Trigeminal Neuralgia like Pain Behavior Following Compression of the Rat Trigeminal Ganglion

Gwi Y. Yang,Jun H. Mun,Yoon Y. Park,Dong K. Ahn KOREAN ACADAMY OF ORAL BIOLOGY 2009 International Journal of Oral Biology Vol.34 No.3

We recently described a novel animal model of trigeminal neuropathic pain following compression of the trigeminal ganglion (Ahn et al., 2009). In our present study, we adapted this model using male Sprague-Dawley rats weighing between 250-260 g and then analyzed the behavioral responses of these animals following modified chronic compression of the trigeminal ganglion. Under anesthesia, the rats were mounted onto a stereotaxic frame and a 4% agar solution (10 μL) was injected in each case on the dorsal surface of the trigeminal ganglion to achieve compression without causing injury. In the control group, the rats received a sham operation without agar injection. Air-puff, acetone, and heat tests were performed at 3 days before and at 3, 7, 10, 14, 17, 21, 24, 30, 40, 55, and 70 days after surgery. Compression of the trigeminal ganglion produced nociceptive behavior in the trigeminal territory. Mechanical allodynia was established within 3 days and recovered to preoperative levels at approximately 60 days following compression. Mechanical hyperalgesia was also observed at 7 days after compression and persisted until the postoperative day 40. Cold hypersensitivity was established within 3 days after compression and lasted beyond postoperative day 55. In contrast, compression of the trigeminal ganglion did not produce any significant thermal hypersensitivity when compared with the sham operated group. These findings suggest that compression of the trigeminal ganglion without any injury produces prolonged nociceptive behavior and that our rat model is a useful system for further analysis of trigeminal neuralgia.

Idiopathic Trigeminal Neuralgia Misdiagnosed as Secondary Trigeminal Neuralgia Caused by Neurogenic Tumor in the Infratemporal Fossa: A Case Report

Cha Jun-yong,Son Byung Chul 대한말초신경학회 2020 The Nerve Vol.6 No.2

A 64-year-old male patient presented with a 7-year history of chronic paroxysmal, stabbing, and electrical shock-like pain involving his mandibular nerve. After 1 year of successful medical treatment with carbamazepine, the pain was not controlled. Magnetic resonance imaging (MRI) revealed a small mass around the peripheral course of the right trigeminal nerve in the infratemporal fossa. The patient’s trigeminal pain was very similar to that of classical trigeminal neuralgia. However, radiosurgery was performed to manage the infratemporal mass around the right trigeminal nerve. Despite the radiation therapy, pain worsened and became unbearably in the next 6 months. A suboccipital approach was performed for microvascular decompression of the neurovascular conflict, or an intradural sensory rhizotomy to block the transmission of the tumor pain. Typical neurovascular compression by the superior cerebellar artery was confirmed and only microvascular decompression was performed. The trigeminal pain that persisted for 7 years was resolved after the surgery. Even if a mass lesion located close to the peripheral course of the trigeminal nerve, possibility of classical trigeminal neuralgia due to neurovascular compression should be suspected if there is no direct involvement of the trigeminal nerve by the mass and the nature of trigeminal pain is consistent with classical trigeminal neuralgia.

이차성 삼차신경통에서 경피적 고주파 삼차신경절제술에 의한 동통조절 효과

강승범,손병철,김문찬,강준기,Kang, Seong-Buhm,Son, Byung-Chul,Kim, Moon-Chan,Kang, Joon-Ki 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.1

