Favorable outcome of decompression of the trigeminal nerve in a case of bilateral neuralgia

A case of the bilateral trigeminal neuralgia produced by compression of the V cranial nerve roots by the branch of the anterior lower cerebral artery and post-hemorrhagic aggregates is presented. Complete recovery was obtained in the result of 2-stage, intracranial relief of the right and left trigeminal nerve roots. Neurologists share the opinion that intracranial surgical relief of the V cranial nerve root produces favourable result in case of trigeminal neuralgia resistant to pharmacotherapy.     

Lesions of spinal and trigeminal dorsal root entry zone for deafferentation pain. Experience of 35 cases

Spinal and trigeminal dorsal root entry zone destruction (DREZ-tomy) was performed on 35 patients with deafferentation pain of various types. Overall, satisfactory pain relief was obtained in 65.5% of spinal DREZ-tomy cases in the follow-up observation. The result in the brachial plexus avulsion group was the best (82.4% improved), followed by the limb pain group without root avulsion (50.0%), but the truncal or visceral pain group showed the worst result (33.3%). Two patients with postherpetic trigeminal neuralgia were completely relieved of pain in the average follow-up period of 32 months, while in 2 patients with postrhizotomy facial pain, pain recurred 4 months after the operation in 1, and, in the other, pain in the medial part of the face remained unchanged. Complications were seen in about 60% of the patients, which were, however, all mild, except for 2 cases of death due to gastrointestinal disease.     

Successful treatment of phantom pain with dorsal root entry zone coagulation

We studied 22 patients with amputation due to trauma, gangrene, or cancer. All developed postamputation pain, underwent a dorsal root entry zone (DREZ) procedure, and were followed from 6 months to 4 years after surgery. Overall, only 8 (36%) of these 22 patients had pain relief. However, good results were obtained in 6 (67%) of 9 patients with phantom pain alone, and in 5 (83%) of 6 patients with traumatic amputations associated with root avulsion. Poor results were obtained in patients with both phantom and stump pain, or stump pain alone. The DREZ procedure has a well-defined, but limited role in the treatment of postamputation pain.     

Application of stereotactic principles to the treatment of trigeminal neuralgia.

The application of neuroanatomical and neurophysiological principles to the functional surgery of the trigeminal nerve is discussed. Particular attention has been directed toward correlating the three-dimensional anatomical features of the trigeminal nerve and the surrounding structures to the two-dimensional radiograph of this same region. In this regard, 20 trigeminal nerves, including the surrounding neurovascular structures from 10 cadaver sphenoid blocks, were examined. Measurements of the third, fourth and sixth cranial nerves in relation to the profile of the clivus were made from lateral radiographs of the sphenoid blocks. The position of the internal carotid artery in relation to these structures was also noted. These neurovascular relationships are of clinical importance when using the percutaneous thermocoagulation technique for the treatment of trigeminal neuralgia.     

Therapeutic protocol in the treatment of trigeminal neuralgia

The ideal treatment of trigeminal neuralgia is still an open question. A recent large series reporting the results from the three available percutaneous techniques has been reviewed. Fifty consecutive cases, treated from January 1984 to January 1985, are reported. Microcompression was performed as the first approach in all cases. The other techniques were adopted only in case of failure of microcompression.     

Neurosurgical technique of the dorsal root entry zone operation

The dorsal root entry zone operation was introduced in 1976 to relieve the pain of brachial plexus avulsion. Since then it has been applied to pain treatment in paraplegia, postherpetic pain, phantom limb pain and other types of of deafferentation pain. Over 400 operations have been done at the Duke University Medical Center with overall good results in 60% of pain patients.     

Contribution of trigeminal and facial reflexes to the localization of Vth, VIIth, and VIIIth cranial nerve dysfunction.

After a review of electrophysiological studies in 1,500 cases concerning different types of lesions of the trigeminal nerve, the acousticofacial complex, and the brain stem, one can conclude that beside the intensive clinical examination which most often allows a precise topographic diagnosis, study of trigeminofacial and facial reflexes appears to be an essential diagnostic method to determine the topography of the lesions. On the other hand, this study can sometimes contribute to the prognostic evaluation as well as the choice of the approach in some lesions concerning the acousticofacial complex.     

