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Balloon compression rhizolysis in the surgical management of trigeminal neuralgia
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determinants of long-term outcome. Follow-up using questionnaire and patient examination was carried out at 1 month, 1 year and 5 and 10 years postoperatively~ With a ~nimum follow-up of 5 years, 62$, of the patients had complete relief of back pain and leg pain. 96% were happy that they had undergone the surgery and 93% were able to return to work. 9% reported that their back pain at 5 and 10 years was as severe or worse than preoperatively and 11% reported that their leg pain was as severe or worse than preoperatively. The reoperation rate was 18%. Preoperative factors that were found to be significantly associated with outcome at 1 year postoperatively were not significantly associated with outcome at 5---l0 years postoperatively. The authors conclude that the results of lumbosacral discectomy appear favorable as evaluated in their study, but comment that preoperative factors useful as predictors of short-term outcome are much less reliable when considering the long-term results. Inhibition of dorsal horn cell responses by stimulation of the Kolliker fuse nucleus. - C-3. Hodge, Jr., A.V.
Apkarian and R.T. Stevens, .I. Neurosurg., 66 (1986) 825-833. This study examines the effects of stimulation of the Kolliker fuse nucleus (KF) on responses of dorsaf horn neurons to inn~uous and noxious cutaneous stimulation in anesthetised cats. Stimulation of the KF produced potent inhibition of the responses of dorsal horn cells to both types of stimuli but the threshold for responses to noxious stimuli was significantly lower. Depletion of biogenic amines by pretreatment with reserpine resulted in a significant decrease in the KF spinal inhibitory effects, suggesting their dependence on intact noradrenergic stores. The authors feel that the Kolliker-fuse spinal system is an important noradrenergic dependent site for brain-stem modulation of spinal processing of noxious, potentially painful stimuli. They also believe that the KF nucleus is the major source of catecholamine innervation to the spinal cord and believe that the KF nucleus rather than the locus coeruleus and subcoeruleus are the primary nuclei in the so-called parabrachial region of the pons involved in catecholaminergic modulation of spinal nocioception. Balloon compression
rhizolysis in the surgical rn~a~e~~t of trigeminal neuralgia. - C.J. Belber and R.A. Rak, Neurosurgery, 20 (1987) 908-913. The authors describe their experience in treating trigeminal neuralgia in 25 patients by percutaneous balloon compression rhizolysis of the trigeminal nerve. A no. 4 French Fogarty catheter was guided by fluoroscopy through the foramen ovale into Meckel’s cave and the balloon was inflated tightly for a few minutes with soluble contrast agent to compress the gasserian ganglion rootlets under light endotracheal anesthesia. All patients experienced immediate pain relief with mild numbness in all 3 divisions but with sparing of the cornea1 reflex. There was often transient weakness of the ipsilateral muscles of mastication. 76% of patients followed between 6 months and 7 years had permanent cure of their pain and there were 8 recurrences. The authors believe that the advantages of this procedure include its high rate of efficacy, low rate of dysesthesias, absence of discomfort for the patient during the procedure, short operative time, technical ease of perfor~ng the procedure, minimal morbidity and no risk of loss of cornea1 sensation. The authors believe that microvascular decompression should be the first operation considered for trigeminal neuralgia but that their balloon compression technique is the procedure of choice for the aged and medically infirmed.
Prognostic factors implicated in the microsurgical treatment of trigeminal ueuralgia. - M. Sindou and J. Szapiro, Jr. In: M. Samii (Ed.), Surgery In and Around the Brain Stem and the Third Ventricle, Springer, Heidelberg, 1986, pp. 273-279. The authors have analyzed the results in 150 patients referred for trigeminal neuralgia and operated upon at the cerebella-pontine angle, i..e, 20% of their total series of 759 patients with tic douloureux (609 of them having been submitted to percutaneous RF thermocoagulation). In 14 of the above 150 patients, a tumour, an angioma or a giant aneurysm have been found and with its removal a total relief of pain has been obtained.
