Novel Techniques for Trigeminal Neuralgia Including Trigeminal Neurostimulators

Novel Techniques for Trigeminal Neuralgia Including Trigeminal Neurostimulators

Arvin R. Wali (University of California – San Diego, USA), Christian Lopez (University of California – San Diego, USA), Peter Abraham (University of California – San Diego, USA), Michael G. Brandel (University of California – San Diego, USA), David R. Santiago-Dieppa (University of California – San Diego, USA), Jeffrey A. Steinberg (University of California – San Diego, USA), Robert C. Rennert (University of California – San Diego, USA), Jeffrey Scott Pannell (University of California – San Diego, USA), John F. Alksne (University of California – San Diego, USA) and Alexander A. Khalessi (University of California – San Diego, USA)
Copyright: © 2018 |Pages: 21
DOI: 10.4018/978-1-5225-5349-6.ch006
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Several innovative surgical options for the management of trigeminal neuralgia have emerged over the past 40 years. In addition to microvascular decompression, other techniques have been introduced for the treatment of trigeminal neuralgia and facial nerve pain. This chapter describes the following novel therapeutic modalities: endoscopic microvascular decompression, radiosurgery, radiofrequency, thermocoagulation, glycerol rhizotomoy, balloon compression, Gasserian ganglion stimulation, and subcutaneous trigeminal nerve stimulation. For each of these techniques, this chapter provides a description of the procedure, criteria for patient selection, and discusses published data regarding patient outcomes.
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Patients with trigeminal neuropathic pain refractory to medical management can be treated with a variety of minimally invasive surgical approaches that either augment or differ from standard microvascular decompression (MVD). For example, endoscopy is increasingly being used to augment traditional microvascular decompressions due to improvements in visualization of the source of vascular or structural compression and ability to intra-operatively confirm an adequate decompression (Artz et al., 2008; C. H. Halpern, S. S. Lang, & J. Y. Lee, 2013; Lang, Chen, & Lee, 2012; Sandell, Ringstad, & Eide, 2014). Other minimally invasive techniques that differ from microvascular decompression include stereotactic radiosurgery surgery (SRS), percutaneous radiofrequency nerve ablation, rhizotomy, balloon compression, and neurostimulation, all of which rely on nerve root lesioning or manipulation to alleviate painful symptoms. Specifically, SRS utilizes radiation, while radiofrequency thermocoagulation and glycerol rhizotomy use percutaneously delivered heat currents and chemicals to achieve nerve root destruction (Hakanson, 1981; Kanpolat, Savas, Bekar, & Berk, 2001; J. K. Lee, Choi, Ko, Choi, & Lim, 2012; William H. Sweet & James G. Wepsic, 1974). Balloon compression similarly utilizes percutaneous placement of an inflatable balloon to cause physical compression of the trigeminal ganglia (Mullan & Lichtor, 1983). Percutaneously delivered neurostimulators can also be used to modulate nerve signals within the trigeminal nerve and distal branches (Holsheimer, 2001). This chapter will discuss the operative nuances of each of these techniques and the published data regarding their comparative efficacy to treat trigeminal nerve pain.

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