trigeminal neuralgia - min-saude.pt
TRANSCRIPT
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TRIGEMINAL NEURALGIA
Marcos Barbosa
Serviço de Neurocirurgia
HOSPITAIS DA UNIVERSIDADE DE COIMBRA
COIMBRA, PORTUGAL
EANS COURSE
ANTALYA, Feb 2007
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TRIGEMINAL NEURALGIA
HISTORY
Jurjani (11th century)
John Locke (17th century)
Charles Bell (1829)
Armand Trosseau (1853)
Dandy (1932)
Bergouingnan (1942)
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TRIGEMINAL NEURALGIA
CLINICAL PRESENTATION
brief, intense paroxysms confined to one or
more divisions of the trigeminal nerve
electric shock/stabbing
trigger-zone
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TRIGEMINAL NEURALGIA
CLINICAL PRESENTATION
day/night
V2, V3, V1
increase number
sensory disturbances
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TRIGEMINAL NEURALGIA
DIFFERENTIAL DIAGNOSIS
MS
atypical facial pain syndromes
cluster headache
postherpetic neuralgia
geniculate neuralgia (Ramsay Hunt)
sphenopalatine ganglion neuralgia
glossopharyngeal neuralgia
dental disease, orbital disease
temporomandibular dysfunction
temporal arteritis
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TRIGEMINAL NEURALGIA
IMAGING
MRI
- rule out pathologies
- show vascular contact (?)
- 3D fusion MRI
- MRI virtual endoscopy
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TRIGEMINAL NEURALGIA
PREOPERATIVE SIMULATION FOR
MICROVASCULAR DECOMPRESSION IN
PATIENTS WITH IDIOPATHIC TRIGEMINAL
NEURALGIA: VISUALIZATION WITH THREE-
DIMENSIONAL MAGNETIC RESONANCE
CISTERNOGRAM AND ANGIOGRAM FUSION
IMAGING.
Satoh, Toru M.D.; Onoda, Keisuke M.D.; Date, Isao
M.D.
Neurosurgery. 60(1):104-114, January 2007
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TRIGEMINAL NEURALGIA
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TRIGEMINAL NEURALGIA
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TRIGEMINAL NEURALGIA
THREE-DIMENSIONAL VISUALIZATION OF NEUROVASCULAR COMPRESSION: PRESURGICAL USE OF VIRTUAL ENDOSCOPY CREATED FROM MAGNETIC RESONANCE IMAGING
[FUNCTIONAL AND STEREOTACTIC: Technique and Application]
Takao, Tetsuro M.D.; Oishi, Makoto M.D.; Fukuda, Masafumi M.D.; Fujii, Yukihiko M.D.; Ishida, Go; Sato, Mitsuya M.D.
Neurosurgery:Volume 63(1) Operative Neurosurgery Supplement 1July 2008p ONS139-ONS146
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TRIGEMINAL NEURALGIA
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TRIGEMINAL NEURALGIA
MEDICAL THERAPY
carbamazepine
phenytoin
oxcarbazepine
gabapentim
lamotrigine
clonazepan
baclofen
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TRIGEMINAL NEURALGIA
SURGICAL TREATMENT
mvd
selective percutaneous lesion
(RF, balloon, glycerol)
radiosurgery
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TRIGEMINAL NEURALGIA
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TRIGEMINAL NEURALGIA
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TRIGEMINAL NEURALGIA
Rhoton, Albert L. Jr. M.D. Neurosurgery: Volume 47(3) Supplement September 2000 pp S93-S129
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TRIGEMINAL NEURALGIA
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TRIGEMINAL NEURALGIA
OPERATIVE FINDINGS (97%)
arterial channels 374 (80,3%)
venous channels 65 (13,9%)
tumor 12 (2,6%)
negative 15 (3,2%)
total 466
Russel R. Lonser and Ronald I. Apfelbaum
“Operative Neurosurgical Techniques”
Vol 2, pp 1531-1538 (2006)
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TRIGEMINAL NEURALGIA
COMPRESSIVE ARTERY
SCA – 80%
SCA+AICA – 9%
AICA – 8%
Basilar – 2%
Others – 1%
Russel R. Lonser and Ronald I. Apfelbaum
“Operative Neurosurgical Techniques”
Vol 2, pp 1531-1538 (2006)
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TRIGEMINAL NEURALGIA
INITIAL RESULTS
complete relief – 91%
pain reduced – 6%
pain not relieved – 2%
death – 1%Russel R. Lonser and Ronald I. Apfelbaum
“Operative Neurosurgical Techniques”
Vol 2, pp 1531-1538 (2006)
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TRIGEMINAL NEURALGIA
COMPLICATIONS
cranial nerve dysfunction – 12,6%
dizziness, ataxia – 3%
infarction – 1,8%
seizures – 1%
death – 1%Russel R. Lonser and Ronald I. Apfelbaum
“Operative Neurosurgical Techniques”
Vol 2, pp 1531-1538 (2006)
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TRIGEMINAL NEURALGIA
LONG-TERM RESULTS
no recurrence - 62%
mild pain (no medication) - 5%
pain controlled with medication -14%
severe pain not controlled “ - 18%
died - 1%Russel R. Lonser and Ronald I. Apfelbaum
“Operative Neurosurgical Techniques”
Vol 2, pp 1531-1538 (2006)
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TRIGEMINAL NEURALGIA
Rhoton, Albert L. Jr. M.D. Neurosurgery: Volume 47(3) Supplement September 2000 pp S93-S129
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TRIGEMINAL NEURALGIA
Rhoton, Albert L. Jr. M.D. Neurosurgery: Volume 47(3) Supplement September 2000 pp S93-S129
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TRIGEMINAL NEURALGIA
Rhoton, Albert L. Jr. M.D.