determinants of long-term outcome. Follow-up using questionnaire and patient examination was carried out at 1 month, 1 year and 5 and 10 years postoperatively~ With a ~nimum follow-up of 5 years, 62$, of the patients had complete relief of back pain and leg pain. 96% were happy that they had undergone the surgery and 93% were able to return to work. 9% reported that their back pain at 5 and 10 years was as severe or worse than preoperatively and 11% reported that their leg pain was as severe or worse than preoperatively. The reoperation rate was 18%. Preoperative factors that were found to be significantly associated with outcome at 1 year postoperatively were not significantly associated with outcome at 5---l0 years postoperatively. The authors conclude that the results of lumbosacral discectomy appear favorable as evaluated in their study, but comment that preoperative factors useful as predictors of short-term outcome are much less reliable when considering the long-term results. Inhibition of dorsal horn cell responses by stimulation of the Kolliker fuse nucleus. - C-3. Hodge, Jr., A.V.
Apkarian and R.T. Stevens, .I. Neurosurg., 66 (1986) 825-833. This study examines the effects of stimulation of the Kolliker fuse nucleus (KF) on responses of dorsaf horn neurons to inn~uous and noxious cutaneous stimulation in anesthetised cats. Stimulation of the KF produced potent inhibition of the responses of dorsal horn cells to both types of stimuli but the threshold for responses to noxious stimuli was significantly lower. Depletion of biogenic amines by pretreatment with reserpine resulted in a significant decrease in the KF spinal inhibitory effects, suggesting their dependence on intact noradrenergic stores. The authors feel that the Kolliker-fuse spinal system is an important noradrenergic dependent site for brain-stem modulation of spinal processing of noxious, potentially painful stimuli. They also believe that the KF nucleus is the major source of catecholamine innervation to the spinal cord and believe that the KF nucleus rather than the locus coeruleus and subcoeruleus are the primary nuclei in the so-called parabrachial region of the pons involved in catecholaminergic modulation of spinal nocioception. Balloon compression
rhizolysis in the surgical rn~a~e~~t of trigeminal neuralgia. - C.J. Belber and R.A. Rak, Neurosurgery, 20 (1987) 908-913. The authors describe their experience in treating trigeminal neuralgia in 25 patients by percutaneous balloon compression rhizolysis of the trigeminal nerve. A no. 4 French Fogarty catheter was guided by fluoroscopy through the foramen ovale into Meckel’s cave and the balloon was inflated tightly for a few minutes with soluble contrast agent to compress the gasserian ganglion rootlets under light endotracheal anesthesia. All patients experienced immediate pain relief with mild numbness in all 3 divisions but with sparing of the cornea1 reflex. There was often transient weakness of the ipsilateral muscles of mastication. 76% of patients followed between 6 months and 7 years had permanent cure of their pain and there were 8 recurrences. The authors believe that the advantages of this procedure include its high rate of efficacy, low rate of dysesthesias, absence of discomfort for the patient during the procedure, short operative time, technical ease of perfor~ng the procedure, minimal morbidity and no risk of loss of cornea1 sensation. The authors believe that microvascular decompression should be the first operation considered for trigeminal neuralgia but that their balloon compression technique is the procedure of choice for the aged and medically infirmed.
Prognostic factors implicated in the microsurgical treatment of trigeminal ueuralgia. - M. Sindou and J. Szapiro, Jr. In: M. Samii (Ed.), Surgery In and Around the Brain Stem and the Third Ventricle, Springer, Heidelberg, 1986, pp. 273-279. The authors have analyzed the results in 150 patients referred for trigeminal neuralgia and operated upon at the cerebella-pontine angle, i..e, 20% of their total series of 759 patients with tic douloureux (609 of them having been submitted to percutaneous RF thermocoagulation). In 14 of the above 150 patients, a tumour, an angioma or a giant aneurysm have been found and with its removal a total relief of pain has been obtained.