Cases reported "Trigeminal Neuralgia"

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11/53. trochlear nerve palsy after repeated percutaneous balloon compression for recurrent trigeminal neuralgia: case report and pathogenic considerations.

    OBJECTIVE AND IMPORTANCE: Repeated percutaneous balloon compression for the treatment of idiopathic trigeminal neuralgia is infrequent. When a second procedure is performed, the outcome is unknown. A patient developed an isolated trochlear nerve palsy after undergoing percutaneous trigeminal ganglion balloon compression for a second time. The mechanism of diplopia and the complications associated with this technique were studied. CLINICAL PRESENTATION: The patient was a 67-year-old woman with a history of medically refractory idiopathic trigeminal neuralgia involving all three divisions of the right trigeminal nerve. INTERVENTION: Percutaneous balloon compression was performed. Despite initial total relief from pain without complications, the patient again displayed manifestations of trigeminal neuralgia 3 months after the procedure. The pain disappeared after she underwent a second balloon compression procedure, but she developed an isolated trochlear nerve palsy, which spontaneously resolved in 2 months. CONCLUSION: Isolated trochlear nerve palsy is a rare and reversible complication after percutaneous balloon compression for trigeminal neuralgia. This case illustrates that the mechanism of injury to the fourth nerve is the result of an erroneous technique: excessive penetration of the Fogarty catheter in Meckel's cave beyond the porus trigemini and compression of the cisternal segment of the trochlear nerve when the inflated balloon is pushed against the tentorium.
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ranking = 1
keywords = trigeminal ganglion, ganglion
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12/53. Trigeminal trophic syndrome--report of four cases and review of the literature.

    BACKGROUND: Trigeminal trophic syndrome is a unilateral, frequently crescent-shaped neurotrophic ulceration of the face occurring after injury to the trigeminal nerve. The appearance of the ulcers resembles other disease entities such as granulomatous disease, neoplasm, vasculitis, infection, and factitial dermatitis. OBJECTIVES: The objectives of this study are to increase awareness of this disorder and to emphasize the importance of eliciting a thorough neurologic history when evaluating facial ulcerations. methods: Four cases are reported and, using medline, the English and non-English literature from 1982 to 2002 is reviewed. RESULTS: Including this report, there have been 60 cases of trigeminal trophic syndrome reported from 1982 to 2002. The age at presentation ranged from 14 months to 93 years. time of onset from injury to the trigeminal ganglion or its branches and the development of the ulcers ranged from 2 weeks to 30 years. One-third of the patients had undergone trigeminal nerve ablation for the treatment of trigeminal neuralgia and another third had a history of stroke. Other causes included craniotomy, head trauma, herpes infection. CONCLUSION: The majority of cases of trigeminal trophic syndrome are associated with a history of stroke or trigeminal nerve ablation. Successful surgical outcome can be achieved if the underlying neurologic pathology is addressed before the reconstructive procedure.
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ranking = 1
keywords = trigeminal ganglion, ganglion
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13/53. Unanticipated complication of percutaneous radiofrequency trigeminal rhizotomy: rhinorrhea: report of three cases and a cadaver study.

    OBJECTIVE AND IMPORTANCE: Several neurosurgical procedures have been developed for the treatment of idiopathic trigeminal neuralgia: vascular decompression of the trigeminal root in the brainstem, percutaneous trigeminal ganglion procedures, and external beam radiosurgery. Percutaneous radiofrequency electrodes target the trigeminal fibers in the gasserian ganglion through the foramen ovale. Several complications of radiofrequency trigeminal rhizotomy (RF-TR) have been described, including puncture of the carotid artery, the cavernous sinus, and the cranial nerves. This study presents a very rare complication of percutaneous RF-TR, rhinorrhea, and attempts to define its mechanism. CLINICAL PRESENTATION: Of 2375 patients with idiopathic trigeminal neuralgia who underwent 2958 percutaneous RF-TR procedures, 3 developed subsequent rhinorrhea, which resolved spontaneously in 2 to 3 days. TECHNIQUE: Two formalin-fixed cadavers were dissected to demonstrate the relationship between the foramen ovale and the tuba auditiva and the mechanism of rhinorrhea. CONCLUSION: This article presents a very rare complication of RF-TR. Rhinorrhea and/or cerebrospinal fluid fistulae in the nasopharyngeal cavity are benign complications of RF-TR that result from puncturing both the membranous portion of the tuba auditiva (eustachian tube) and Meckel's cave with the rhizotomy needle.
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ranking = 1.1531540502706
keywords = trigeminal ganglion, gasserian ganglion, gasserian, ganglion
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14/53. Long-term relief of posttraumatic headache by sphenopalatine ganglion pulsed radiofrequency lesioning: a case report.

    Posttraumatic headache is a common and disabling pain syndrome in patients who sustain a head injury. Unfortunately, conventional treatments may fail or cause intolerable side effects. Because chronic headache may be mediated by central and peripheral neural processes, these structures may be therapeutic targets. One target, the sphenopalatine ganglion (SPG), is implicated in several headache disorders and has been lesioned for headache relief. Because of the risks of neurolytic procedures, nonablative procedures that provide pain relief would be useful. We present a case wherein a man in his late twenties with posttraumatic headache obtained more than 17 months of relief with SPG pulsed-mode radiofrequency lesioning. SPG pulsed-mode radiofrequency is a nonablative, neural lesioning method that may be useful in the treatment of posttraumatic headache.
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ranking = 0.00080040578514068
keywords = ganglion
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15/53. Recurrent atrial tachyarrhythmia triggered by percutaneous balloon rhizotomy of the trigeminal nerve.

