Repeat percutaneous rhizotomy for trigeminal neuralgia is not associated with an increased risk of postoperative complications.

BACKGROUND AND OBJECTIVES: Patients undergoing percutaneous rhizotomy for trigeminal neuralgia (TN) may require several procedures to manage their pain. However, it is not fully understood whether repeat procedures influence postoperative complication rates. METHODS: We retrospectively reviewed patients undergoing rhizotomy at our institution from 2011 to 2022. Patients were included only if they had no history of prior interventions including microvascular decompression (MVD) or radiosurgery. We collected baseline patient information, pain characteristics, and postoperative complications for each patient. Patients were dichotomized into those undergoing primary rhizotomy versus those undergoing a repeat rhizotomy. Potential drivers of postoperative complications were included in a multivariate logistic regression model. RESULTS: Of the 1904 cases reviewed, 965 met our inclusion criteria. 392 patients underwent primary rhizotomy, and 573 patients underwent repeat rhizotomies. The repeat rhizotomy group was significantly older, p<0.001. Patients in the repeat rhizotomy group expressed higher frequencies of bilateral pain, p=0.01. Patients in the repeat rhizotomy group demonstrated a significantly higher rate of preoperative numbness and postoperative numbness, p<0.001. There were no significant differences in any of the considered complications between the single rhizotomy and repeat rhizotomy groups. On multivariate logistic regression, repeat rhizotomy did not predict an increased risk of any postoperative complications, p=0.14. CONCLUSIONS: Patients undergoing repeat rhizotomy may be at risk of postoperative numbness but are not at increased risk for postoperative complications. These results are of use to patients who are poor surgical candidates, and thus may require multiple rhizotomies to effectively manage their pain over time.

Meta-analysis and sequential analysis of acupuncture compared to carbamazepine in the treatment of trigeminal neuralgia.

BACKGROUND: In this randomized controlled trial (RCT) comparing current acupuncture with carbamazepine for trigeminal neuralgia, meta- and sequential analyses were utilized. AIM: To guide clinical decision making regarding the treatment of trigeminal neuralgia with carbamazepine. METHODS: The RCT literature on needle comparison was searched in various Chinese biomedical databases including Chinese Biomedical Literature Database, Wanfang Data, VIP Database, as well as international databases such as Excerpt Medica Database, Cochrane Library, PubMed, and Web of Science, along with related clinical registration platforms such as World Health Organization International Clinical Trial Registry Platform, ChiCTR, and Clinical Trials up to 1 April 2020. Risk of bias was evaluated using the Cochrane Collaborative Risk Bias tool, primary outcome measures (pain reduction) were analyzed using STATA meta-analysis, outcome measures were analyzed using trial sequential analysis 0.9.5.10 Beta sequential analysis, GRADE was used to assess the evidence, and adverse reactions were documented. RESULTS: This study analyzed 16 RCTs with a total of 1231 participants. The meta-analysis revealed a statistically significant difference in pain reduction between acupuncture and carbamazepine [standardized mean difference (SMD) = 1.47; 95% confidence interval (CI): 0.99-1.95], although the quality of evidence was deemed to be of extremely low quality. Cumulative meta-analysis based on the year of publication indicated that carbamazepine treatment first demonstrated a statistically significant difference in pain reduction in 2014 and remained relatively stable over time [SMD = 1.84; 95%CI: 0.22-3.47]. Additionally, the number of adverse events associated with acupuncture was significantly lower compared to carbamazepine. CONCLUSION: Acupuncture for trigeminal neuralgia is better than analgesia and safer than carbamazepine; however, firm conclusions still require a high-quality, multicenter, large-sample RCT to confirm these findings.

Factors associated with outcomes following microvascular decompression for the treatment of primary trigeminal neuralgia in adults: a systematic review and meta-analysis.

