Pub Date : 2019-07-01DOI: 10.1093/med/9780190887674.003.0008
E. Levin
Geniculate neuralgia is a rare syndrome of episodic, lancinating pain located within the ear canal. There may be a trigger point within the canal and associated with disorders of tearing, taste, and salivation. It is important to distinguish geniculate neuralgia from other causes of inner ear pain, including structural lesions and glossopharyngeal or trigeminal neuralgia. MRI may show vascular conflict with CN VII/VIII complex. Typical treatment is with carbamazepine. Surgery is reserved for those patients who have an incomplete response to medication. Surgery is directed at microvascular decompression of the CN VII/VIII complex with or without sectioning of the nervus intermedius. The entry zones of CN IX and X may also be explored. Complications and management are discussed.
{"title":"Geniculate Neuralgia","authors":"E. Levin","doi":"10.1093/med/9780190887674.003.0008","DOIUrl":"https://doi.org/10.1093/med/9780190887674.003.0008","url":null,"abstract":"Geniculate neuralgia is a rare syndrome of episodic, lancinating pain located within the ear canal. There may be a trigger point within the canal and associated with disorders of tearing, taste, and salivation. It is important to distinguish geniculate neuralgia from other causes of inner ear pain, including structural lesions and glossopharyngeal or trigeminal neuralgia. MRI may show vascular conflict with CN VII/VIII complex. Typical treatment is with carbamazepine. Surgery is reserved for those patients who have an incomplete response to medication. Surgery is directed at microvascular decompression of the CN VII/VIII complex with or without sectioning of the nervus intermedius. The entry zones of CN IX and X may also be explored. Complications and management are discussed.","PeriodicalId":372220,"journal":{"name":"Pain Neurosurgery","volume":"302 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132690344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780190887674.003.0003
Jeffrey A. Brown
Multiple sclerosis is a common secondary cause of trigeminal neuropathic pain. It occurs because of the presence of sclerotic plaque within the highly myelinated trigeminal pathway. Patients with multiple sclerosis (MS) may also have a vascular compressive etiology; however, the two-year success rate for microvascular decompression is merely 15%. Ablative treatment also has a high pain recurrence rate that is as high as 50% in one year regardless of the surgical option selected. Balloon compression rhizotomy is a simple treatment option in MS patients. When done, the balloon compression site is at the retrogasserian portion of the trigeminal nerve and not the trigeminal ganglion. Balloon compression is associated with a trigeminal depressor response for which one must be prepared to treat with iv atropine.
{"title":"Secondary Trigeminal Neuralgia (Balloon Compression Rhizolysis)","authors":"Jeffrey A. Brown","doi":"10.1093/MED/9780190887674.003.0003","DOIUrl":"https://doi.org/10.1093/MED/9780190887674.003.0003","url":null,"abstract":"Multiple sclerosis is a common secondary cause of trigeminal neuropathic pain. It occurs because of the presence of sclerotic plaque within the highly myelinated trigeminal pathway. Patients with multiple sclerosis (MS) may also have a vascular compressive etiology; however, the two-year success rate for microvascular decompression is merely 15%. Ablative treatment also has a high pain recurrence rate that is as high as 50% in one year regardless of the surgical option selected. Balloon compression rhizotomy is a simple treatment option in MS patients. When done, the balloon compression site is at the retrogasserian portion of the trigeminal nerve and not the trigeminal ganglion. Balloon compression is associated with a trigeminal depressor response for which one must be prepared to treat with iv atropine.","PeriodicalId":372220,"journal":{"name":"Pain Neurosurgery","volume":"89 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134555944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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