Neurosurgery: Volume 47(3)
Supplement
September 2000 pp S93-S129
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TRIGEMINAL NEURALGIA
Rhoton, Albert L. Jr. M.D. Neurosurgery: Volume 47(3) Supplement September 2000 pp S93-S129
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TRIGEMINAL NEURALGIA
Rhoton, Albert L. Jr. M.D. Neurosurgery: Volume 47(3) Supplement September 2000 pp S93-S129
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TRIGEMINAL NEURALGIA
Rhoton, Albert L. Jr. M.D. Neurosurgery: Volume 47(3) Supplement September 2000 pp S93-S129
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TRIGEMINAL NEURALGIA
Rhoton, Albert L. Jr. M.D. Neurosurgery: Volume 47(3) Supplement September 2000 pp S93-S129
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TRIGEMINAL NEURALGIA
Rhoton, Albert L. Jr. M.D. Neurosurgery: Volume 47(3) Supplement September 2000 pp S93-S129
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TRIGEMINAL NEURALGIA
Rhoton, Albert L. Jr. M.D. Neurosurgery: Volume 47(3) Supplement September 2000 pp S93-S129
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TRIGEMINAL NEURALGIA
Rhoton, Albert L. Jr. M.D. Neurosurgery: Volume 47(3) Supplement September 2000 pp S93-S129
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TRIGEMINAL NEURALGIA
Rhoton, Albert L. Jr. M.D. Neurosurgery: Volume 47(3) Supplement September 2000 pp S93-S129
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TRIGEMINAL NEURALGIA
RETROGASSERIAN GLYCEROL RHIZOLYSIS
PERCUTANEOUS RADIOFREQUENCY
RHIZOTOMY
BALOON COMPRESSION
STEREOTACTIC RADIOSURGERY
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TRIGEMINAL NEURALGIA
GLYCEROL RHIZOLYSIS
classic ITN in elderly, infirm patients
MS
recurrence after MVD
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TRIGEMINAL NEURALGIA
GLYCEROL RHIZOLYSIS
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TRIGEMINAL NEURALGIA
GLYCEROL RHIZOLYSIS
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TRIGEMINAL NEURALGIA
GLYCEROL RHIZOLYSIS
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TRIGEMINAL NEURALGIA
GLYCEROL RHIZOLYSIS
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TRIGEMINAL NEURALGIA
GLYCEROL RHIZOLYSIS
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TRIGEMINAL NEURALGIA
RADIOFREQUENCY
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TRIGEMINAL NEURALGIA
RADIOFREQUENCY
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TRIGEMINAL NEURALGIA
RADIOFREQUENCY
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TRIGEMINAL NEURALGIA
RADIOFREQUENCY
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TRIGEMINAL NEURALGIA
RADIOFREQUENCY
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TRIGEMINAL NEURALGIA
RADIOSURGERY
2003 – 12,560 (source: Leksell GNS)
2 years follow-up
initial pain relief in 95,5%
recurrences in 3,3%
3 weeks to pain relief (1 day to 20 months)
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TRIGEMINAL NEURALGIA
RADIOSURGERY
complications - dysesthesias 16,7% (70Gy)
32% (90Gy)
(may start up to 19 months, median 8)
- dry eye syndrome 5%
- impaired taste 4%