Trigeminal Neuralgia
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Transcript Trigeminal Neuralgia
Trigeminal Neuralgia
By
Dr. Ravindra Srivastava
Consultant Neurosurgeon
VIMHANS, New DELHI
Paroxysms of severe, lancinating, electric
shock-like bouts of facial pain, lasting for
seconds to minutes and restricted to
distribution of the trigeminal nerve. No
neurologic deficit is present and is not
attributed to another disorder.
Incidence : 4-5/ 1,00,000
Female Predominance (Male: Female = 1:2
– 2:3
usually unilateral (Right Side)
mandibular (60%) (V3)
maxillary (V2) (35%)
ophthalmic VI branch (5%)
Trigger zones - cheek, lip, nose or buccal
mucosa.
Triggers - shaving, brushing teeth, drinking,
eating or even slight breeze
Etiology
- Idiopathic (Vascular)
- Tumour V (nerve) Schwannoma or Cerebello
pontine angle Tumors
- Herpes Simplex virus infection
- Multiple Sclerosis
4% of Patients with Multiple sclerosis have
Trigeminal Neuralgia
2% Patients with Trigeminal Neuralgia have
Multiple sclerosis
Vascular- Aberrant loop of artery
-Superior cerebellar artery (75.5%),
- AICA (9.6%)
-PCA (0.7%) or
-vein (68.2%) found to be compressing the
root entry zone of the V nerve in 80-90% of
patients at surgery. Eliminating the
compression provides long term relief.
Investigations
Whether there is an identifiable cause of
disease, particularly with a view to surgical
cure.
MRI SCAN- 3D CISS with MPR
sequences & MRA
MRI scan should be obtained in
-Younger Patient
-Atypical clinical Features, including sensory
loss or a dull burning pain between paroxysms
-Patients who do not respond to initial
medical therapy.
Management
Medical
Surgical
Gasserian ganglion level Procedures:-Micro vascular Decompression MVD
Ablative treatments
-Radiofrequency thermocoagulation (RFT)
-Glycerol Rhizolysis (GR)
-Ballon Compression (BC)
-Stereotactic Radio surgery (SRS)
Peripheral procedures
-Peripheral Neuroectomy
-Cryotheraphy
-Alcohol Block
MVD
Concept of Dandy (1920)
Popularized by Janetta.
GOLD STANDARD as it deals the underlying
cause.
Retromastoid Sub occipital craniotomy,
Retraction of superolateral margin of
cerebellum, arachnoid is dissected & vessel
freed, piece of shredded teflon placed
between the vessel & the nerve to separate
them.
OF1185 pts treated by Barker at al with
mean follow up of 6.5Yrs, 70% had excellent
results at 10yrs.
Our results in 10patients in whom MVD was
done 80% -85% had excellent results over of
period 5 Yrs.
Thank You