Objective : There are many treatment modalitis in management of idiopathic trigeminal neuralgia. In the secondary trigeminal neuralgia, there has been only sporadic reports of the etiology. Authors report the treatment result of secondary trigeminal neuralgia with percutaneous radiofrequency rhizotomy. Methods : During last ten years, 129 trigeminal neuralgias were treated by percutaneous radiofrequency(RF) rhizotomy by authors. Among them, nine patients were secondary trigeminal neuralgias. These patients refused treatment for the primary cause and only wanted pain control. The offending lesions were three arachnoid cysts, six tumors. The mean age was 47.8 years and the mean duration of follow-up was 6.2 years. The right V2,3 distribution was most prevalent area of pain. Authors used the conventional Hartel's anterior approach and straight electrode for RF lesion generation. Result : The early result was satisfactory. Eight of nine patients became free of pain and one patient needed minimal dose of carbamazepine. The overall pain control was 100%. There was no mortality or morbidity for initial RF rhizotomy. During follow-up, four patients showed recurrence of pain(44%). Among these, two underwent repeated RF rhizotomy and became free of pain. The other two were controlled with medical management. Conclusion : These results indicate that the percutaneous RF rhizotomy is effective means of pain control. Overall recurrence was somewhat higher than that of idiopathic trigeminal neuralgia. Even with recurrence, however, repeated RF rhizotomy seems to be effective method of control of pain in these cases.

Atypical triggers in trigeminal neuralgia: the role of A-delta sensory afferents in food and weather triggers

( Wenjun Koh ),( Huili Lim ),( Xuanxuan Chen ) 대한통증학회 2021 The Korean Journal of Pain Vol.34 No.1

Background: Trigeminal neuralgia is a debilitating craniofacial pain syndrome that is characterized by paroxysms of intense, short-lived electric shock-like pains in the trigeminal nerve distribution. Recently, the presence of triggers has become one of the key diagnostic criteria in the 3rd edition of the International Classification of Headache Disorders. Light touch is the most common trigger, however other non-mechanical triggers, such as cold weather and certain foods, have been thought to provoke trigeminal neuralgia anecdotally. We aimed to characterize the prevalence and characteristics of these atypical triggers. Methods: We conducted a retrospective, cross-sectional study of atypical triggers in trigeminal neuralgia patients seen in a tertiary pain clinic in Singapore. Patients were recruited via clinic records, and study data were identified from physician documentation. Results: A total of 60 patients met the inclusion criteria. Weather triggers were observed in 12 patients (20%), of which five patients (8%) reported strong winds, 4 patients (7%) reported cold temperatures, and 3 patients (5%) reported cold winds as triggers. Fifteen patients (25%) had a specific food trigger, of which 10 patients (17%) reported hard or tough food, 5 patients (8%) reported hot/cold food, 4 patients (7%) reported spicy food, and 2 patients (3%) reported sweet food as triggers. Conclusions: Although trigeminal neuralgia is most commonly triggered by mechanical stimuli, atypical triggers such as cold temperatures and certain foods are seen in a significant proportion of patients. These atypical triggers may share a common pathway of sensory afferent Aδ fiber activation.

Percutaneous Radiofrequency Thermocoagulation in Trigeminal Neuralgia : Analysis of Early and Late Outcomes of 156 Cases and 209 Interventions

Gunduz, Hasan Burak,Cevik, Orhun Mete,Asilturk, Murad,Gunes, Muslum,Uysal, Mustafa Levent,Sofuoglu, Ozden Erhan,Emel, Erhan The Korean Neurosurgical Society 2021 Journal of Korean neurosurgical society Vol.64 No.5

Objective : Trigeminal neuralgia is one of the most common causes of facial pain. Our aim is to investigate the efficacy and borders of percutaneous radiofrequency thermocoagulation in the treatment of trigeminal neuralgia. Methods : Between May 2007 and April 2017, 156 patients with trigeminal neuralgia were treated with radiofrequency thermocoagulation. These 156 patients underwent 209 procedures. In our study, we investigated the early and late results of percutaneous radiofrequency thermocoagulation under guiding fluoroscopic imaging in the treatment of trigeminal neuralgia. Barrow Neurological Institute (BNI) pain scale was used for grading the early results. In addition, Kaplan-Meier survival analysis was used to assess long-term outcomes. Of the 156 patients who underwent radiofrequency thermocoagulation for trigeminal neuralgia, 45 had additional disease. Patients with this condition were evaluated with their comorbidities. Early and late results were compared with those without comorbidity. Results : In 193 of 209 interventions BNI pain scale I to III results were obtained. Out of the 193 successful operation 136 patients (65.07%) were discharged as BNI I, 14 (6.70%) as BNI II, 43 (20.58%) as BNI III. Sixteen patients (7.65%) remained uncontrolled (BNI IV and V). While the treatment results of trigeminal neuralgia patients with comorbidity seem more successful in the early period, this difference was not observed in follow-up examinations. Conclusion : Finally, we concluded that percutaneous radiofrequency thermocoagulation of the Gasserian ganglion is a safe and effective method in the treatment of trigeminal neuralgia. However, over time, the effectiveness of the treatment decreases. Neverthless, the reapprability of this intervention gives it a distinct advantage.