This study aimed to evaluate pain assessment strategies and factors associated with outcomes after microvascular decompression for the treatment of primary trigeminal neuralgia in adults. We conducted a systematic review and meta-analysis of English, Spanish, and French literature. We searched three databases, PubMed, Ovid, and EBSCO, from 2010 to 2022 and selected studies including patients with primary trigeminal neuralgia, clear pain assessment, and pain outcomes. Population means and standard deviations were calculated. Studies that included factors associated with postoperative outcomes were included in the meta-analysis. A total of 995 studies involving 5673 patients with primary trigeminal neuralgia following microvascular decompression were included. Patients with arteries compressing the trigeminal nerve demonstrated optimal outcomes following microvascular decompression (odds ratio [OR]= 0.39; 95% confidence interval [CI] = 0.19-0.80; X2 = 46.31; Dof = 15; I2 = 68%; P = < 0.0001). Conversely, when comparing arterial vs venous compression of the trigeminal nerve (OR = 2.72; 95% CI = 1.16-6.38; X2 = 23.23; Dof = 10; I2 = 57%; P = 0.01), venous compression demonstrated poor outcomes after microvascular decompression. Additionally, when comparing single-vessel vs multiple-vessel compression (OR = 2.72; 95% CI = 1.18-6.25; X2 = 21.17; Dof = 9; I2 = 57%; P = 0.01), patients demonstrated unfavorable outcomes after microvascular decompression. This systematic review and meta-analysis evaluated factors associated with outcomes following microvascular decompression (MVD) for primary trigeminal neuralgia (PTN). Although MVD is an optimal treatment strategy for PTN, a gap exists in interpreting the results when considering the lack of evidence for most pain assessment strategies.

Different mechanisms guide the antinociceptive effect of bone marrow-mononuclear cells and bone marrow-mesenchymal stem/stromal cells in trigeminal neuralgia.

AIMS: Trigeminal neuralgia (TN) is a type of chronic orofacial pain evoked by trivial stimuli that manifests as episodes of excruciating and sudden, recurrent paroxysmal pain. Most patients are refractory to pharmacological therapy used for the treatment of TN. Mononuclear cells (MNC) and mesenchymal stem/stromal cells (MSC) have shown therapeutic potential in painful neuropathies, but their mechanism of action is not fully understood. The present work aimed to investigate the antinociceptive effect and mechanism of action of MNC and MSC in experimental TN. MATERIALS AND METHODS: Mice submitted to the chronic constriction injury of the infraorbital nerve (CCI-ION) mouse model of TN received a single intravenous injection of saline, MNC, or MSC (1 × 106 cells/mouse). The effect of the treatments on the behavioral signs of painful neuropathy, morphological aspects of the infraorbital nerve, and inflammatory and oxidative stress markers in the infraorbital nerve were assessed. KEY FINDINGS: MNC and MSC improved behavioral painful neuropathy, activated key cell signaling antioxidant pathways by increasing Nrf2 expression, and reduced the proinflammatory cytokines IL-1ß and TNF-α. However, treatment with MSC, but not MNC, was associated with a sustained increase of IL-10 and with the re-establishment of the morphometric pattern of the infraorbital nerve, indicating a difference in the mechanism of action between MNC and MSC. In line with this result, in IL-10 knockout mice, MSC transplantation did not induce an antinociceptive effect. SIGNIFICANCE: Importantly, these data suggest an IL-10-induced disease-modifying profile related to MSC treatment and reinforce cell therapy's potential in treating trigeminal neuralgia.

Evaluating the Influence of Acute and Chronic Orofacial Pains on the Overall Comprehensive Quality of Life.

