Trigeminal Neuralgia: A Comprehensive Guide

Preface
Contents
Part I: Basics of Trigeminal Neuralgia
Overview of Trigeminal Neuralgia
1 Definition of Trigeminal Neuralgia
2 History
3 Epidemiology
4 Etiology and Pathophysiology
5 Diagnosis
6 Treatment
6.1 Nonsurgical Treatment
6.2 Surgical Treatment
References
Pathogenesis of Trigeminal Neuralgia
1 Basic Anatomy
2 Pain Transmission
3 Pain Modulation in Central Nervous System
4 Pathophysiology of Trigeminal Neuralgia
4.1 Nerve Vascular Compression and Focal Demyelination
4.2 Sodium Channel and Potassium Channel in Trigeminal Neuralgia
References
Clinical Diagnosis of Trigeminal Neuralgia
1 Introduction
2 Clinical Diagnosis of TN
3 Classifications of TN
References
Differential Diagnosis of Trigeminal Neuralgia
1 Trigeminal Neuropathic Pain
1.1 Herpes Zoster/ Postherpetic Pain
1.2 Trauma
1.3 Other Secondary Causes
2 Primary Headache Disorders
2.1 Trigeminal Autonomic Cephalalgia (TAC)/Orofacial TAC
3 Idiopathic Pain Conditions: Persistent Idiopathic Facial Pain (PIFP) and Constant Unilateral Facial Pain with Additional Attacks (CUFPA)
References
Electrophysiological Diagnosis “Now and Future” for Trigeminal Neuralgia
1 Introduction
2 Electrophysiological Study
2.1 Corneal Reflex
2.1.1 Methodology
2.1.2 Applications
2.2 Blink Reflex
2.2.1 Methodology
2.2.2 Applications
2.3 Jaw Jerk (Masseter Reflex)
2.3.1 Methodology
2.3.2 Applications
2.4 Masseter Inhibitory Reflex (MIR)
2.4.1 Methodology
2.4.2 Applications
2.5 Trigeminal Somatosensory-Evoked Potentials
2.6 Laser-Evoked Potentials and Contact Heat-Evoked Potentials
3 Conclusion
References
Magnetic Resonance Imaging Evaluation of Trigeminal Neuralgia
1 MR Imaging Techniques Used for Trigeminal Neuralgia
2 Anatomy of the Cisternal Segment of the Trigeminal Nerve
3 MRI Evaluation of Trigeminal Neuralgia
3.1 MRI Evaluation of Classical TN
3.2 MRI Evaluation of Secondary TN
3.3 MRI Evaluation of Persistent or Recurrent TN After MVD
4 Conclusion
References
Recent Advances and Future Perspective in MRI Technique for the Trigeminal Neuralgia
1 Introduction
2 Fast Imaging Technique
3 MR Cisternography (Heavily T2-Weighted/Proton Density Imaging)
4 Post-contrast 3D T1-Weighted Images
5 Volumetric Analysis of the Brain in Patients with Trigeminal Neuralgia
6 Diffusion Tensor Imaging
7 Resting-State Functional MRI
8 7T MRI
References
Medical Treatment in Trigeminal Neuralgia
1 Introduction
2 Management for Long-Term Therapy (Table 2)
2.1 First-Line Treatment
2.1.1 Carbamazepine
2.1.2 Oxcarbazepine
2.2 Other Medications
2.2.1 Lamotrigine
2.2.2 Gabapentin
2.2.3 Pregabalin
2.2.4 Pimozide
2.2.5 Baclofen
2.2.6 Clonazepam
2.2.7 Valproate
2.2.8 Phenytoin
2.2.9 Botulinum Toxin Type A
3 Management for Acute Exacerbation
4 Investigating Medications
5 Conclusion
References
Part II: Microvascular Decompression
Anesthetic Management of Microvascular Decompression for Trigeminal Neuralgia
1 Preoperative Management
2 Intraoperative Management
2.1 Positioning
2.2 Anesthesia for Intraoperative Neuromonitoring
2.3 Trigeminal Arrhythmia
2.4 Cranial Nerve Dysfunction and Respiratory Center Injury
2.5 Pneumocephalus and Cerebrospinal Fluid Leakage
2.6 Venous Air Embolism
3 Postoperative Management
