Trigeminal Neuralgia: Role and Neurosurgical Indications of Peripheral Alcohol Injections, Controlled Radiofrequency Thermocoagulation, Gasserian Ganglion Compression with Balloon and Microvascular Decompression in Posterior Cranial Fossa. Experience in 437 Patients

Abstract

IntroductionTrigeminal neuralgia (TN) is a common cause of facial pain. Current supposed pathophysiology is that primary trigeminal neuralgia is caused by demyelination of trigeminal sensory fibers and that it often results from compression by an overlying artery or vein. Causes of symptomatic trigeminal neuralgia include multiple sclerosis and compressive space-occupying masses in the posterior fossa [1].Because of the lack of an unique therapeutic approach effective at the same way for all the patients affected from trigeminal neuralgia, many therapies are accomplishable, from pharmacological ones [2-4] to minor or major surgical procedures [5][6][7][8][9][10][11][12]; recently, radiosurgical therapies have an important role, too [13][14][15][16][17]. Pharmacological therapies should be the first therapeutic approach. In the study we report the surgical treatments which have been performed in a series of patients affected by TN.The aim of the presented study is to underline that TN not responsive to medical therapy should be approached with different surgical therapies according to neuralgia (interested division, gravity) and patient's characteristics (age and general conditions). We consider mandatory this analysis in order to achieve the best result performing in each patient the most appropriate therapeutic option. Materials and MethodsFour-hundred-thirty-seven patients affected from TN refractory to every previously performed medical therapy are presented; all the patients were affected from primary TN according to the criteria of the

Epigenetic and Therapeutic Analysis of various Neurological Disorders

“…A number of neurological disorders seem to have an etiological connection to defects in one or more DNA repair pathways. Acute multiple sclerosislike leukoencephalopathy revealing HIV infection may also occur in rare cases [5][6][7]. Berger et al first described 7 HIV patients with neurological diseases resembling multiple sclerosis [8][9][10].…”