Background Orofacial discomfort refers to various disorders that affect the mouth, jaws, and face. These conditions may substantially influence a person's quality of life (QoL). This kind of pain may be categorised into two primary classifications: acute and chronic. Acute orofacial pain (OFP) usually occurs suddenly and lasts for a short period. It is commonly caused by specific factors such as dental treatments, traumas, or infections. Hence, this study aimed to assess the influence of acute and chronic orofacial discomfort on the overall QoL. Methodology This research used a convenience sample to gather data from the five groups. It was conducted as a cross-sectional study. Four categories of OFP syndromes were utilised: temporomandibular disorders (TMDs), atypical dental pain (ADP), trigeminal neuralgia (TN), and persistent dentoalveolar pain disorder (PDAP). In addition, a control group consisting of individuals who did not experience any discomfort was also included in the study. Participants received a standardised explanation of the questionnaires utilised, and in most instances, they completed them at the clinic under the supervision of one of the investigators. Results The correlations between each version of the Oral Health Impact Profile (OHIP) were statistically significant (p < 0.001), with correlation values ranging from 0.92 to 0.97. When comparing the occurrence of OHIP items across the four pain types, we identified 18 variations that exceeded the 35% prevalence threshold we established for identifying important items that frequently occur out of the 315 comparisons. The question "Have you had a painful aching in your mouth?" showed a low frequency in patients with TN, TMD, and ADP but a significant prevalence in patients with PDAP (90%). This difference in prevalence across pain types was the biggest seen. The question that seemed to distinguish between the pain categories most effectively was "Have you experienced a toothache?" This question had a high occurrence in PDAP (65%) and ADP (60%), perhaps allowing for differentiating these two diseases from TN and TMD. The highest prevalence differences, over 30%, were most often seen when PDAP was included as one of the disorders being compared. ADP had the fewest variances, over 30%, occurring just seven times. Conclusion Both acute and chronic OFPs have a major negative influence on QoL, but they affect it differently and to differing extents. Injury-related acute pain obviously poses rapid and severe restrictions on physical function and causes temporary psychological distress and temporary social exclusion. On the other hand, chronic pain for the patient always implies being locked in a physical world that does not allow him or her to bypass physical limitations, psychological disorders remain constant, and isolation from other people persists for life.

Technique of Awake Computed Tomography-guided Percutaneous Balloon Compression of the Gasserian Ganglion for Trigeminal Neuralgia.

BACKGROUND: The classic percutaneous balloon compression (PBC) technique is used to complete an operation under the guidance of C-arm radiography under general anesthesia, making communication with patients during the operation impossible. It is not accurate or objective to predict the classic technique's curative effect solely by determining whether the projection of the x-ray lateral image of the filled balloon is pear-shaped. OBJECTIVES: This study aimed to upgrade classic PBC to awake computed tomography (CT)-guided PBC technology under conscious local anesthesia and analgesia monitoring. STUDY DESIGN: Prospective clinical study. SETTING: Department of Anesthesiology and Pain Medical Center, Jiaxing, People's Republic of China. METHODS: Puncture was designed and guided by CT scanning, and the curative effect was assessed by asking the patients about what they are feeling during the operation. RESULTS: CT can design the puncture path and accurately guide puncture, observe the position and shape of the balloon through 3-dimensional reconstruction during the operation, and judge the curative effect according to the patient's chief concern. LIMITATIONS: Local anesthetic analgesia is not perfect, resulting in some patients experiencing pain during surgery. CONCLUSIONS: PBC can be completed under conscious local anesthesia and analgesia. Its curative effect and operative end standard can be determined according to the patient's chief concern. Under CT guidance, the puncture path can be designed to complete an accurate puncture and to intuitively understand the position and shape of the balloon.

Temporary Gasserian ganglion stimulation utilizing SNM electrode in subacute herpetic trigeminal neuralgia.

Objective: Gasserian ganglion stimulation (GGS) is a neuromodulation technique that has been extensively applied in treating postherpetic trigeminal neuralgia. However, permanent implantation of GGS was preferred in most treatment approaches. Few studies have investigated temporary GGS for the treatment of acute/subacute herpetic trigeminal neuralgia. Moreover, previous research has reported lead dislocation when utilizing traditional electrodes, which was associated with poor pain relief. In GGS research, preventing the accidental displacement of lead following implantation has consistently been a primary objective. Methods: We report a case of a 70-year-old woman with subacute herpetic trigeminal neuralgia who underwent temporary GGS for 14 days utilizing a sacral neuromodulation (SNM) quadripolar-tined lead. Computed tomography-guided percutaneous foramen ovale (FO) puncture and temporary SNM electrode implantation were performed during the surgery. A telephone interview was conducted to record a 12-month follow-up. Results: At admission, zoster-related trigeminal pain severity was assessed to be 9/10 on the visual analog scale (VAS). After a 14-day GGS treatment, the pain assessed on the VAS score reduced to 1/10 at discharge but increased to 4/10 at the 12-month follow-up after surgery. Additionally, the anxiety level improved from 58 points to 35 points on the Self-Rating Anxiety Scale (SAS), and the depression level improved from 62 points to 40 points on the Self-Rating Depression Scale (SDS). The Physical Component Summary score of the 12-item Short-Form Health Survey (SF-12) increased from 33.9 to 47.0, and the Mental Component Summary (MCS) score of the SF-12 increased from 27.4 to 41.9. Conclusion: Temporary GGS might be a potentially effective treatment for subacute herpetic trigeminal neuralgia, and an SNM electrode might be a good choice for reducing the risk of dislocation.

