Trigeminal Neuralgias: A Neurosurgical Illustrated Guide

Preface
Acknowledgments
Contents
1: Introduction: Definition of Trigeminal Neuralgia and Evolution of Concepts
1.1 Definition of Trigeminal Neuralgia
1.2 Evolution of Concepts
2: Terminology and Classification of Trigeminal Neuralgias
2.1 Criteria for Diagnosis of Trigeminal Neuralgia
2.2 Classification on Presumed Etiology
2.2.1 Secondary Trigeminal Neuralgia
2.2.2 Classical Trigeminal Neuralgia
2.2.3 Idiopathic Trigeminal Neuralgia
3: Anatomy of the Trigeminal Nerve (TGN)
3.1 Descriptive Anatomy of the TGN
3.1.1 The Trigeminal Nerve in the Trigeminal Cave
3.1.2 The Trigeminal Root in the Cerebellopontine Angle
3.1.3 The Trigeminal Root Entry Zone
3.2 Functional Anatomy of the TGN
4: Anatomy of the Neighbouring Vessels and Structures Surrounding the Trigeminal Nerve
4.1 Arteries
4.2 Veins
4.3 Surrounding Structures
4.3.1 Role of the Size of the Cerebello-Pontine Angle Cistern
4.3.2 Role of the Upper Petrous Ridge
4.3.3 Influence of Focal Arachnoiditis
4.3.4 Presence of Global Radicular Atrophy
5: Trigeminal Neuralgias: Clinical Presentations, Neurological Assessment, and Specialty Investigations
5.1 Problems of Characterization
5.1.1 Trigeminal Neuralgia May Result from Various Pathologies
5.1.2 The Clinical Presentations of Trigeminal Neuralgia
5.1.3 The Atypical Trigeminal Neuralgia
5.1.4 Distinction Between Classical Trigeminal Neuralgia and Painful Trigeminal Neuropathies
5.2 Mechanisms
5.2.1 Hypotheses
5.2.2 Structural Abnormalities
5.2.3 Electrophysiological Abnormalities
5.2.4 Anomalies in Secondary Trigeminal Neuralgias
5.2.5 The Question of Genetic Involvement
5.3 Epidemiology
5.4 Clinical Presentation in Its Typical Form
5.4.1 Pain Quality
5.4.2 Pain Topography
5.4.3 Conditions of Triggering Pains
5.4.4 Negativity of the Neurological Examination
5.4.5 Evolution
5.4.6 Trigeminal Pre-neuralgia
5.5 Other Clinical Presentations
5.5.1 Atypical Trigeminal Neuralgia (= Trigeminal Neuralgia with Concomitant Continuous Pain)
5.5.2 Trigeminal Neuralgia with Autonomic Involvement
5.5.3 Trigeminal Neuralgia After Long Evolution
5.5.4 Trigeminal Neuralgia After Trigeminal Surgery
5.6 Clinical Assessment
5.6.1 Neurological Assessment
5.6.2 Other Specialty Investigations
5.6.3 The Way to Assess Pain Intensity in Therapeutic Results
6: Trigeminal Neuralgias: Neuro-Imaging Assessment
6.1 Standard Imaging Should Rule Out Secondary Neuralgias
6.2 Detection of the Neurovascular Conflicts
6.3 Diffusion Tensor Imaging (DTI) MRI
7: Differential Diagnoses of Trigeminal Neuralgias
7.1 The Secondary Trigeminal Neuralgias
7.2 The Painful Trigeminal Neuropathies
7.3 The Trigeminal Autonomic Cephalalgias (TACs)
7.3.1 Cluster Headache
7.3.2 Other Types of TACs
7.4 Neuralgias Outside the Trigeminal Territory
7.4.1 Vago-Glossopharyngeal Neuralgia
7.4.2 Neuralgia of the Intermedius Nerve
7.4.3 Neuralgia of the Superior Laryngeal Nerve
7.4.4 Occipital Neuralgia
7.4.5 The Neck-Tongue Syndrome
7.5 Atypical Facial Pain (= Persistent Idiopathic Facial Pain)
8: Pharmacological Treatment of Trigeminal Neuralgias
8.1 Carbamazepine (Tegretol®)
8.2 Oxcarbazepine (Trileptal®)
8.3 Other Antiepileptics
8.4 Non-antiepileptic Drugs
9: Micro-Vascular Decompression (MVD) and Other Open Microsurgical Procedures for Trigeminal Neuralgias
9.1 Brief on the Evolution of the Surgical Treatments
9.2 Anatomical-Pathological Findings in Patients with Neuro-Vascular Conflicts
9.2.1 Incidence of the Neuro-Vascular Conflicts
9.2.2 Situation of the NVC Along the Trigeminal Root
9.2.3 Location of the NVCs Around the Trigeminal Root
9.2.4 Degrees of Compression of the NVCs
9.2.5 Other Anomalies of (or in) the Posterior Fossa
9.3 Mechanisms of Pain in the Roots Compressed by the NVC
9.4 Main Technical Risks of the MVD Procedure for Trigeminal Neuralgia
9.4.1 Risk of Hearing Loss on the Approach: How to Avoid
9.4.2 Risks from Venous Sacrifices: How to Avoid Venous Infarction
9.4.3 Risks Linked to the Decompression: How to Avoid Neo-Compression
9.5 Surgical Steps
9.6 Surgical Technique of MVD According to Vessels
9.6.1 The Superior Cerebellar Artery (SCA)
9.6.2 The Anterior Inferior Cerebellar Artery (AICA)
9.6.3 The Vertebrobasilar Artery (VBA)
9.6.4 Material for Decompression
9.6.5 Venous Neuro-Vascular Conflicts (NVCs)
9.7 Outcome After MVD
9.7.1 Pain Relief
9.7.2 The Puzzling Case of the Venous Compressions
9.7.3 Complications
9.7.4 Conclusions and Perspectives
9.8 The Other Open Microsurgical Procedures
9.8.1 The Sub-Temporal Trigeminal Retrogasserian Neurotomy
9.8.2 The Juxta-Pontine Trigeminal Rhizotomy
9.8.3 Internal Neurolysis
10: Percutaneous Lesioning-Techniques for Trigeminal Neuralgias
10.1 Brief on the Evolution of the Surgical Treatments
10.2 The Percutaneous Hartel Route
10.3 Radiofrequency- Thermorhizotomy
10.3.1 Procedure
10.3.2 Outcome
10.4 Balloon Compression
10.4.1 Procedure
10.4.2 Outcome
10.5 Glycerol Injection
10.5.1 Procedure
10.5.2 Outcome
11: Stereotactic Radiosurgery for Trigeminal Neuralgias
11.1 Brief on the Evolution of the Surgical Treatments
11.2 Procedure
11.3 Outcome
11.3.1 Main Published Series
11.3.2 Comparisons Between GK & LINAC & CK
11.3.3 Results After Second and Third Surgeries
11.3.4 Comparisons with Other Techniques
11.4 Conclusions
12: Decision-Making and Conclusions
Epilogue
References
Index