    Stimulation of sensory branches of the trigeminal nerve is known to cause sudden bradycardia (trigeminocardiac reflex). However we report a case where percutaneous balloon rhizotomy of the trigeminal ganglion provoked atrial tachyarrhythmias during two separate treatments. On both occasions the patient was treated with antiarrhythmic drugs and reverted to sinus rhythm within days. Our case demonstrates that surgery involving the trigeminal nerve may cause variable cardiovascular effects that are often clinically significant. Possible mechanisms and management of arrhythmias in this setting are discussed.
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ranking = 1
keywords = trigeminal ganglion, ganglion
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16/53. Pain relief by stellate ganglion block in a case with trigeminal neuralgia caused by a cerebellopontine angle tumor.

    A 29-year-old woman with symptoms suggestive of trigeminal neuralgia is presented. Because of her age, an intracranial tumor was suspected, but images of a brain computerized tomography scan revealed nothing in particular. A magnetic resonance imaging was scheduled 2 weeks later. However, as the pain increased and occurred more frequently, the patient returned to the hospital 2 days later. After a stellate ganglion block with transient nausea and dizziness, the pain was noticeably relieved. Using magnetic resonance scanning, a tumor in the cerebellopontine angle was discovered, and at surgical resection was diagnosed as an epidermoid tumor. stellate ganglion block may provide pain relief to some patients who are suspected to have symptomatic trigeminal neuralgia.
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ranking = 0.00096048694216881
keywords = ganglion
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17/53. Treatment of trigeminal neuralgia associated with multiple sclerosis: case report.

    The incidence of trigeminal neuralgia (TN) in patients with multiple sclerosis is higher than in the general population. If pharmacologic therapy fails, invasive procedures in the gasserian ganglion are usually offered. Microvascular decompression is not routinely performed. The authors report a patient with persistent TN after repetitive trigeminal radiofrequency rhizotomy and finally successful microvascular decompression after demonstration of neurovascular compression with high-resolution MRI.
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ranking = 0.15315405027064
keywords = gasserian ganglion, gasserian, ganglion
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18/53. Pathophysiology of trigeminal neuralgia: new evidence from a trigeminal ganglion intraoperative microneurographic recording. Case report.

    The origin of trigeminal neuralgia (TN) appears to be vascular compression of the trigeminal nerve at the root entry zone; however, the physiological mechanism of this disorder remains uncertain. The authors obtained intraoperative microneurographic recordings from trigeminal ganglion neurons in a patient with TN immediately before percutaneous radiofrequency-induced gangliolysis. Their findings are consistent with the idea that the pain of TN is generated, at least in part, by an abnormal discharge within the peripheral nervous system.
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ranking = 5
keywords = trigeminal ganglion, ganglion
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19/53. Gamma knife surgery for refractory postherpetic trigeminal neuralgia: targeting in one session both the retrogasserian trigeminal nerve and the centromedian nucleus of the thalamus.

    OBJECT: The authors tested the hypothesis that two targets are needed to treat postherpetic trigeminal neuralgia (TN): one in the trigeminal nerve for the direct sharp pain and one in the thalamus for the diffuse burning pain. methods: Three patients with refractory postherpetic TN were treated with gamma knife surgery (GKS) through a novel two-target approach. In a single treatment session, both the trigeminal nerve and centromedian nucleus were targeted. First, the trigeminal nerve, ipsilateral to the facial pain, was treated with 60 to 80 Gy. Second, the centromedian nucleus was localized using standard coordinates and by comparing magnetic resonance images with a stereotactic atlas. A single dose of 120 to 140 Gy was delivered to the target point with a single 4-mm isocenter. patients were followed clinically and with neuroimaging studies. Pain relief was scored as excellent (75-100%), good (50-75%), poor (25-50%); or none (0-25%). Follow up ranged from 6 to 53 months. There were no GKS-related complications. Two patients died of unrelated medical illnesses but had good or excellent pain relief until death. One patient continues to survive with 44 months follow up and no decrease in pain intensity, but with a decreased area of pain. CONCLUSIONS: Combined GKS of the centromedian nucleus and trigeminal nerve in a single treatment session is feasible and safe, and the effect was promising. A larger study is required to confirm and expand these results.
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ranking = 0.12681323049327
keywords = gasserian
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20/53. Intraorbital surgery for trigeminal neuralgia.

    PURPOSE: First-division trigeminal neuralgia, or tic douloureux refractory to medications, presents problems to the surgeon because of the desirability of preserving corneal sensation. A new operation is described that may provide longer duration of pain relief than conventional supraorbital neurectomy, with preservation of the corneal reflex. methods: Four patients underwent resection of the supratrochlear and supraorbital nerves within the orbit accessed from an upper eyelid skin crease incision. RESULTS: Three patients with typical idiopathic trigeminal neuralgia involving branches of the frontal nerve are without pain 22 to 25 months after surgery. The final patient with atypical pain had no improvement after the procedure. Frontal nerve distribution anesthesia is present in all patients. Postoperative ptosis resolved in all patients within 4 months of surgery. CONCLUSIONS: This procedure should be added to the treatment options for patients with first-division trigeminal neuralgia. By avoiding injury to the trigeminal root and ganglion, this surgery carries no risk of facial motor dysfunction, dysthesia, and/or anesthesia in the other trigeminal branches including corneal anesthesia.
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ranking = 0.00016008115702814
keywords = ganglion
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