TRIGEMINAL NERVE COMPRESSION (TGNC) SURGICAL TECHNIQUE FOR THE TREATMENT OF TRIGEMINAL NEURALGIA; STUDY OF 40 CASES IN 5 YEARS

Main Article Content

Dr. Muhammad Nawaz Khan
Dr. Muhammad Idris Khan
Dr. Riaz ul Iqbal
Dr Muddasir Shah
Sajid Ali
Shahzad Ahmad Khan

Keywords

Compression, Intracisternal component, Trigeminal nerve, Trigeminal Neuralgia

Abstract

Background: To evaluate the outcome of an innovative surgical approach i-e compression technique of trigeminal nerve at the intra- cisternal part of the nerve for relief of trigeminal neuralgia pain.


Methods: This observational study was conducted in Hayatabad Medical Complex and Lady Reading hospital Peshawar from Jun 2014 to Jun 2019. After Ethical Committee permission all cases of Trigeminal Neuralgia operated via TGNC Technique were studied and followed Post operatively for maximum 1 year.


 Results: During our study period 40 patients were operated. There were 25 (62.5%) female & 15(37.5%) male patient with male to female ratio of 3:5. The patients ages were in the range of 34 to 84 years with mean of 54.76 ± 9.6 SD.  Majority of the patients were complaining of pain in the right side of the face having frequency of 33 (82.5%) and both V2, V3 were involved in the facial pain with greatest proportion almost frequency of 16 (40%). Total 38 patients were completely pain free at 1year post op. However 2 patients presented with recurrent pain in the same area and same side of the face.


Conclusion: Compression of intra-cisternal component of trigeminal nerve for trigeminal neuralgia is the safe and effective procedure and potentially alternative to MVD procedure or at least the only gold standard option in cases where no significant vascular loop conflict is found .It has the potential to be performed endoscopically via single bur hole in the near future .