Intra-fractional corrections and clinical outcomes in frameless image-guided radiosurgery for trigeminal neuralgia.

Purpose: Precision targeting is crucial to successful stereotactic radiosurgery for trigeminal neuralgia (TGN). We investigated the impact of intra-fractional 6-dimensional corrections during frameless image-guided radiosurgery (IGRS) for pain outcome in TGN patients. Materials and methods: A total of 41 sets of intra-fractional corrections from 35 patients with TGN treated by frameless IGRS from 2009 to 2013 were retrospectively studied. For each IGRS, the intra-fractional 6-dimensional shifts were conducted at 6 couch angles. Clinical pain outcome was recorded according the Barrow Neurological Institute (BNI) 5-points score. The relationship in 6-dimensional corrections and absolute translational distances between patients with pain relief score points <2 versus ≥2 were analyzed. Results: The absolute mean lateral, longitudinal, and vertical translational shifts were 0.46 ± 0.15 mm, 0.36 ± 0.16 mm and 0.21 ± 0.08 mm, respectively, with 97% of translational shifts being within 0.7 mm. The absolute mean lateral (pitch), longitudinal (roll), and vertical (yaw) rotational corrections are 0.33 ± 0.24°, 0.18 ± 0.09°, and 0.27 ± 0.15°, respectively, with 97% of rotational corrections being within 0.6°. The median follow-up duration for pain outcome was 26 months after IGRS. The average calculated absolute shift for patients with pain relief <2 and ≥2 BNI points, were 0.228 ± 0.008 mm and 0.259 ± 0.007 mm, respectively. There was no statistically significant difference in the translational shifts, rotational corrections or absolute distances between these two patient groups. Conclusions: Our data demonstrate high spatial targeting accuracy of frameless IGRS for TGN with only nominal intra-fraction 6-dimensional corrections.

Idiopathic Intracranial Hypertension as a Differential Diagnosis in Persistent Idiopathic Facial Pain: A Case Report.

Persistent idiopathic facial pain (PIFP), previously known as atypical facial pain (ATFP), is a chronic pain disorder with the characteristic of persistent, undulating pain in the face or the teeth without a known cause or any structural correlation. Women are more commonly affected than men. We report a case of a 38-year-old married female patient with a history of Crohn's disease who presented to the oral and maxillofacial surgery (OMFS) clinic with chronic dull bilateral facial pain and headache mainly affecting the right side of the face and neck without a known cause. She was initially diagnosed with PIFP due to a badly decayed right wisdom tooth. Wisdom teeth were extracted secondary to vague complaints of discomfort due to wisdom teeth; however, no significant improvement was noticed. Further investigations were carried out with new CT scans and magnetic resonance venography (MRV), which revealed evidence of having idiopathic intracranial hypertension (IIH), described as increased intracranial pressure with facial pain, headache, tinnitus, and papilledema. The patient was referred to neurology and received appropriate treatment. She began her treatment with topiramate, then transitioned to acetazolamide, underwent bilateral botulinum toxin (botox) injections into the temporal region, and underwent regular follow-up. The patient was significantly improved. Idiopathic intracranial hypertension must be ruled out in cases of PIFP that do not respond to ordinary treatment measures.

Trigeminal neuralgia caused by venous compression: a comprehensive literature review.

