Invasive procedures for treatment of trigeminal neuralgia (TGN) include percutaneous radiofrequency thermocoagulation (PRT), partial sensory rhizotomy (PSR), and microvascular decompression (MVD). Using a nationwide discharge registry from The Netherlands, we assessed the frequency of use and patient characteristics, and evaluated treatment failure for each patient undergoing PRT, PSR, or MVD from January 2002 through December 2004. Only patients without a procedure in the year prior were included. Primary outcome was readmission for repeat procedures for TGN or known complications within 1year. Comparability of patient populations was assessed through propensity scores based on hospital, age, sex, and comorbidity. Conditional logistic regression matched on propensity score was used to calculate relative risks (RR) with 95% confidence intervals (CIs) for repeat procedures or complications. During the study period, 672 patients with TGN underwent PRT, 39 underwent PSR, and 87 underwent MVD. Hospital type was the predominant determinant of procedure type; age, sex, and comorbidity were weak predictors. The RR for repeat procedures for PSR was 0.21 (95% CI: 0.07 to 0.65) and for MVD was 0.13 (95% CI: 0.05 to 0.35) compared with PRT (RR 1). For complications, the RR of PSR was 5.36 (95% CI: 1.46 to 19.64) and of MVD was 4.40 (95% CI: 1.44 to 13.42). Sex, urbanization, and comorbidity did not influence prognosis, but hospital and surgical volume did. In conclusion, although PSR and MVD are associated with a lower risk of repeat procedure than PRT, they seem to be more prone to complications requiring hospital readmission. Microvascular decompression and partial sensory rhizotomy are associated with a lower risk of undergoing a repeat procedure compared with percutaneous radiofrequency thermocoagulation but are more prone to complications requiring readmission to hospital.

A nationwide study of three invasive treatments for trigeminal neuralgia

REPRINT OF POLISH TRANSLATION OF ARTICLE BY ACCORD INTERNATIONAL ASSOCIATION FOR THE STUDY OF PAIN (IASP) - Pain 152 (2011) 507-513 A nationwide study of three invasive treatments for trigeminal neuralgia

Bioresonance hypothesis: a new mechanism on the pathogenesis of trigeminal neuralgia.

Meta-Analysis on Safety and Efficacy of Microsurgical and Radiosurgical Treatment of Trigeminal Neuralgia.

Purpose
The study aims to assess the efficacy and safety of surgical treatment of trigeminal neuralgia (TN) in our department and to identify prognostic factors.

Surgical treatment of trigeminal neuralgia. Results from the use of glycerol injection, microvascular decompression, and rhizotomia.

Trigeminal neuralgia (TN) is a common pain syndrome and is characterized by recurrent episodes of intense lancinating pain in one or more divisions of the trigeminal nerve. Neurovascular compression (NVC) has been considered as the main cause of TN in the root entry zone (REZ) of the trigeminal nerve in the cerebellopontine angle cistern. Microvascular decompression (MVD) is the surgical procedure of choice for the treatment of medically refractory TN. MVD has also been shown to provide pain relief even in patients without visible neurovascular compression. Additionally, it has been accepted that MVD can provide the highest rate of long-term patient satisfaction with the lowest rate of pain recurrence. We did, systematic review of the subject and also our own experiences.

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Microvascular decompression as a surgical management for trigeminal neuralgia: a critical review of the literature.

Sir, Intracranial sewing needles constitute a minor fraction of intracranial foreign bodies and are generally the remnants of attempted infanticides. They are mostly inserted via the fontanelles, cranial sutures, and more rarely through the orbits in infancy for the purpose of killing unwanted babies. Notably, infants may be subjected to such cruel murder attempts in eastern cultures in which marrying multiple wives is allowed, so that these infants become the victims of competition between the spouses (1). Survivors may become symptomatic in adult years and admit to hospital because of mild to moderate headache, epileptic attacks, and abscesses. However, some patients live completely symptom-free and intracranial needles could only be detected accidentally in plain craniographies mostly after head traumas (1–3). Reported patients in literature harbor mostly single or two intracranial needles; however, Yilmaz et al. (4) from Turkey reported a 10-year-old boy who developed cerebral abscess due to five intracranial sewing needles. Likewise, our case was a 16-year-old boy who suffered from a mild head trauma and plain craniographies revealed four adjacent intracranial needles in the frontal region within the cerebral parenchyma (Fig. 1a,b). Computed tomography scanning demonstrated that three of the needles embedded in both frontal lobes and one was extending down in the anterior interhemispheric fissure without any obvious ventricular or major artery involvement (Fig. 2). Since the patient is symptom-free and the diagnosis was purely incidental without any risks of infection or potential neurovascular injury, our approach was conservative. In conclusion, intracranial sewing needles, a rare but a dreadful incidence should always be considered in neurosurgical practice.

Baki S. Albayrak

Papers

Microvascular decompression as a surgical management for trigeminal neuralgia: a critical review of the literature.

Letter to the editor--An incidental diagnosis of four adjacent intracranial sewing needles in a 16-year-old boy: a survivor of an infanticide attempt?