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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the past few years the following methods have been accepted as the treatment of choice in trigeminal neuralgia: transcutaneous electrical nerve stimulation (TENS), drug treatment--especially carbamazepine, controlled thermocoagulation, percutaneous retrogasserian rhizotomy with glycerol, microvascular decompression. The attending physician will prefer the treatment from which he expects the best results. However,the choice of treatment should take into consideration the age and general condition of the patient, the possible side effects, the quality of pain and treatments already performed.
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PMID:[Treatment for trigeminal neuralgia. An overview]. 181 70

Fourteen patients suffering from idiopathic trigeminal neuralgia (refractory to medication) were treated by injection of glycerol into the trigeminal ganglion. The changes in cerebral blood flow (CBF) after glycerol injection were quantified by intravenous 133Xe emission tomography. There was a significant 11% (P less than 0.01) increase in ipsilateral CBF and an 8% (P less than 0.05) increase in contralateral CBF 1 h after glycerol injection. The interhemispheric difference was significant (P less than 0.05). The increase was significantly greater in the ipsilateral internal carotid territory, in the anterior cerebral artery and middle cerebral artery territories (superficial (P less than 0.05), deep territories (P less than 0.001]. We suggest that these changes are due to the release of substance P and/or calcitonin gene-related peptide, from terminals of the trigeminal-vascular system during glycerol injection.
Pain 1991 Jul
PMID:Glycerol injection into the trigeminal ganglion provokes a selective increase in human cerebral blood flow. 189 4

Medical treatment of chronic cluster headaches (cluster headaches that occur frequently without remission) can be very difficult. In many patients, the pain remains severe despite all medication trials. For these patients, previous reports recommend radiofrequency trigeminal rhizotomy, which risks corneal anesthesia and subsequent corneal decompensation. As a safer, yet effective, treatment, retro-Gasserian injections of glycerol were given to eight patients having intractable chronic cluster headaches. Needle penetration into the trigeminal cistern, glycerol amount (0.55 ml), and length of patient elevation after the procedure (80-90 degrees upright for 10 h) were modified for maximal exposure of the V1 division. Three patients required one additional injection, and one patient required two additional injections. Verbal pain scales (means +/- 1 standard error of the mean) were: 9.1 +/- 0.30 (preoperative), 2.6 +/- 1.10 (1 mo postoperative), and 2.1 +/- 0.64 (1 yr postoperative). Daily headache frequency decreased from 6.0 +/- 2.0 (preoperative) to 0.2 +/- 0.09 (i.e., one headache every 5 days) (1 yr postoperative). Three of the eight patients had no headaches after 1 year. There were no instances of corneal or facial anesthesia. One year postoperatively, five patients required no medication, and three remained on low doses of medication for headache treatment. In contrast to previous limited reports of glycerol injections for cluster headaches, results with these patients having chronic cluster headaches support the use of glycerol injections as a viable treatment alternative, with significant pain relief and corneal safety.
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PMID:Trigeminal cisternal injection of glycerol for treatment of chronic intractable cluster headaches. 194 29

The relation between postoperative sensory deterioration and surgical outcome in 54 patients treated by retrogasserian glycerol rhizotomy for trigeminal neuralgia was studied. The facial sensibility was assessed one day and three months postoperatively. Thresholds for perception and pain were determined quantitatively using transcutaneous electrical stimulation and clinically by light touch and pinprick tests. At a follow-up one year after surgery there was no significant difference in pain relief between patients who did show and patients who did not show sensory deterioration at the one day or three months evaluations. Nevertheless, there was a tendency for higher recurrence rate in patients with mild or no sensory disturbance.
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PMID:Relation between sensory disturbance and outcome after retrogasserian glycerol rhizotomy. 195 Jun 83

Propofol is a new intravenous anaesthetic agent chemically unrelated to barbiturate, steroid, imidazole, or eugenol agents. It is available as 1% solution in an aqueous solution of 10% soya bean oil, 2.25% glycerol and 1.2% purified egg phosphatide. The desirable features of the drug are rapid, clear emergence from anaesthesia, lack of cumulation, lack of effect on adrenal steroidogenesis, and has no adverse effect on liver and renal function. In emulsion form, it does not release histamine, nor has it been associated with anaphylactoid reactions. Although, it causes pain on injection, it infrequently results in phlebitis or thrombosis. It causes hypotension and respiratory depression during induction. The induction dose in healthy adults is 2-2.5 mg/kg. Older or debilitated individuals require less propofol for induction.
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PMID:Pharmacology of propofol. 202 66