3.1 Extubation and Airway Management
3.2 Macroglossia
3.3 Nausea and Vomiting
3.4 Postoperative Pain
3.5 Postoperative Delirium (PODE)
4 Anesthetic Management of Radiofrequency Ablation (RFA) for TN
References
Intraoperative Neurophysiological Monitoring for Trigeminal Neuralgia in Microvascular Decompression
1 Introduction
2 Brainstem Auditory Evoked Potentials (BAEPs)
2.1 BAEPs Monitoring during INM and Hearing
2.2 Warning Criteria
2.2.1 BAEPs Changes of Mechanism
2.3 Other Methods of Preservation Hearing
3 Trigeminal Nerve Somatosensory Evoked Potentials
3.1 Optimal Test of T-SEP Method
4 Masseter Reflex
4.1 Optimal Test of Masseter Reflex Method
5 Blink Reflex
5.1 Optimal Test of Blink Reflex Method
6 Free-Running Electromyography
6.1 Optimal Electrode Insertion Method for Trigeminal Nerve EMG Measurement
References
The Principal Surgical Techniques for Microvascular Decompression: Surgical Treatment for Trigeminal Neuralgia
1 Introduction
2 Surgical Anatomy
3 Making Surgical Field
3.1 Dural Incision and CSF Drainage
4 Basic Surgical Techniques
4.1 Microsurgical Dissection and Trigeminal Nerve Indentification
5 Neurovascular Decompression
5.1 Nerve Exploration
5.2 Neurovascular Decompression
5.3 Complicated Cases
5.3.1 Venous Offender
5.3.2 No Vascular Conflict
6 The Unexpected Complications during Surgery
6.1 Cerebellar Swelling
6.2 Sudden Hemorrhage
7 Conclusion
References
Pitfalls and Pearls in Microvascular Decompression for Trigeminal Neuralgia
1 Setting for Operative Room
2 Patient Positioning and Preparation
3 Craniotomy
4 Epidural Bleeding Control and Dural Opening (Fig. 4)
5 Entering Intracranially
6 Approach to the Superior Petrosal Vein
7 Management of a Bleeding Superior Petrosal Vein
8 Approach to Trigeminal Nerve and Neurovascular Decompression
References
Microvascular Decompression for Trigeminal Neuralgia; Transposition Procedure
1 Decompressing Materials for MVD Surgery
2 Decompression Procedure: Transposition
3 Role of Transposition in Vein as an Offending Vessel
References
Postoperative Cerebrospinal Fluid Leakage and Closing Technique for Microvascular Decompression
1 Postoperative CSF Leakage
2 Incidence
3 Factors Affecting Postoperative CSF Leakage
4 Clinical Symptoms
5 Diagnosis
5.1 Biochemical Diagnosis
5.1.1 Glucose Oxidase Test
5.1.2 Beta-2 Transferrin Test (β-2 TRF)
5.1.3 Beta-Trace Protein Test (β-TP)
5.2 Radiologic Diagnosis
5.2.1 Temporal Bone Computed Tomography (TBCT)
5.2.2 Magnetic Resonance Imaging (MRI)
5.3 Endoscopic Ear Examination
6 Management
6.1 Conservative Management
6.2 Lumbar Drainage
6.3 Surgical Management
7 Dural Closure Technique
7.1 Triple Layer Reinforced Dural Repair Technique: Durogen, Tachosil, Artificial Bone Cement
References
Operative Complications of Microvascular Decompression for Trigeminal Neuralgia
1 Introduction
2 Methods
3 Results
3.1 Operative Complications
3.2 Tricks to Overcome Complications
3.2.1 Paresthesia and Skin Incision
3.2.2 Optimal Position
3.2.3 Intradural Procedure
4 Conclusion
References
Postoperative Prognosis After Microvascular Decompression for Trigeminal Neuralgia
1 Pain Outcomes After Microvascular Decompression
2 Prognostic Factors for Outcome of Microvascular Decompression
2.1 Patient-Related Factors
2.1.1 Age