Stem cells from human exfoliated deciduous teeth attenuate trigeminal neuralgia in rats by inhibiting endoplasmic reticulum stress

Yang, Zhijie,Wang, Chun,Zhang, Xia,Li, Jing,Zhang, Ziqi,Tan, Zhao,Wang, Junyi,Zhang, Junyang,Bai, Xiaofeng The Korean Pain Society 2022 The Korean Journal of Pain Vol.35 No.4

Background: The treatment of trigeminal neuralgia remains a challenging issue. Stem cells from human exfoliated deciduous teeth (SHED) provide optimized therapy for chronic pain. This study aimed to investigate the mechanisms underlying the attenuation of trigeminal neuralgia by SHED. Methods: Trigeminal neuralgia was induced by chronic constriction injury of the infraorbital nerve. The mechanical threshold was assessed after model establishment and local SHED transplantation. Endoplasmic reticulum (ER) morphology and Caspase12 expression in trigeminal ganglion (TG) was evaluated as well. BiP expression was observed in PC12 cells induced by tunicamycin. Results: The local transplantation of SHED could relieve trigeminal neuralgia in rats. Further, transmission electron microscopy revealed swelling of the ER in rats with trigeminal neuralgia. Moreover, SHED inhibited the tunicamycin-induced up-regulated expression of BiP mRNA and protein in vitro. Additionally, SHED decreased the up-regulated expression of Caspase12 mRNA and protein in the TG of rats caused by trigeminal neuralgia after chronic constriction injury of the infraorbital nerve mode. Conclusions: This findings demonstrated that SHED could alleviate pain by relieving ER stress which provide potential basic evidence for clinical pain treatment.

치과병원에 내원한 삼차신경통환자의 치험예 (34예 분석)

김인정,최종훈,김종열,Kim, In-Jung,Choi, Jong-Hoon,Kim, Chong-Youl 대한안면통증구강내과학회 2000 Journal of Oral Medicine and Pain Vol.25 No.2

This study was carried out among 34 patients who visited Yonsei Dental Hospital from 1996. 1. to 1999. 5 for trigeminal neuralgia. By studying the patient's treatment prior to visiting our hospital, features of trigeminal neuralgia, treatment process of trigeminal neuralgia, prognosis of treatment, consultation with other professions and involvement of surgery, etc., the results are as follows: 1. 67.7% of onset age range from 40s to 60s, and average age is 50.2. 2. Ratio of right to left involvement is 1:2.1, male to female ratio is 1:1.9. 3. Occurrence rate of each branch is V3(44.1%), V2(11.8%), V1+V2+V3(11.8), V1+V2(8.8%). 4. Treatments prior to admission to our hospital are extraction(5.9%), endodontic treatment(5.9%), medication(11.8%), Oriental Medicine treatment(5.9%). 5. Routes of admittance to our hospital are by their preference(55.9%), local clinic referral(32.4%), E.N.T referral(5.9%), Neurology referral(5.9%). 6. 70.6% of patients treated at our hospital who were relieved of symptoms, were referred to Neurology(66.7%) and Pain Clinic(33.3%) for the reason of relapse, side effects of the drug itself, incomplete relief of pain. 7. 2 patients who were referred to medical part showed brain vessels contacting trigeminal nerve root on Brain MRangiography. But pain is being controlled by medication and no specific surgical procedure was carried out. The results show that 17.7% of patients admitted received inappropriate early treatment. In order to relieve tooth loss and patient's psychologic stress due to inappropriate treatment, precise differential diagnosis must be made among local teeth disease and idiopathic facial pain. Medication may show side effects of the drug itself, incomplete relief of pain or relapse of symptoms. Therefore, to treat trigeminal neuralgia appropriately by drug injection, surgery or radiation therapy, consultations among dentists, neurologists and anesthesiologists are required.