This study reviews the results and complications of 162 percutaneous thermocoagulations of the gasserian ganglion in 124 patients with typical idiopathic trigeminal neuralgia. The mean duration of follow-up observation was 3.7 years (range, 1-6 years). One hundred eighteen of 124 patients continued to show complete pain relief 1 month after the operation, and at the end of follow-up observation, 83 of 124 patients (67%) continued to enjoy complete pain relief (recurrence rate, 28.2%). Anesthesia dolorosa occurred in 3% of cases, dysesthesia in 3%, and paresthesia in 17%; neuroparalytic keratitis with permanent reduction of visual acuity was observed in 2% of cases, permanent diplopia in 1%, permanent hearing deficit in 3%, and permanent impairment of mastication in 3%. We compare thermocoagulation with other surgical procedures (microvascular decompression, glycerol injection, and percutaneous decompression) used in the treatment of trigeminal neuralgia.
Clin J Pain 1990 Jun
PMID:Percutaneous controlled thermocoagulation in the treatment of trigeminal neuralgia. 213 10

From 1984 to 1989, 112 patients with typical drug-refractory trigeminal neuralgia were treated by retrogasserian glycerol injection. The present study assesses results and complications after a mean follow-up period of 3.5 years (range 0.1-5.5 years). One hundred and three of 112 patients (91.9%) showed complete pain relief 1 month postoperatively, and at the end of follow-up 80 patients (71.4%) were still enjoying complete pain relief (recurrence rate 20.5%). Abnormal facial sensations were noted in 49 patients, the most common complication being mild hypoesthesia (32% of patients), while paresthesia occurred in 19% of cases and dysesthesia in 3%. The corneal reflex was absent in 3% of patients and reduced in 5%. None of the patients developed anesthesia dolorosa, permanent masseter weakness, neuroparalytic keratitis, or diplopia.
Clin J Pain 1990 Dec
PMID:Retrogasserian glycerol injection: a retrospective study of 112 patients. 213 29

The results in 122 patients with trigeminal neuralgia who underwent percutaneous retrogasserian glycerol injection are presented. Eighty patients were followed from 38 to 54 months. The recurrence rate at 54 months was 72% (Kaplan-Meier analysis), and the median pain-free interval was 32 months. Complications associated with the procedure were significantly high: 63% of the patients had definite hypesthesia of the face and 29% had unpleasant dysesthesias, including two cases of anesthesia dolorosa. Sensory disturbances were most frequent in patients who had received a previous alcohol block procedure. Among the patients without previous peripheral procedures, 50% developed sensory disturbances. Because of the high rates of recurrence and sensory disturbances, the authors prefer microvascular decompression for the management of trigeminal neuralgia.
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PMID:Percutaneous retrogasserian glycerol injection in the management of trigeminal neuralgia: long-term follow-up results. 219 39

Nineteen patients with trigeminal neuralgia were treated with either trigeminal ganglion glycerolysis or glycerolysis and intracranial microvascular decompression. All had a good degree of pain relief. Of those receiving glycerol alone (group A), 50% subjectively reported a mild reduction of fine tactile sensation. A similar response was reported by those treated with both glycerol and decompression (group B). The degree of sensory loss was so mild that thermal testing was useless as a discriminatory tool. The degree of sensory loss was not greater when both surgical procedures were performed than when the less-invasive trigeminal ganglion glycerolysis alone was used.
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PMID:An evaluation of sensory changes and pain relief in trigeminal neuralgia following intracranial microvascular decompression and/or trigeminal glycerol rhizotomy. 221 95

The effects of percutaneous retrogasserian glycerol rhizolysis were observed in a population of 58 cases of classical trigeminal neuralgia. The follow-up period ranged from 7 to 52 months postoperatively. It was noted that 84% of the patients had immediate relief of pain. The overall recurrence rate was 29%. Based on Kaplan-Meier survival curves, the overall half-life (T1/2) of this procedure was 16 months. Although none of the patients developed anesthesia dolorosa or corneal ulceration, one group of patients developed either a clinical or subclinical persistent "minimal hypesthesia." In these there was a statistically significant difference in the T1/2 associated with this procedure (p = 0.01). This finding suggests that, contrary to the general belief, persistent hypesthesia after glycerol rhizolysis is a negative indicator of long-term success.
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PMID:Relation of hypesthesia to the outcome of glycerol rhizolysis for trigeminal neuralgia. 229 85


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