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REVIEW ARTICLE
Year : 2017  |  Volume : 12  |  Issue : 4  |  Page : 585-597

Trigeminal neuralgia


1 Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
2 Department of Radio Diagnosis and Imaging, All India Institute of Medical Science, New Delhi, India
3 Department of Radio Diagnosis and Imaging, NSCB Medical College, Jabalpur, Madhya Pradesh, India

Date of Web Publication3-Oct-2017

Correspondence Address:
Yad Ram Yadav
Department of Neurosurgery, NSCB Medical College, Jabalpur - 482 003, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajns.AJNS_67_14

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  Abstract 


Trigeminal neuralgia (TN) is a sudden, severe, brief, stabbing, and recurrent pain within one or more branches of the trigeminal nerve. Type 1 as intermittent and Type 2 as constant pain represent distinct clinical, pathological, and prognostic entities. Although multiple mechanism involving peripheral pathologies at root (compression or traction), and dysfunctions of brain stem, basal ganglion, and cortical pain modulatory mechanisms could have role, neurovascular conflict is the most accepted theory. Diagnosis is essentially clinically; magnetic resonance imaging is useful to rule out secondary causes, detect pathological changes in affected root and neurovascular compression (NVC). Carbamazepine is the drug of choice; oxcarbazepine, baclofen, lamotrigine, phenytoin, and topiramate are also useful. Multidrug regimens and multidisciplinary approaches are useful in selected patients. Microvascular decompression is surgical treatment of choice in TN resistant to medical management. Patients with significant medical comorbidities, without NVC and multiple sclerosis are generally recommended to undergo gamma knife radiosurgery, percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation procedures. Partial sensory root sectioning is indicated in negative vessel explorations during surgery and large intraneural vein. Endoscopic technique can be used alone for vascular decompression or as an adjuvant to microscope. It allows better visualization of vascular conflict and entire root from pons to ganglion including ventral aspect. The effectiveness and completeness of decompression can be assessed and new vascular conflicts that may be missed by microscope can be identified. It requires less brain retraction.

Keywords: Cranial nerve, microvascular decompression, neurosurgical procedures/methods, route entry zone, trigeminal nerve diseases, trigeminal neuralgia, trigeminal neuralgia/surgery


How to cite this article:
Yadav YR, Nishtha Y, Sonjjay P, Vijay P, Shailendra R, Yatin K. Trigeminal neuralgia. Asian J Neurosurg 2017;12:585-97

How to cite this URL:
Yadav YR, Nishtha Y, Sonjjay P, Vijay P, Shailendra R, Yatin K. Trigeminal neuralgia. Asian J Neurosurg [serial online] 2017 [cited 2017 Dec 14];12:585-97. Available from: http://www.asianjns.org/text.asp?2017/12/4/585/215788




  Introduction Top


Trigeminal neuralgia (TN) is defined as sudden, severe, brief, stabbing, and recurrent pain within the distribution of one or more branches of the trigeminal nerve (TR N). Several destructive and nondestructive techniques are available for properly selected cases.[1] Microvascular decompression (MVD) may be considered over other techniques to provide the longest duration of pain freedom.[2] Younger patients benefit from MVD whereas the elderly patients with poor risk are more suitable for percutaneous procedures[3] and gamma knife radiosurgery (GKRS).[4]

This review is based on 17 years search on PubMed and Google including 27 years personal experience of over 600-microvscular decompression surgeries for TN.


  Etiology Top


Although multiple mechanism involving peripheral pathologies at root (compression or traction), and dysfunctions of brain stem, basal ganglion, and cortical pain modulatory mechanisms could have role, neurovascular conflict is the most accepted theory. Artery or vein[5] is usually compressing the TR N near the pons injuring myelin sheath and causing erratic hyperactive functioning of the nerve. Focal arachnoid thickening, angulation, adhesion, traction, tethering or torsion, fibrous ring around the root, cerebello-pontine angle (CPA) tumors, brain stem infarction, aneurism, and arteriovenous malformation (AVM) can also cause TN.[6],[7]

Central causes of the disease have also been proposed for TN; reduced basal ganglia μ-opioid receptor,[8] altered gray matter (GM) in sensory, and motor cortex has been implicated.[9] The dysfunction of multiple modulatory mechanisms probably plays a key role in the pathophysiology.[10]

