Presentation on theme: "By Dr. Ravindra Srivastava Consultant Neurosurgeon VIMHANS, New DELHI"— Presentation transcript:
1By Dr. Ravindra Srivastava Consultant Neurosurgeon VIMHANS, New DELHI Trigeminal NeuralgiaByDr. Ravindra SrivastavaConsultant NeurosurgeonVIMHANS, New DELHI
2Paroxysms of severe, lancinating, electric shock-like bouts of facial pain, lasting for seconds to minutes and restricted to distribution of the trigeminal nerve. No neurologic deficit is present and is not attributed to another disorder.Incidence : 4-5/ 1,00,000Female Predominance (Male: Female = 1:2 – 2:3
3usually unilateral (Right Side) mandibular (60%) (V3)maxillary (V2) (35%)ophthalmic VI branch (5%)Trigger zones - cheek, lip, nose or buccal mucosa.Triggers - shaving, brushing teeth, drinking, eating or even slight breeze
4Etiology - Idiopathic (Vascular) - Tumour V (nerve) Schwannoma or Cerebello pontine angle Tumors- Herpes Simplex virus infection- Multiple Sclerosis4% of Patients with Multiple sclerosis have Trigeminal Neuralgia2% Patients with Trigeminal Neuralgia have Multiple sclerosis
5Vascular- Aberrant loop of artery -Superior cerebellar artery (75.5%),- AICA (9.6%)-PCA (0.7%) or-vein (68.2%) found to be compressing the root entry zone of the V nerve in 80-90% of patients at surgery. Eliminating the compression provides long term relief.
6InvestigationsWhether there is an identifiable cause of disease, particularly with a view to surgical cure.
7MRI SCAN- 3D CISS with MPR sequences & MRA MRI scan should be obtained in-Younger Patient-Atypical clinical Features, including sensory loss or a dull burning pain between paroxysms-Patients who do not respond to initial medical therapy.
11MVD Concept of Dandy (1920) Popularized by Janetta. GOLD STANDARD as it deals the underlying cause.Retromastoid Sub occipital craniotomy, Retraction of superolateral margin of cerebellum, arachnoid is dissected & vessel freed, piece of shredded teflon placed between the vessel & the nerve to separate them.
13OF1185 pts treated by Barker at al with mean follow up of 6 OF1185 pts treated by Barker at al with mean follow up of 6.5Yrs, 70% had excellent results at 10yrs.Our results in 10patients in whom MVD was done 80% -85% had excellent results over of period 5 Yrs.