pathogenesis remains one of the most challenging topics in neuroscience. Today, there are many theories and hypotheses regarding the peripheral and central mechanisms of trigeminal neuralgia. The most popular theory is the neurovascular conflict that occurs between the trigeminal nerve and the cerebral vessels, but this theory is not the only one. It is known that even after microvascular decompression, patients may continue to experience facial pain. Therefore, other pathogenetic mechanisms are discussed: short circuit theory, multineuronal mechanism, allergic and immune hypothesis, gate theory, bioresonance hypothesis, trigeminal convergence projection theory, “ignition” hypothesis and ion channel pathology. TN is a clinical diagnosis, and its establishing requires certain criteria proposed by the International Headache Society. Using instrumental research methods, namely magnetic resonance imaging of the brain, is necessary for the differential diagnosis of classical and symptomatic TN, and imaging results should always be interpreted in combination with clinical data to make correct decisions on further treatment tactics.

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Percutaneous trigeminal tractotomy for trigeminal neuralgia: Postoperative MRI findings

Cited by 4 publications

References 14 publications

Open and Percutaneous Trigeminal Nucleotractotomy: A Case Series and Literature Review

Open and Percutaneous Trigeminal Nucleotractotomy: A Case Series and Literature Review

Computed tomography-guided trigeminal tractotomy-nucleotomy for refractory chronic craniofacial pain: a case report

Trigeminal neuralgia at the present stage: Pathophysiology, classification, diagnosis and treatment (literature review)

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