Demyelination, dysmyelination giving increases to electrical hyper excitability, spontaneous and triggered ectopic impulse and cross excitation among neighboring afferents have been proposed in ignition hypothesis.[11] According to the bio resonance hypothesis, TR N fibers are damaged when the vibration frequency of nerve and surrounding structure becomes close to each other.[12] The brain sagging/arterial elongation hypothesis is also believed to cause nerve compression.[5]

Vascular theory

Although it has been generally assumed that vascular contact at the root entry zone (REZ) cause TN, conflict anywhere on the root at central or peripheral myelin, in the region of REZ, or at transition zone between central and peripheral myelin can cause TN.[6] REZ and transition zone between central and peripheral myelin are distinct sites and that these terms should never be used interchangeably.[13] Peripheral myelin is more resistant to compression as compared to central myelin or transition zone.[14] The normal pulsation of artery may not be traumatic[15] enough to produce TN, strokes due to unbending of artery loop usually causes pathological changes in root.[16] Although displacement or grooving of the nerves has been observed in normal individuals,[17] more severe root indentation or distortion in proximal root is likely to produce TN.[18] Arterial compression is commonly seen, venous conflict alone or in combination to arterial compression has been observed in some patients as a cause of TN.[19]

Persistent primitive trigeminal artery,[20] its aneurysm,[21] and vertebrobasilar dolichoectasia[22] may cause TN. Sharper trigeminal-pontine angle,[23] smaller CPA cisterns and short cisternal TR Ns[24],[25] can facilitate the neurovascular compression (NVC). Narrow foramen may be etiologically important in a small percentage of TN patients, especially in recurrent or residual cases in the absence of vascular compression during surgery.[26]


  Pathophysiology Top


Exact pathophysiology of TN remains controversial. Chronic nerve compression results in demyelination, with progressive axonal degeneration in small unmyelinated and thinly myelinated fibers. Demyelination can leads to ephaptic transmission; reentry mechanism causes an amplification of sensory inputs. Ultra-structural and biochemical changes in axon and myelin are not only seen in root but also in  Gasserian ganglion More Details or in both the structures.[27] Atrophy of the TR N is also seen.[28],[29] The GM volume reduction in the primary and secondary somatosensory cortex, orbitofrontal areas, thalamus, insula, anterior cingulate cortex, cerebellum, and dorsolateral prefrontal cortex has been observed.[30],[31] Lower axial kurtosis and higher axial diffusivity in corticospinal tract, superior longitudinal fasciculus, anterior thalamic radiation, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, cingulated gyrus, forceps major, and uncinate fasciculus was observed. There was complex functional connectivity density reorganization of hippocampus, striatum, thalamus, precentral gyrus, precuneus, prefrontal cortex, and inferior parietal lobule.[32] It is difficult to say whether the changes in cortical and subcortical area are cause or effect in TN.


  Clinical Features Top


TN is characterized by episodes of spontaneous pain or a triggered intense facial pain that last for short duration. Pain may be like stabbing, electric shocks, burning, pressing, crushing, exploding, shooting, boring, shock-like sensations, migraine like, piercing, prickling, or a combination. TN is usually of two varieties with Type 1 as intermittent pain and Type 2 is constant. Although a subset of patients can progress from Type 1 to Type 2 TN over time, their pathological and prognostic profiles nevertheless resembled those of Type 1. Proponents of progressive change in character of pain theory think that the TN, atypical neuralgia, and trigeminal neuropathic pain may represent a continuous spectrum rather than discrete pathology,[33] whereas others believe that Type 1 and Type 2 TN represent distinct entities.[34]

Usually, pain resolves completely between the attacks. It usually does not occur when the person is asleep. It is estimated that 1 in 15,000 or 20,000 people suffer from TN, actual figure may be higher due to frequent misdiagnosis.[35] Higher incidence of TN as compared to other cranial nerves neuralgias could be due to longer lengths and more volumes of the central myelin.[36] Disease usually involve single division, it may slowly spread to other division. TN may be associated with ipsilateral hemifacial spasm (painful tic convulsive).[37] Multiple cranial nerve neuralgias, although rare, can occur.[38] It is usually unilateral, bilateral presentation is rare.[39] Rapid spreading to other division, bilateral involvement, or simultaneous involvement of other nerve suggests a secondary disease such as multiple sclerosis (MS) or expanding cranial tumor.