Trigeminal neuralgia (TN), a severe facial pain condition, is often treated with microvascular decompression (MVD). While MVD is effective for arterial neurovascular compression, its efficacy in cases of venous compression and the intraoperative management of such cases remain areas of debate. This review aimed to analyze the intraoperative management strategies for offending veins during MVD and evaluate the outcomes of these procedures in cases of TN with purely venous compression. An extensive review of studies reporting on the intraoperative handling of veins and the surgical outcomes of MVD in purely venous compression cases was conducted. Fifteen full-text studies were included, encompassing a total of 600 patients. Notably, 82.33% of these patients achieved a Barrow Neurological Institute (BNI) I pain score, with follow-up periods ranging from 3 months to 12 years. MVD is a viable and effective treatment option for TN in cases of venous compression, with a significant proportion of patients experiencing substantial pain relief.

A causal effect study of cortical morphology and related covariate networks in classical trigeminal neuralgia patients.

Structural covariance networks and causal effects within can provide critical information on gray matter reorganization and disease-related hierarchical changes. Based on the T1WI data of 43 classical trigeminal neuralgia patients and 45 controls, we constructed morphological similarity networks of cortical thickness, sulcal depth, fractal dimension, and gyrification index. Moreover, causal structural covariance network analyses were conducted in regions with morphological abnormalities or altered nodal properties, respectively. We found that patients showed reduced sulcal depth, gyrification index, and fractal dimension, especially in the salience network and the default mode network. Additionally, the integration of the fractal dimension and sulcal depth networks was significantly reduced, accompanied by decreased nodal efficiency of the bilateral temporal poles, and right pericalcarine cortex within the sulcal depth network. Negative causal effects existed from the left insula to the right caudal anterior cingulate cortex in the gyrification index map, also from bilateral temporal poles to right pericalcarine cortex within the sulcal depth network. Collectively, patients exhibited impaired integrity of the covariance networks in addition to the abnormal gray matter morphology in the salience network and default mode network. Furthermore, the patients may experience progressive impairment in the salience network and from the limbic system to the sensory system in network topology, respectively.

Preoperative Evaluation of Neurovascular Relationship in Primary Trigeminal Neuralgia(PTN) by Magnetic Resonance Virtual Endoscopy(MRVE) Combined with 3D-FIESTA-c and 3D-TOF-MRA.

Objective: This study aims to evaluate the effectiveness of Magnetic Resonance Virtual Endoscopy combined with 3D-FIESTA-c and 3D-TOF-MRA in preoperative assessment of MVD for PTN, with a focus on accurately detecting neuromuscular contact. Methods: We retrospectively analyzed clinical and imaging data from 240 patients with unilateral primary trigeminal neuralgia undergoing MVD surgery between April 2016 and July 2023. Preoperative scans with 3D-FIESTA-c and 3D-TOF-MRA were performed, and MRVE images were obtained to analyze the relationship between the trigeminal nerve and adjacent vessels. Using the findings during microvascular decompression (MVD) surgery as the gold standard, the diagnostic results of 3D-TOF-MRA + 3D-FIESTA-c were considered as group I, while the combined use of MRVE, 3D-TOF-MRA + 3D-FIESTA-c was considered as group II. Results: In 240 cases, group I had a positive rate of 96.25% and an accuracy rate of 86.25% for identifying responsible blood vessels, while group II had a positive rate of 98.3% and an accuracy rate of 94.17%. There were no statistically significant differences in positive rates between group I and group II, group I and MVD, or group II and MVD (P > 0.05). However, there were statistically significant differences in accuracy rates (P < 0.05). The accuracy for single and multiple arteries with group I was 99.38% and 80.0%, respectively, while with group II, it was 100% and 95.0%. No statistically significant difference was found in accuracy for single or multiple arteries (P>0.05). The accuracy of evaluating responsibility veins with or without other vessels was 52.73% and 80.0%, respectively, with a statistically significant difference (P<0.05). Conclusion: MRVE combined with 3D-TOF-MRA + 3D-FIESTA-c significantly improves the accuracy of identifying responsibility vessels, especially veins, in preoperative assessment for MVD. This has important clinical implications for preoperative decision-making and surgical planning.

