Microvascular decompression for trigeminal neuralgia: Update

Division of Diagnostic, Surgical and Medical Sciences, Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK.
Current opinion in neurology (Impact Factor: 5.73). 06/2012; 25(3):296-301. DOI: 10.1097/WCO.0b013e328352c465
Source: PubMed

ABSTRACT A recent Cochrane systematic review of surgical interventions for trigeminal neuralgia found not a single trial of what is becoming the most popular surgical intervention, namely microvascular decompression (MVD). With an increasing number of anticonvulsant drugs it is likely that patients may not be offered a surgical option for management of their trigeminal neuralgia for many years.
Current studies repeat much of what is already in the literature but there is an increasing appreciation of the value of preoperative imaging and the need to be more precise with the diagnosis. The search for prognosticators for good outcomes continues to dominate the literature.
Microvascular decompression in correctly diagnosed patients is probably the most effective therapy. However, high-quality prospective studies of MVD in a population that has been well phenotyped and which is assessed pre and postoperatively using psychometrically tested questions, administered at regular intervals by independent observers, are needed to provide clear evidence of its superiority over medical therapies.

  • Cephalalgia 09/2012; 32(15). DOI:10.1177/0333102412459577 · 4.12 Impact Factor
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    ABSTRACT: IntroductionTrigeminal neuralgia (TN) affects primarily women over 50 years of age and its etiology is unknown in most cases. Drugs are first line treatment, but they are ineffective in 40% of cases. Interventional therapies are a management option in those cases.Objective To determine the safety and efficacy of Gasserian ganglion thermal (TR) radio frequency in patients with TN.Materials and methodsDescriptive, prospective follow-up study of a cohort of 15 patients with a diagnosis of TN who underwent Gasserian ganglion TR at the Colombian Pain Institute between May 2010 and May 2011, with at least one year follow-up.ResultsThe mean age of the patients intervened was 52 years, 73% were females with right-sided predominance (67%) with involvement mainly of the second and third branch of the trigeminal nerve. After the intervention, all 15 patients went from severe pain to a condition ranging between mild and no pain, and 50% were even pain-free one year after the procedure.ConclusionsTN has a significant effect on quality of life. The main treatment is pharmacological but when it fails, Gasserian ganglion TR is an effective and safe option available in our setting.ResumenIntroducciónLa neuralgia del trigémino (NT) afecta principalmente a mujeres mayores de 50 años y es de causa desconocida en la mayoría de pacientes. Los fármacos son la primera línea de tratamiento, aunque son inefectivos en el 40% de los casos; las terapias intervencionistas son entonces una alternativa de manejo.ObjetivoDeterminar la eficacia y la seguridad de la radiofrecuencia térmica (RT) en el ganglio de Gasser en pacientes con NT.Materiales y métodoSe realizó un estudio de tipo descriptivo, prospectivo, de seguimiento a una cohorte de 15 pacientes con diagnóstico de NT, en quienes se realizó RT del ganglio de Gasser en el Instituto Colombiano del Dolor entre los meses de mayo de 2010 y mayo de 2011, con un seguimiento no inferior a un año.ResultadosLa edad promedio de los pacientes intervenidos fue de 52 años. El 73% fueron mujeres, con predominio derecho (67%), y las principales ramas trigeminales comprometidas fueron la segunda y la tercera. Después de la intervención los 15 pacientes pasaron de dolor severo a un estado entre nada de dolor y dolor leve, e incluso el 40% se encontraron libres de dolor al año del procedimiento.ConclusionesLa NT afecta de forma importante la calidad de vida. Su principal tratamiento es farmacológico, pero cuando no es efectivo, la RT del ganglio de Gasser es una alternativa eficaz, segura y disponible en nuestro medio.
    Revista Colombiana de Anestesiologia 04/2013; 41(2):127–131. DOI:10.1016/j.rcae.2013.03.001
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    ABSTRACT: Orofacial pain in its broadest definition can affect up to 7% of the population. Its diagnosis and initial management falls between dentists and doctors and in the secondary care sector among pain physicians, headache neurologists and oral physicians. Chronic facial pain is a long term condition and like all other chronic pain is associated with numerous co-morbidities and treatment outcomes are often related to the presenting co-morbidities such as depression, anxiety, catastrophising and presence of other chronic pain which must be addressed as part of management . The majority of orofacial pain is continuous so a history of episodic pain narrows down the differentials. There are specific oral conditions that rarely present extra orally such as atypical odontalgia and burning mouth syndrome whereas others will present in both areas. Musculoskeletal pain related to the muscles of mastication is very common and may also be associated with disc problems. Trigeminal neuralgia and the rarer glossopharyngeal neuralgia are specific diagnosis with defined care pathways. Other trigeminal neuropathic pain which can be associated with neuropathy is caused most frequently by trauma but secondary causes such as malignancy, infection and auto-immune causes need to be considered. Management is along the lines of other neuropathic pain using accepted pharmacotherapy with psychological support. If no other diagnostic criteria are fulfilled than a diagnosis of chronic or persistent idiopathic facial pain is made and often a combination of antidepressants and cognitive behaviour therapy is effective. Facial pain patients should be managed by a multidisciplinary team.
    The Journal of Headache and Pain 04/2013; 14(1):37. DOI:10.1186/1129-2377-14-37 · 3.28 Impact Factor
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