It is common after 50 years of age. TN is uncommon in young adults. Presentation in children is rare.[40] It is more common in females than males. Co-morbid depression is observed. It can be associated with Dandy walker syndrome, small posterior fossa, brain stem infarct, hydrocephalus, MS, lesions in relations to TR N, and opposite side tumor, etc.


  Diagnosis Top


The diagnosis of TN is essentially clinical. Although such patients do not have any neurodeficit with normal blink reflex,[41] quantitative sensory testing have shown subtle sensory abnormalities which may not be detected in routine clinical examination.[42] Magnetic resonance imaging (MRI) imaging is aimed to detect changes in trigeminal root, any NVC and to rule out secondary pathology. MRI can diagnose entire course of nerve,[43] root atrophy, and CPA cistern.[28] Single finding (changes in nerve or the presence of vascular conflict) in MRI scan may not be helpful in deciding symptomatic side, combination of vascular conflict, and anatomical changes in nerve, are highly likely to be associated with symptomatic TN.[44]

Detection of changes in trigeminal root

Diffusion tensor imaging (DTI) can detect increase in apparent diffusion coefficient and decrease in fraction of anisotropy (FA) in TR N.[45],[46] Atrophic changes are also associated in TN. Coregistration of three-dimensional fast imaging employing steady-state (3D FIESTA) imaging and DTI facilitates excellent delineation of cisternal segments of TR Ns.[47] The deformity of the cranial nerves can be demonstrated using multislice motion-sensitized driven equilibrium technique.[48]

Vascular conflict detection

3D FIESTA,[49],[50] and contrast-enhanced 3D time-of-flight (TOF) magnetic resonance angiography (MRA) in combination with unenhanced MRA could help in the identification of vessel.[51] 3D T2 high-resolution MRI in combination with 3D TOF-MRA and 3D T1-gadolinium enhanced imaging is reliable in detecting the degree of the root compression.[52],[53] Although 3D - magnetic resonance cisternography can determine NVC in most of patients, it does have limitations in identification of venous compression.[54] Such veins can be detected by the 3D multifusion volumetric imaging using multidetector row computed tomography.[55]

3D high resolution MRI and image fusion technology could be useful for diagnosis of NVC in majority of patients.[56],[57] Image fusion of 3D constructive interference in steady-state and high-resolution MRA is able to depict the complex anatomical relationships between neural and vascular structures.[58],[59] Fusion MRI with multiplanar reconstruction can provide information about severity of the neurovascular contact.[60] Although both 1.5 and 3.0-T MRI can provide preoperative assessment of the compressing vessels,[61] 3-T may be of value when 1.5-T is equivocal.[62]


  Medical Treatment Top


Carbamazepine (CBZ) is drug of choice in TN; baclofen, lamotrigine, clonazepam, oxcarbazepine, topiramate, phenytoin, gabapentin, pregabalin, and sodium valproate can be used.[63],[64],[65] Multi drugs are useful when patients are unable to tolerate higher doses of CBZ.[66] With an availability of increasing number of anticonvulsant drugs, it is likely that surgical option may not be offered for many years.[67]

Intravenous infusion of a combination of magnesium and lidocaine can be very effective in some patients.[68] Five percent lidocaine plaster[69] and 8% capsaicin patch[70] can be useful in some TN. The 5-HT R3 antagonists, neurokinin-1 antagonists, or mast cell stabilizers may have role in the treatment of TN. A multidisciplinary approach using antidepressants and anti-anxiety drugs such as amitriptyline[71] and duloxetine is needed for the management of emotional status.[72]

Botulinum toxin Type A injections may be offered before surgery or unwilling to undergo surgery, and in failed drug treatment.[73] Tetracaine nerve block as an additional treatment after CBZ, acupuncture and peripheral nerve stimulation can be used.[74],[75],[76] Deep brain stimulation of the posterior hypothalamus may be considered as an adjunctive procedure for refractory TN of first division,[77] especially in MS.[78] Motor cortex stimulation can be used in certain neuropathic or deafferentation pain.[79] Treatment of associated tumor, AVM, epidermoid, aneurism, and hydrocephalus in  Chiari malformation More Details can resolve TN.[80]