2.1.2 Brain Structure
2.2 Disease-Related Factors
2.2.1 Coexistence with Ipsilateral HFS or Contralateral TN
2.2.2 Type of TN Pain
2.2.3 Branches of TN
2.2.4 Magnetic Resonance Imaging (MRI)
2.2.5 Degree of Neurovascular Compression
2.3 Surgery-Related Factors
2.3.1 Offending Vessels
2.3.2 Surgical Methods
2.4 Models
3 Microvascular Decompression Versus Other Treatments
3.1 Versus Radiofrequency Rhizotomy
3.2 Versus Stereotactic Radiosurgery
3.3 Versus Percutaneous Balloon Compression
3.4 Versus Percutaneous Thermocoagulation
4 Primary Microvascular Decompression Versus Subsequent Microvascular Decompression
5 Redo Microvascular Decompression
References
Redo Surgery for Failed MVD
1 Operative Technique
2 Our Results
References
Part III: Ablative Treatment and Related Issues
Nerve Block, Pulsed RF Treatment, and Percutaneous Neurolysis for Trigeminal Neuralgia
1 Peripheral Branch Block of the Trigeminal Nerve and Percutaneous Neurolysis for Peripheral Branch of Trigeminal Nerve
1.1 Supraorbital Nerve Block and Pulsed Radiofrequency (RF) Treatment [1, 2]
1.1.1 Anatomy
1.1.2 Indications
1.1.3 Methods
Blind Technique
Ultrasound Guidance Technique
Pulsed RF Treatment
1.1.4 Effects
1.1.5 Complications
1.2 Supraorbital Nerve Neurolysis
1.2.1 Indications
1.2.2 Methods
Blind Technique
Ultrasound Guidance Technique
1.2.3 Effects
1.2.4 Complications
1.3 Infraorbital Nerve Block and Pulsed RF Treatment [1, 2]
1.3.1 Anatomy
1.3.2 Indications
1.3.3 Methods
Blind Technique
Ultrasound Guidance Technique
Pulsed RF Treatment
1.3.4 Effects
1.3.5 Complications
1.4 Infraorbital Nerve Neurolysis
1.4.1 Indications
1.4.2 Methods
Blind Technique
Ultrasound Guidance Technique
1.4.3 Effects
1.4.4 Complications
1.5 Mental Nerve Block and Pulsed RF Treatment [1, 2]
1.5.1 Anatomy
1.5.2 Indications
1.5.3 Methods
Blind Technique
Ultrasound Guidance Technique
Pulsed RF Treatment
1.5.4 Effects
1.5.5 Complications
1.6 Mental Nerve Neurolysis
1.6.1 Indications
1.6.2 Methods
Blind Technique
Ultrasound Guidance Technique
1.6.3 Effects
1.6.4 Complications
2 Sphenopalatine Ganglion Block [1]
2.1 Anatomy
2.2 Indications
2.3 Methods [21]
2.3.1 Transnasal Approach
2.3.2 Transoral Approach
2.3.3 Infrazygomatic Approach
2.3.4 Pulsed RF Treatment
2.4 Effects
2.5 Complications
3 Major Branch Block of the Trigeminal Nerve, Pulsed RF Treatment, and Percutaneous Neurolysis for Major Branch of Trigeminal Nerve
3.1 Maxillary Nerve Block and Pulsed RF Treatment [1]
3.1.1 Anatomy
3.1.2 Indications
3.1.3 Methods
Infrazygomatic Approach
Pulsed RF Treatment
3.1.4 Effects
3.1.5 Complications
3.2 Percutaneous Neurolysis for Maxillary Nerve
3.2.1 Indications
3.2.2 Methods
Infrazygomatic Approach
3.2.3 Effects
3.2.4 Complications
3.3 Mandibular Nerve Block and Pulsed RF Treatment [1]
3.3.1 Anatomy
3.3.2 Indications
3.3.3 Methods
Lateral Extraoral Route, Coronoid Approach (Blind Technique)
Lateral Extraoral Route, Coronoid Approach (C-Arm Fluoroscopy Guidance)
Perioral Approach
Pulsed RF Treatment
3.3.4 Effects
3.3.5 Complications
3.4 Percutaneous Neurolysis for Mandibular Nerve
3.4.1 Indications
3.4.2 Methods
Lateral Extraoral Route, Coronoid Approach (Blind Technique)
Lateral Extraoral Route, Coronoid Approach (C-Arm Fluoroscopy Guidance)