Mesencephalic root fibers of the trigeminal nerve in the cat

The trigeminal nerve has three motor roots and one sensory root in the cat. One of the motor roots can be divided into two bundles: the larger and the smaller. These motor roots form the common root with the sensory root at the exit from the pons, sometimes being separated partially by the subarachnoidal space between the medial and the ventral part of the common root. The mesencephalic root fibers are observed numerously in all the motor roots. Some degenerated fibers are observed in the sensory root. The transitional zone of the trigeminal nerve root between central and peripheral nervous system is occupied by interlocking processes of the fibrous astrocyte.     

Problems with retrogasserian glycerol in the treatment of trigeminal neuralgia

Following glycerol injections for trigeminal neuralgia. H?kanson, Lunsford, Apfelbaum, Beck and Lobosky and Dieckmann, among others, report that few patients have sensory loss and dysesthesia and a high percentage have sustained gratifying relief. Such was not our experience or that of Laitinen, Price, Siegfried, or Takusagawa, among others. Our own disappointing results re initial failures to achieve relief, significant sensory loss including corneal anesthesia and some dysesthesias in 77 patients are described.     

Radiofrequency thermocoagulation of Gasserian ganglion and its rootlets for trigeminal neuralgia.

Thirty-nine patients with trigeminal neuralgia, not controlled by medical treatment, were treated by radio-frequency thermocoagulation of the Gasserian ganglion and its posterior rootlets. Thirty-six received satisfactory pain relief. In 30 patients touch sensation in the treated territory was preserved. The corneal reflex was affected in only six patients, two of whom subsequently developed keratitis. There were no other complications apart from a minor unpleasant sensation in eight patients. By selectively destroying pain fibres this technique offers the scope of preserving touch sensation in the treated area. Moreover, the zone of analgesia can be restricted to the affected region by sensory mapping through electrode stimulation before thermocoagulation. Its simplicity, low morbidity, associated short hospital stay, and the increased ability to preserve touch sensation, especially of the cornea, seem to make it preferable to other forms of surgical management for trigeminal neuralgia.     

Adult monkey coronoid process after resection of trigeminal nerve motor root.

A smaller or absent coronoid process has been reported, by some investigators but not by others, in growing animals following resection of the temporalis muscle. The trauma of resection, altered function, hemorrhage, scar tissue, and changes in vascularity may have influenced the results. The purpose of this experiment was to observe in adult Macaca mulatta the fully grown coronoid process after decreasing or eliminating neurofunctional activity of the temporalis muscle unilaterally without the trauma of local resection. In two males and three females the motor root of the trigeminal nerve which innervates the temporalis muscle was resected intracranially. In three control animals of both sexes the same surgical procedure was performed except for resection of the nerve. At postmortem, one year later, the temporalis muscle mass was atrophic on the resected side. There were no significant morphological differences, however, between the right and left sides of the mandible, including the coronoid process, regardless of which motor root of the fifth nerve had been resected, which side had been sham-operated, or sex. An extensive deposit of calculus on the buccal surfaces of the teeth on the operated nerve side was a consistent, conspicuous finding.     

微球囊压迫介入治疗三叉神经痛

目的：三叉神经痛是口腔科常见疾病之一,病因不清。令患者难于忍受。多年来人们探索出很多的治疗手段,这些方法均不同程度伴有疗效、副损伤及并发症上的各种缺点。经研究经介入方法利用微球囊能改变了三叉神经半月节的解剖位置从而缓解其周围压力,进而治疗了三叉神经痛且疗效很好。结论：微球囊加压介入治疗三叉神经痛是目前有效治疗三叉神经痛的方法。     

Experimental anatomical considerations of the dorsal root entry zone lesions for pain relief

Dorsal root entry zone (DREZ) lesions were made in the cervical dorsal horn in cat and monkey. Terminal degeneration was observed in the lateral cervical nucleus in cat and contralateral VPL in monkey by Fink-Heimer stain. WGA-HRP was injected in the cervical dorsal horn of cat and retrograde labelled cells were observed mainly in the raphe nucleus, parabrachial nucleus, locus coeruleus, K?lliker-Fuse nucleus, Eddinger-Westphal nucleus, and hypothalamic area, indicating that these descending fiber systems are involved by the DREZ lesion. The functional role of these fibers in regard to deafferentation pain relief seems now to be open to discussion.