  Gamma Knife Radiosurgery Top


Radiation may block the conduction of excessive sensory information responsible for triggering pain attacks.[81] Radiosurgery results in about 50% drop in FA values at the target with no significant change in outside the target nerve. Radiosurgery primarily affects myelin sheath.[82]

TN after a failed MVD, significant medical comorbidities, and MS are generally recommended to undergo GKRS.[4] It is indicated in typical or atypical TN,[83] with or without vascular compression,[84] and in recurrence after GKRS, glycerol rhizotomy (GR), radiofrequency thermocoagulation (RFTC), and percutaneous balloon compression (PBC).[85],[86],[87] Repeat GKRS provides a similar rate of pain relief as the first procedure. The best responses are observed when there is good pain control after first procedure, with new sensory dysfunction and in single division nerve distribution typical TN.[85],[86],[87],[88]

GKRS can be given using one or two isocenters[89] and targeting radiosurgery posteriorly at dorsal REZ,[90] or anteriorly in retrogasserian zone.[91] 80 Gy,[90] 85 Gy,[92] and 90 Gy can be used. Lower dose to the root are associated with less side effect, whereas higher doses provide better pain control with less risk of recurrences but more side effect such as facial numbness. The benefits and risks of higher dose must be carefully discussed with patients, since bothersome facial numbness, may be an acceptable for patients with severe pain.[93]

Radiosurgery can be given using single fraction; multiple fractions can deliver comparatively higher doses. Although hypofractionated stereotactic radiotherapy is not associated with any facial numbness, single fraction radiosurgery provides better pain relief and a lower recurrence rate as compared to hypofractionated technique.[94] Radiosurgery can be given with or without frame based method,[95] with MRI or computerized tomography (CT) planning when there is contraindication to MRI.[96]

Initial pain relief is 77%–96%, which takes about 1–3 weeks (sometimes 10 weeks or longer). Results are better in typical neuralgia with single nerve distribution pain.[88] About 37%[97] and 95%[98] of patients become pain free within 48 h, and 10 days of procedure, respectively. Although the long-term results of GKRS are not as satisfactory as MVD,[99],[100] it is an effective alternative with more than 50% long-lasting pain relief.[101],[102] Pain control rate is inferior in vertebrobasilar ectasia highlighting need for multimodality management.[103] Although GR provides urgent pain relief than GKRS, Gamma knife provides better long-term pain relief with less morbidity.[104],[105]

Recurrence can be seen in about 15% and 50% at 32 months[98] and long-term follow up, respectively.[101],[102] Trigeminal sensory deficit is observed in 30%–35%[98],[106] which is more in diabetes mellitus, after RFTC,[107] pain relief coming after 30 days of GKRS,[97] failed MVD or GR[108] and repeat GKRS.[87] The cyber knife provides the high precision of dose with the sparing of healthy tissues.[109],[110],[111] Effectiveness and safety of frameless stereotactic radiosurgery (SRS) using cyber knife system are comparable to frame bases SRS.[112] X-knife radiosurgery also provides effective pain relief with a low complication rate.[113]


  Percutaneous Balloon Compression Top


PBC selectively avoids injury to the small unmyelinated fibers that mediate the corneal reflex. Balloon compression is indicated in patients difficult to communicate, MS, failed MVD, with significant medical comorbidity, multiple divisions including first division,[114] without vascular compression,[115] and in repeat PBC.[116] PBC is reserved for patients in whom the effect of GR has been of short duration or difficult to repeat due to cisternal fibrosis.[117]

3D CT reconstructions can identify an ideal pear shape configuration to improve outcome.[118] Procedure can be performed under local or general anesthesia.[119] There is controversy regarding duration of compression, in one study there were no differences in outcomes between 60 s and longer times,[117] whereas in other study, longer compression time of 70–90 s resulted in better outcome.[119],[120] Pear shape balloon is an indication of proper compression and higher pain-free survival,[120],[121] whereas persistent elliptical shape is a bad sign and an indication for aborting the procedure. There is 2% risk of technical failures.[122]