Comparison of the Efficacy of Complete Endoscopic and Microscopic Vascular Decompression in the Treatment of Classical Trigeminal Neuralgia.

OBJECTIVE: To compare whether there is a difference in the efficacy of complete endoscopic microvascular decompression (EVD) and microscopic microvascular decompression (MVD) in patients with classical trigeminal neuralgia (CTN). METHODS: From January 2014 to January 2021, 297 CTN patients were assigned to the retrosigmoid approach EVD (138 cases) and the MVD groups (159 cases); to compare whether there are differences in the pain control rate, recurrence, complications of CTN patients between the 2operations, and separately predict the factors related to prognosis of both groups. RESULTS: There was no significant difference in painless rates at 1, 3, and 5 years after surgery (P = 0.356, P = 0.853, P = 1), and overall incidence of complications (P = 0.058) between the EVD and MVD groups. The EVD group had shorter surgical decompression duration than the MVD group (P < 0.001). The painless rate of patients with vertebrobasilar trigeminal neuralgia in the EVD group was higher than that in the MVD group, but the difference was not statistically significant (90% vs. 61.1%, P = 0.058). The independent risk factors associated with a good prognosis in the EVD group were a shorter course of the disease and severe neurovascular conflict, while severe neurovascular conflict is the only independent risk factor associated with a good prognosis in the MVD group. CONCLUSIONS: For CTN patients, compared with traditional MVD, EVD is also safe and effective and has the advantage of shorter decompression time.The predictive results of prognostic factors also suggest that CTN patients may benefit more from early surgical treatment.

Clinicopathological characteristics of secondary trigeminal neuralgia due to cerebellopontine angle tumors. / æ¡¥å°è„‘è§’è‚¿ç˜¤ç»§å‘æ€§ä¸‰å‰ç¥žç»ç—›çš„ä¸´åºŠç— ç†ç‰¹å¾.

OBJECTIVES: Cerebellopontine angle (CPA) tumors are a common cause of secondary trigeminal neuralgia (TN), characterized by their concealed location, slow progression, and difficulty in early detection. This study aims to explore the clinicopathological characteristics of patients with secondary TN due to CPA tumors to enhance understanding and management of secondary TN. METHODS: A retrospective analysis was conducted on clinical data and pathological results of 116 patients with CPA tumor-related TN treated at Xiangya Hospital of Central South University from January 1, 2017 to December 31, 2022. The study analyzed the relationship of tumor pathological types with clinical manifestations, tumor location, surgical methods, and treatment outcomes. RESULTS: Among the cases, 95.7% (111/116) were benign tumors, 3.4% (4/116) were malignant tumors, and 0.9% (1/116) were borderline tumors. Benign tumors were predominantly acoustic neuromas, meningiomas, and schwannomas. Among the patients, 46.6% (54/116) presented with isolated TN, while 53.4% (62/116) exhibited other associated symptoms depending on factors such as tumor growth location and rate. The complete resection rate in this group was over 90%, with 41.4% (48/116) of patients undergoing concurrent microvascular decompression after tumor resection, predominantly for schwannomas. The overall effective rate of surgical treatment reached 93.9%, with schwannomas showing higher efficacy rates compared with acoustic neuromas and meningiomas (P<0.05). The recurrence rate of acoustic neuromas was significantly higher than that of meningiomas and schwannomas (P<0.05). CONCLUSIONS: CPA tumors are a major cause of secondary TN, predominantly benign, with occasional underdiagnosed malignant tumors. Early diagnosis and treatment significantly impact prognosis. Different tumor types vary in clinical symptoms, surgical approaches, and treatment efficacy. Surgical strategies should balance tumor resection extent and neural function preservation, with microvascular decompression as necessary.

Multiple sclerosis relapse presenting as trigeminal neuralgia.

