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Diagnosis and Management of Facial Pain
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Caroline P. Smith, Tim Woolford, Rajiv K. Bhalla
Trigeminal neuralgia is characterised by unilateral paroxysms of brief but severe pain followed by asymptomatic periods without pain, although a constant dull ache may persist in some patients. Pain is often described as stabbing or lancinating, burning, pressing, crushing, exploding or shooting, and patients may describe a trigger area on the face so sensitive that touching or even air currents may trigger an episode. Vascular (arterial and venous) compression of the trigeminal nerve roots is the likely cause in most cases. Magnetic resonance imaging (MRI) should be performed to exclude multiple sclerosis or middle fossa pathology. Carbamazepine is the drug of choice for management. Gabapentin, lamotrigine and topiramate are useful as second-line agents. Microvascular decompression produces satisfactory relief in most well-selected cases.
Benign Oral and Dental Disease
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Konrad S. Staines, Alexander Crighton
MRI is an essential first investigation when TN is suspected and medical therapy should be instituted quickly. The medication of choice is determined by the patient’s other medication, medical and home circumstance and the treating physician’s experience with TN patients. Carbamazepine is often the first-line medication but it causes significant sedation, balance disorders, nystagmus and drug interactions. Oxcarbazepine and lamotrigine are effective alternatives with fewer side effects in most patients. Lamotrigine must be introduced over several weeks and is often used once initial symptom control is achieved with carbamazepine. Surgical treatment for TN is indicated in the young or where the dose of medication is significantly impacting on the patient’s quality of life. A microvascular decompression is the treatment of choice where the MRI indicates that a vascular loop is compressing the trigeminal root. This procedure will usually result in a pain-free patient, off medication for several months although lower doses of the anti-neuralgic medicines are needed eventually. Destructive procedures to the trigeminal ganglion are quicker and simpler operations for the less fit patient and stereotactic radiosurgery (gamma knife) requires no operation at all.
Electrocardiography
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Manual of Neuroanesthesia, 2017
During transnasal transsphenoidal approach to pituitary tumors, rhythm disturbances may occur as a result of TCR (observed in 10%–12% cases) due to cavernous sinus stimulation or anterior hypothalamic stimulation, causing parasympathetic outflow. An abrupt onset of tachyarrhythmias may occur in pituitary apoplexy due to midbrain compression. Similar changes may be observed in microvascular decompression for trigeminal neuralgia.
Successful microvascular decompression surgery for dolichoectatic vertebral artery compression of medulla oblongata in a patient with hypersomnia disorder
Published in British Journal of Neurosurgery, 2023
Mohammad Ghorbani, Maziar Azar, Karan Bavand, Hamidreza Shojaei, Reza Mollahoseini
A 43 year old male presenting with hypersomnia from 7 years ago referred to our practice for more diagnostic and therapeutic interventions. His symptoms exacerbated with snoring, slurred speech and sleep apnea since 6 months which was affected his job as a driver. He had a past history of palatine surgery that was not helpful for him. On admission time, his physical examinations seemed normal. Early diagnostic evaluation was done with polysomnography and revealed a central sleep apnea. Therefore a brain MRI was requested and showed a vertebrobasilar dolichoectatasia (Figure 1). Also a spiral brain CT angiography was performed and confirmed that an abnormal vascular loop has kinked the brainstem. After ruling out of other causes and considering disable condition of the patient, consultation with him and his family was done and then the authors decided to do microvascular decompression surgery for him.
Management of veins during microvascular decompression for idiopathic trigeminal neuralgia
Published in British Journal of Neurosurgery, 2018
Xu Zhao, Shuai Hao, Minqing Wang, Chao Han, Deguang Xing, Chengwei Wang
Microvascular decompression (MVD) has been widely accepted as an effective surgical choice for idiopathic trigeminal neuralgia (TN) patients who fail to respond or become intolerant to medical treatment. The surgical outcome depends on various factors, e.g. the type of offending vessel. Although arterial compression has been reported to be the main cause of TN in most cases, venous compression alone or in combination with arterial compression has also been frequently observed during surgery.1–3 Venous compression may be the main cause of incomplete decompression and symptom recurrence.4–6 In most cases, it is difficult to dissect offending veins from the nerve, and thus, the neurosurgeon faces the difficult choice of sacrificing the veins or decompressing them with preservation. There is no universal consensus on the management of veins. Some authors advocated the preservation of veins because sacrificing the veins may affect the brainstem or cerebellum and cause severe complications.7–11 Others claimed to cut the veins because saving the veins may result in unsatisfactory decompression or recurrence.4,12 In the present study, we retrospectively summarized the various types of offending vessels based on the surgical findings and described our experience regarding the treatment of veins during the procedure of MVD.
Glossopharyngeal neuralgia as initial symptom in combined hyperactive dysfunction syndrome: case report
Published in British Journal of Neurosurgery, 2023
Pelin Kuzucu, Tolga Türkmen, Göktuğ Ülkü, Mesut Emre Yaman, Şükrü Aykol
Wang et al reported the largest number of cases related to CHDS.4In these reported six cases, three were presented with unilateral symptoms whereas three had CHDS in bilateral fashion. The presenting symptom was HFS in five cases and TN in one case. Only in one case, one of the offending vessels was in venous origin. SCA, PICA, AICA, and VA were the offending vessels in arterial origin. Two of the six patients were the woman and all patients were in middle to old age. Microvascular decompression had been performed in all patients. Symptoms resolved immediately in three patients. In three of the six patients’ symptoms resolved with time. Cao et al reported only two female cases of a combination TN-HFS-GPN in their series of 44 patients with CHDS.5 The initial symptom in these two cases was HFS followed by TN-GPN. The offending vessel in their cases was in arterial origin. In one patient microvascular decompression was performed. In the second patient, partial sensory rhizotomy was added to microvascular decompression surgery. Symptoms resolved in both two cases. A recent case reported by Perez-Roman et al. was a 66-year-old man, complaint from the right TN, followed by HFS and TN. The V, VII, and IX nerves were compressed by a dolichoectatic VA. Microvascular decompression with a clip-sling suspension technique augmented with Teflon felt pledgets was performed. Symptoms of the patient resolved after surgery. In contrast to the relevant literature, our case was a 73-year-old man presented at the first time in the literature with GPN as initial symptom followed by TN and HFS. SCA, petrous vein, and AICA were the offending vessels in TN, HFS, and GPN, respectively. Microvascular decompression was performed, and patients’ symptoms resolved immediately after surgery. Another unique feature was that the VII-VIII nerve complex was compressed by the vein of the middle cerebellary peduncle.