삼차신경통의 한의학적 치료에 대한 국내 임상 연구 고찰

차현지,이예지,김효빈,김범석,성기정,이영록,최강민,김진엽,전주현,김은석,김영일,Cha, Hyun Ji,Lee, Ye Ji,Kim, Hyo Bin,Kim, Beom Seok,Sung, Ki Jung,Lee, Young Rok,Choi, Kang Min,Kim, Jin Youp,Jeon, Ju Hyun,Kim, Eun Seok,Kim, Young Il 대전대학교 한의학연구소 2020 혜화의학회지 Vol.29 No.2

Objectives : The aim of this study is to review clinical studies on trigeminal neuralgia treatment through Korean Medicine. Methods : We used search engines such as KISS, RISS, KOREAMED and NDSL. We limited cases as idiopathic trigeminal neuralgia without comorbidities. We excluded dissertation. We considered papers published after year 2000. Results : Fourteen studies were searched for this study. Various treatments such as acupuncture therapy, herbal medicine, moxibustion therapy, manipulation, pharmocopuncture, vomiting therapy were practiced for trigeminal neuralgia. Conclusions : All study were case report and evidence level of the searched studies was not high. They reported meaningful improvement through Korean Medicine treatment and these studies implied effectiveness and safety of Korean Medicine for Trigeminal neuralgia.

증례보고 : 설인신경통으로 오인된 삼차신경통

강유진 ( Yoo Jin Kang ),전연수 ( Yeon Su Jeon ),김용신 ( Yong Shin Kim ),이현탁 ( Hyeon Tak Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.6

Trigeminal neuralgia (TGN) is a relatively well-known disorder with characteristic brief attacks of shooting pain in the facial regions. Atypical signs like constant pain and/or sensory abnormalities can develop as the disease progresses. Some cases begin with atypical signs and later develop all the hallmarks of TGN. The atypical forms of TGN can be misdiagnosed as other pain disorders. We present a patient with facial pain who demonstrated a transformation in signs of glossopharyngeal neuralgia into typical trigeminal neuralgia. A 71 year-old man was referred for sharp episodic pain in his right side of the face and neck. The pain was mainly in the neck, which was worsened especially by swallowing. The condition was initially diagnosed as a glossopharyngenl neuralgia. While controlling the pain conservatively with a sympathetic blockade, the neck pain disappeared suddenly and lower jaw pain triggered by speaking and chewing became prominent, which are the characteristic signs of trigeminal neuralgia. (Korean J Anesthesiol 2006; 51: 772~4)

추체첨부에 생긴 지주막낭에 의해 유발된 희귀 삼차 신경통 : 증례보고

권지연(Ji-Eyon Kwon),Nurani Rahma Arafah,조성우(Sung-Woo Cho),황기환(Kihwan Hwang) 대한두개저학회 2020 대한두개저학회지 Vol.15 No.2

Vascular compression is the most common cause of classic trigeminal neuralgia. However, other causes should be excluded. We describe a rare case of a patient presenting with typical trigeminal neuralgia associated with an arachnoid cyst in the petrous apex. A 22-year-old female patient with right trigeminal neuralgia for several years was treated with carbamazepine, which relieved the pain temporarily but was completely ineffective for the 3 months prior to presentation. Thin-slice computed tomography and magnetic resonance imaging showed a cephalocele in the petrous apex. Eventually, surgical aspiration of the cyst was performed using an endoscopic endonasal approach, which resulted in complete resolution of her pain. Petrous apex cephalocele should be considered in the differential diagnosis of trigeminal neuralgia, as it can be easily resolved by surgical aspiration.