I present here a case of trigeminal neuralgia (TGN), which is a highly disabling disorder characterized by brief and recurrent shock-like episodes of facial pain. TGN occurs in 2% of people with MS. A 54-year-old woman diagnosed with multiple sclerosis (MS) in 2008 and who was in remission stopped taking her disease-modifying therapy (DMT) in 2018 due to a lack of relapses presented to our facility with excruciating right facial pain. Magnetic resonance imaging (MRI) of the brain with gadolinium showed enhancing plaque involving the proximal cisternal portion of the right trigeminal nerve on axial and sagittal sections. She was started on carbamazepine 300 mg 4 times a day. This case highlights the need for early diagnosis by MRI with gadolinium enhancement and prompt initiation of treatment helped her pain to subside and was able to return a week later to the MS clinic to be restarted on her prior DMT to prevent further MS relapses.

Prevalence of Trigeminal Neuralgia and Persistent Idiopathic Facial Pain in Afyonkarahisar, Türkiye.

BACKGROUND: Population-based studies examining the prevalence of trigeminal neuralgia (TN) and persistent idiopathic facial pain (PIFP) are rare, and data on TN prevalence in Türkiye are very limited, with the prevalence of PIFP being unknown. This study aimed to determine the prevalence of TN and PIFP in Türkiye. MATERIALS AND METHODS: This population-based epidemiological study has a cross-sectional and descriptive design, and it was carried out in Afyonkarahisar, Türkiye. Participants aged 18 years and older were screened by using a self-assessment form to determine potential patients with TN or PIFP. RESULTS: A total of 19,237 individuals were included in this study, of which 17,223 responded to the survey questions. TN was diagnosed in 17 individuals, and the prevalence of TN was calculated as 98.5 per 100,000. PIFP was diagnosed in 35 patients, and the prevalence of PIFP was calculated as 202 per 100,000. The mean age of the patients with TN was 54.29 ± 12.98 years, the mean age of patients with PIFP was 49.80 ± 16.10 years, and the female-to-male ratio was 1.13/1 for TN and 2.18/1 for PIFP. CONCLUSION: The prevalence of PIFP in Türkiye has been reported for the first time by this study. Additionally, a much higher prevalence of TN was found when compared to previous study.

Treatment of recurrent trigeminal neuralgia after microvascular decompression: How to select.

BACKGROUND: This study aimed to investigate individualized treatment strategies and clinical outcomes in patients with recurrent trigeminal neuralgia after undergoing microvascular decompression (MVD). METHODS: One hundred forty-four patients with recurrent trigeminal neuralgia after MVD were retrospectively examined and grouped according to treatment. Surgical efficacy and pain recurrence were analyzed as outcomes. RESULTS: Repeat craniotomy was performed in 31 patients (21.5 %), percutaneous balloon compression (PBC) in 67 (46.5 %), and radiofrequency thermocoagulation (RFT) in 46 (32.0 %). Effectiveness did not differ among the three types of treatment (P = 0.052). The incidence of postoperative complications, including trigeminal nerve cardiac reflex, facial numbness, and mastication weakness, was lower in the craniotomy group than the PBC and RFT groups (P < 0.001). The 5-year pain recurrence rate was significantly higher than the 1-year rate in all groups. Although the 1-year pain recurrence rate did not differ among the groups, the 5-year rate was significantly lower in the repeat craniotomy group than the other groups (P < 0.001). CONCLUSION: Patients with recurrent trigeminal neuralgia after MVD should be treated based on imaging evaluation and general condition. Repeat craniotomy, PBC, and RFT are all effective. Incidence of postoperative complications and long-term pain recurrence-free survival are superior for repeat craniotomy.

Gamma Knife radiosurgery for multiple sclerosis-associated trigeminal neuralgia.