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References

1. Trigeminal neuralgia. Torpy JM, Rogers JL, Golub RM. JAMA. 2013; 309 (10): 1058.
2. Obermann M. Treatment options in trigeminal neural-gia. Ther Adv Neurol Disord. 2010 Mar; 3 (2): 107–15.
3. Katusic S, Beard CM, Bergstralh E, Kurland LT. Inci-dence and clinical features of trigeminal neuralgia, Ro-chester, Minnesota, 1945 – 1984. Ann Neurol. 1990; 27 (1): 89–95.
4. Eboli P, Stone JL, Aydin S, Slavin KV. Historical cha-racterization of trigeminal neuralgia. Neurosurg. 2009 Jun; 64 (6): 1183-6.
5. Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. AAN – EFNS guidelines on trigemi-nal neuralgia management. Eur J Neurol. 2008 Oct; 15 (10): 1013-28.
6. Obermann M. Treatment options in trigeminal neural-gia. Ther Adv Neurol Disord. 2010 Mar; 3 (2): 107– 115.
7. Fromm GH, Terrence CF, Chattha AS. Baclofen in the treatment of trigeminal neuralgia: double – blind study and long-term follow-up. Ann Neurol. 1984 Mar; 15 (3): 240-4.
8. Lindström P, Lindblom U. The analgesic effect of to-cainide in trigeminal neuralgia. Pain. 1987 Jan; 28 (1): 45-50.
9. Ashkan K, Marsh H: Microvascular decompression for trigeminal neuralgia in the elderly: a review of the safety and efficacy. Neurosurg. 2004; 55: 840-850.
10. Broggi G, Ferroli P, Franzini A: Treatment strategy for trigeminal neuralgia: a thirty years experience. Neurol Sci. 2008; 29 (Suppl. 1): S79-S82.
11. Dellaretti M, Rayns N, Touzet G, Sarrazin T, Dubois F, Lartigau E, Blond S: Clinical outcomes after Gamma Knife surgery for idiopathic trigeminal neuralgia: Rev-iew of 76 consecutive cases. J Neurosurg. 2008; 109 (Suppl.): S173-S178.
12. Gronseth G, Cruccu, G, Alksne J, Argoff C, Brainin M, Burchiel K, Nurmikko T, Zakrzewska JM: Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence – based review): report of the Quality Standards Subcommitee American Academy of Neurology and the Europea Federation of Neurological Societies. Neurology, 2008; 71: 1183- 1190.
13. Tolle T, Dukes E, Sadosky A: Patient burden of tri-geminal neuralgia: results from cross – sectional of hea-lth state impairment and treatment patterns in six euro-pean countries. Pain Pract. 2006; 6: 153-160.
14. Jannetta PJ. Arterial compression of the trigeminal ner-ve at the pons in patients with trigeminal neuralgia. J Neurosurg. 1967; 26: 159-62.
15. Revuelta – Gutierrez R, Martinez – Anda JJ, Coll JB, Campos – Romo A, Perez – Peña N. Efficacy and saf-ety of root compression of trigeminal nerve for trige-minal neuralgia without evidence of vascular compress-ion. World Neurosurg. 2013; 80 (3-4): 385-9.
16. Broggi G. Trigeminal neuralgia without evidence of neurovascular conflict: microvascular compression or route entry zone exploration? World Neurosurg. 2013 Sep-Oct; 80 (3-4): 300-1.
17. Punyani SR, Jasuja VR. Trigeminal neuralgia: An insi-ght into the current treatment modalities. J Oral Biol Craniofac Res. 2012 Sep-Dec; 2 (3): 188–97.
18. Chen KS, Sagher O. Trigeminal neuralgia without vas-cular conflict: strategies and outcomes when the culprit goes missing. World Neurosurg. 2013; 80 (3-4): 302-3.
19. Van Loveren H, Tew J M, Keller J T, et al. A 10 – year experience in the treatment of trigeminal neuralgia: Comparison of percuntaneous stereotaxic rhizotomy and posterior fossa exploration. J Neurosurg. 1982; 57: 757-64.
20. Taha JM, Tew JM. Comparison of surgical treatments for trigeminal neuralgia: Reevaluation of radiofrequ-ency rhizotomy. Neurosurgery, 1996; 38: 865-71.
21. Tyler – Kabara EC, Kassam AB, Horowitz MH, Urgo L, Hadjipanayis C, Levy EI, et al. Predictors of out-come in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression. J Neurosurg. 2002; 96: 527–31.
22. Barker FG, II, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular de-compression for trigeminal neuralgia. N Engl J Med. 1996; 334: 1077–83.
23. Sindou M, Leston J, Decullier E, Chapuis F. Microvas-cular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear – cut neurovascular conflicts who underwent pure decom-pression. J Neurosurg. 2007; 107: 1144–53.
24. Kondo A. Follow-up results of microvascular decom-pression in trigeminal neuralgia and hemifacial spasm. Neurosurgery, 1997; 40: 46–51.
25. Tronnier VM, Rasche D, Hamer J, Kienle A, Kunze S. Treatment of idiopathic trigeminal neuralgia: compare-son of long-term outcome after radiofrequency rhizo-tomy and microvascular decompression. Neurosurgery, 2001; 48: 1261–68.
26. Klun B. Microvascular decompression and partial sen-sory rhizotomy in the treatment of trigeminal neuralgia: personal experience with 220 patients. Neurosurgery, 1992; 30: 49–52.
27. Adams CB, Kaye AH, Teddy PJ. The treatment of tri-geminal neuralgia by posterior fossa microsurgery. J Neurol Neurosurg Psychiatry, 1982; 45: 1020–1026.
28. Olson S, Atkinson L, Weidmann M. Microvascular de-compression for trigeminal neuralgia: recurrences and complications. J Clin Neurosci. 2005; 12: 787–789.
29. Lee KH, Chang JW, Park YG, Chung SS. Microvascu-lar decompression and percutaneous rhizotomy in trige-minal neuralgia. Stereotact Funct Neurosurg. 1997; 68: 196–199.
30. Zakrzewska JM, Lopez BC, Kim SE, Coakham HB. Patient reports of satisfaction after microvascular de-compression and partial sensory rhizotomy for trigemi-nal neuralgia. Neurosurgery, 2005; 56: 1304–1311.
31. Zakrzewska JM, Thomas DGT. Patient’s assessment of outcome after three surgical procedures for the manage-ment of trigeminal neuralgia. Acta Neurochir. 1993; 122: 225–230.
32. Poppen J L: An atia of neurosurgical technique and W.B. Saunders, Philadelphia, 1960.
33. Khattak A,Haider A. J Postgrad Med Inst 2016; 30(1): 89-91.

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