Trigeminal neuralgia

Sinusitis Extracranial masses along the course of the trigeminal nerve Pathological enhancement of the trigeminal nerve that could indicate perineural spread of malignancy Cavernous sinus masses Demyelination plaques that might indicate multiple sclerosis Intrinsic brain lesions in the thalamus or t...

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Bibliographic Details
Published in:BMJ (Online) 2014-02, Vol.348 (feb17 9), p.g474-g474
Main Authors: Zakrzewska, Joanna M, Linskey, Mark E
Format: Article
Language:English
Subjects:
Acupuncture
Analgesics, Non-Narcotic - therapeutic use
Balloon treatment
Carbamazepine - analogs & derivatives
Carbamazepine - therapeutic use
CLINICAL REVIEW
Diagnosis, Differential
Epidemiology
Face
Humans
Hypertension
Magnetic Resonance Imaging - methods
Multiple sclerosis
Neuralgia
Neurosurgery
NMR
Nuclear magnetic resonance
Opioids
Pain
Patients
Prognosis
Quality of life
Radiosurgery - methods
Surgery
Surgical outcomes
Trigeminal nerve
Trigeminal Neuralgia - diagnosis
Trigeminal Neuralgia - therapy
Voltage-Gated Sodium Channel Blockers - therapeutic use
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Summary:Sinusitis Extracranial masses along the course of the trigeminal nerve Pathological enhancement of the trigeminal nerve that could indicate perineural spread of malignancy Cavernous sinus masses Demyelination plaques that might indicate multiple sclerosis Intrinsic brain lesions in the thalamus or trigeminal brain stem pathways such as lacunar infarctions Cerebellopontine angle mass lesions such as tumour, epidermoid, dermoid, or arachnoid cyst, aneurysm, or arteriovenous malformation.A multidisciplinary evidence based review of the published literature by the American Academy of Neurology and the European Federation of Neurological Societies concluded that MRI is currently too insensitive for detecting vascular compression of the trigeminal nerve to recommend routine use. 31 32 Some small studies with more sophisticated technology have suggested improved correlations but these technologies are not available routinely at present. 36 However, more sophisticated techniques have been used recently, as reported in small series, which have shown actual changes in the trigeminal nerve. 37 38 Biochemical investigations Depending on the drugs chosen to treat trigeminal neuralgia, particularly among antiepileptic drugs, issues related to reductions in white blood cell count, elevation in liver transaminases, and hyponatraemia are well documented.[...]depending on the treatment planned, a complete blood count at baseline with differential, serum electrolytes, and liver function tests are needed to monitor for potential drug toxicity over time.In this case, two sector blocks were used to custom sculpt the radiation fall-off so that the surface of the brain stem received a dose no greater than 16 Gy Only three randomised controlled trials of reasonable quality have investigated surgical procedures although they do not include microvascular decompression. 53 Furthermore, there is considerable variation in the quality of many cohort data studies. 54 According to large surgical series from multiple sites, microvascular decompression provides patients with about 80% chance of being pain-free without need for further treatment for trigeminal neuralgia, with a recurrence rate of about 10% over 10-20 years. 12 31 32 55 56 57 According to a systematic review for trigeminal neuralgia, the best surgical results in the short term (
ISSN:0959-8138
1756-1833
1756-1833
DOI:10.1136/bmj.g474