BACKGROUND: Gamma Knife radiosurgery (GKRS) has well-known efficacy in the treatment of idiopathic trigeminal neuralgia (TN). However, few studies have evaluated the effects of GKRS in the treatment of multiple sclerosis (MS)-related TN. This study analyzed the efficacy and complications of GKRS for MS-related TN. METHODS: This retrospective study included 28 MS-related TN patients who underwent GKRS with a median follow-up of 27 (range, 12-181) months. The cisternal segment of the trigeminal nerve was targeted with a median radiation dose of 80 (80-90) Gy. Pain intensity was assessed using Barrow Neurological Institute (BNI)-Pain Intensity Scores (BNI-PIS). Before GKRS, all patients suffered from BNI pain levels of 4 or 5. A reduction in pain to BNI 3b or below was deemed as adequate pain relief. RESULTS: The initial proportion of patients who experienced adequate pain relief was 71.4%, with a median interval of 21 (1-45) days. At the final follow-up, 50% of patients had achieved adequate pain relief. Ten patients (35.7%) suffered from complications, including four with facial sensorial dysfunctions, four with a decline in their corneal reflexes, and two with jaw weakness. Among the 20 initial responders, six (30%) patients suffered pain recurrence after a median interval of 35 (12-180) months. CONCLUSIONS: GKRS is an effective means of pain relief in MS-related TN, but has side effects that are relevant to other ablative treatments. The benefits and risks of GKRS should be discussed with patients who wish to avoid surgery or when previous treatments fail.

The efficacy of acupuncture for trigeminal neuralgia: an overview of systematic reviews.

Background: Many systematic reviews (SRs) and meta-analysis (MAs) have reported the efficacy of acupuncture treatment for primary trigeminal neuralgia (PTN), but the quality of evidence is unknown and therefore needs to be evaluated comprehensively. Methods: Eight electronic databases were searched from their inception until January 5, 2024. The methodological quality, reporting quality, and risk of bias of the included SRs were assessed by the assessment of multiple systematic reviews 2 (AMSTAR-2), the Risk of Bias in Systematic Reviews (ROBIS) tool, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The quality of evidence for outcome measures was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results: We identified 13 SRs/MAs met inclusion criteria. According to the results of the AMSTAR-2, six were rated as critically low quality and seven as low quality. According to ROBIS assessment, 8 SRs/MAs were classified as low risk, and 5 SRs/MAs were found to be high risk. The PRISMA report still has some reporting deficiencies in aspects such as protocol and registration, search strategy, risk of bias, additional analyzes and funding. According to the GRADE system, no high-quality evidence was found, 1 was of moderate quality, 4 were of low quality, and 8 were of critical low quality. Conclusion: Based on the evidence collected, acupuncture shows promise as a treatment for PTN patients. However, it is important to note that the included SRs/MAs generally have low methodological quality and evidence quality. Therefore, caution must be exercised when interpreting this conclusion. To enhance future research in this area, it is recommended to adequately report methodological details and adhere to guidelines for conducting SRs/MAs.Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024499280.

Clinical Conditions Targeted by OnabotulinumtoxinA in Different Ways in Medicine.

OnabotulinumtoxinA (BT-A) is used in different medical fields for its beneficial effects. BT-A, a toxin originally produced by the bacterium Clostridium botulinum, is widely known for its ability to temporarily paralyze muscles by blocking the release of acetylcholine, a neurotransmitter involved in muscle contraction. The literature continually reports new hypotheses regarding potential applications that do not consider blockade of acetylcholine release at the neuromuscular junction as a common pathway. In this opinion article, it is our aim to investigate the different pathway targets of BT-A in different medical applications. First of all, the acetylcholine effect of BT-A is used to reduce wrinkles for cosmetic purposes, in the treatment of urological problems, excessive sweating, temporomandibular joint disorders, obesity, migraine, spasticity in neurological diseases, and in various cases of muscle overactivity such as cervical dystonia, blepharospasm, and essential head tremor. In another potential pathway, glutamate A, CGRP, and substance P are targeted for pain inhibition with BT-A application in conditions such as migraine, trigeminal neuralgia, neuropathic pain, and myofascial pain syndrome. On the other hand, as a mechanism different from acetylcholine and pain mediators, BT-A is used in the treatment of hair loss by increasing oxygenation and targeting transforming growth factor-beta 1 cells. In addition, the effect of BT-A on the apoptosis of cancer cells is also known and is being developed. The benefits of BT-A applied in different doses to different regions for different medical purposes are shown in literature studies, and it is also emphasized in those studies that repeating the applications increases the benefits in the long term. The use of BT-A continues to expand as researchers discover new potential therapeutic uses for this versatile toxin.