Perioral Approach
3.4.3 Effects
3.4.4 Complications
4 RF Thermocoagulation of Trigeminal Ganglion or Rootlet [1, 35] and Percutaneous Neurolysis of Trigeminal Ganglion
4.1 RF Thermocoagulation of Trigeminal Ganglion or Rootlet
4.1.1 Anatomy [36]
4.1.2 Indication
4.1.3 Methods
RF Thermocoagulation of the Trigeminal Ganglion
RF Thermocoagulation of the Trigeminal Rootlet
4.1.4 Effects
4.1.5 Complications
4.2 Percutaneous Neurolysis of Trigeminal Ganglion
4.2.1 Indication
4.2.2 Methods [40]
4.2.3 Effects
4.2.4 Complications
References
Percutaneous Radiofrequency Thermal Rhizotomy for Trigeminal Neuralgia
1 Technique of Percutaneous Thermal Rhizotomy Under Sedation
2 Radiofrequency Thermal Rhizotomy Under General Anesthesia
3 Outcome and Complications
4 Conclusion
References
Percutaneous Balloon Compression and Glycerol Rhizotomy
1 Balloon Compression
1.1 Historical Background
1.2 Action Mechanism
1.3 Indications
1.4 Techniques and Equipment
1.5 Preoperative Evaluation
1.6 Preparation of Patient and Anesthesia
1.7 Operative Procedure
1.7.1 Position of Patient and C-Arm
1.7.2 Foramen Ovale Puncture
1.7.3 Meckel’s Cave Cannulation and Trigeminal Porus Compression
1.8 Results
1.9 Complication Avoidance
2 Percutaneous Glycerol Rhizotomy
2.1 Historical Background
2.2 Action Mechanism
2.3 Indications
2.4 Techniques and Equipment
2.5 Operative Procedure
2.6 Results
2.7 Complication Avoidance
2.8 Comparison of Percutaneous Ablative Procedures
3 Conclusion
References
Stereotactic Radiosurgery for Trigeminal Neuralgia
1 Introduction
2 Mechanism of Pain Relief and History of SRS in TN
3 Clinical Outcome of SRS for TN
3.1 Freedom from Pain
3.2 Long-Term Result
3.3 Complications
3.4 Recurrence
4 Target Selection in SRS for TN
5 Optimal Dose of SRS for TN
6 Conclusion
References
Surgical Treatment of Trigeminal Neuralgia: Partial Sensory Rhizotomy
1 Introduction
2 Surgical Indications of the Partial Sensory Rhizotomy
3 Operative Technique
4 Anatomy of TN; Schematic Drawing of the Anatomy of TN, MRI, and Operative Field
5 Clinical Outcome and Postoperative Complications
6 Conclusion
References
Neuromodulation for Trigeminal Neuralgia
1 Introduction
2 Standard Treatment for Trigeminal Neuralgia
2.1 Refractory Trigeminal Neuralgia and Painful Trigeminal Neuropathy
3 Neuromodulation
4 Motor Cortex Stimulation
5 Deep Brain Stimulation
6 Peripheral Nerve Stimulation
7 Spinal Cord Stimulation
8 Conclusion
References
Secondary Trigeminal Neuralgia
1 Introduction
2 Tumor-Induced Trigeminal Neuralgia
2.1 Meningioma and Schwannoma
2.2 Case Illustration
2.3 Dermoid Cyst
3 Trigeminal Neuralgia Due to Multiple Sclerosis
4 Conclusion
References
Glossopharyngeal Neuralgia Focusing on Microvascular Decompression
1 Introduction
2 Anatomy and Pathophysiology
3 Diagnosis
4 Treatment
4.1 Microvascular Decompression (MVD)
5 Conclusion
References
Otalgia and Geniculate Neuralgia
1 Introduction
2 Etiology and Differential Diagnosis
3 Primary Otalgia
3.1 Causes of the Middle Ear
3.2 Causes of the External Auditory Canal
3.3 Causes of the Auricle
4 Secondary Otalgia
4.1 Causes of Head and Neck Problems
4.2 Causes of Aerodigestive Tract Problems
5 Geniculate Neuralgia or Nervus Intermedius Neuralgia
6 Summary
References