PBC is a safe, simple, and effective method of about 90% temporary pain relief.[119],[123] Repeat PBC, though associated with some increase in complications, is reasonably safe.[116] Single trigeminal division, primary procedure in the absence of previous operations, and the pear shape balloon are associated to higher pain-free survival.[119],[120],[121] Results in MS patients are comparable to classic TN. About 14%, 18.9%, 29.5% recurrence is observed within 2, 3, and 5 years follow up, respectively after PBC.[119] Symptomatic dysesthesias,[122] masseter muscle weakness,[124] cardiovascular stress, cheek hemorrhages, corneal ulceration, infections, and transient diplopia are also observed.[125]


  Glycerol Rhizotomy Top


GR is indicated in patients unresponsive to pharmacotherapy,[126] significant medical comorbidities,[4] MS, unilateral and bilateral pain,[127] and after failed MVD.[4] It is cost-effective than MVD, RFTC and GKRS.[128] GR is a safe and efficacious method as a repeat procedure.[129]

The immediate success rate is about 95%[127] with 50%–60% recurrence at 24 months follow up. GR is a simple procedure, and most of the complications are reversible.[126] There is significant positive correlation between the presence of cerebrospinal fluid (CSF) outflow and good success rate.[127] Significant number may experience either mild numbness or dysesthesias. New facial numbness after GR is associated with excellent pain control. Anesthesia dolorosa although rare may be observed.


  Radiofrequency Thermocoagulation Top


RFTC can be used in bilateral pathology,[130] elderly,[130] recurrence after failed MVD,[82] vertebrobasilar dolichoectasia,[131] and MS. Peripheral nerve block,[132] and general anesthesia could relieve perioperative pain without an increase in complications.[133] Although pulsed radiofrequency (PRF) treatment is associated with less complication than conventional RFTC, it is not as effective as the conventional procedure.[134] Higher intraoperative PRF voltage and electrical field intensity may provide better pain relief.[135] Combined PRF and continuous radiofrequency (CRF) can achieve comparable pain relief with lesser side effects as compared to CRF.[136],[137] Initial pain control rate is about 95% with about 25% recurrent pain, occasional jaw weakness, corneal anesthesia, and troublesome dysesthesia.


  Peripheral Nerve Section Top


Peripheral neurectomy is a safe and effective procedure for elderly patients, in rural and remote centers where neurosurgical facilities are not available.[138] Pterygopalatine fossa segment neurectomy of maxillary nerve can be used in elderly who may not tolerate craniotomy, or when RFTC and GR treatment is not possible.[139] Pain relief can be lasting from 15 to 24 months.[138] Loss of sensation and recurrences are associated with peripheral neurectomy.


  Partial Sensory Root Section Top


Partial sensory root sectioning (PSRS) is indicated in MS associated with negative vessel explorations during MVD[140] and in large intra neural vein that is difficult to mobilize.[141] PSRS is also recommended in re exploration after failed MVD when there is no NVC.[142],[143] Excellent to good outcome is observed in 70% cases[144] with minimal sensory loss.


  Microvascular Decompression Top


MVD is indicated in Type 1[34],[84] or Type 2 TN,[145] with NVC.[146] The cure rate is higher in arterial compression compared to venous or no NVC.[147] MVD is also indicated in MS,[148] isolated V2 TN,[149] ectatic vessel with neuralgia,[150] and after SRS.[151] MVD is recommended in younger patients with longer life expectancy and healthy elderly [Figure 1].[152] Although less invasive procedure may be preferable in elderly patients, as complications do tend to increase gradually with an advanced age, MVD in physiologically healthy elderly population remains a reasonable surgical option.[153],[154]
Figure 1: Flow chart showing treatment plan of trigeminal neuralgia resistant to medical management. GKRS = Gamma knife radiosurgery, GR = Glycerol rhizotomy, MVD = Microvascular decompression, PBC = Percutaneous balloon compression, PSRS = Partial sensory root sectioning, RFTC = Radiofrequency thermocoagulation

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Dissection in MVD is not significantly difficult after GKRS.[151] Presurgical virtual endoscopy[155] and 3D computer graphics models can provide excellent visualization of NVC and allows simulation.[156] The dextroscope system can also create a stereoscopic neurovascular model to shorten the learning curve.[157]

Indocyanine green angiography could be a helpful adjunct in decompressing the TR N and can guide the surgeon to the nerve-vessel conflict.[158] All vessels, including the transverse pontine vein near meckel's cave, in relation to the nerve should be decompressed.[158],[159],[160],[161] There may be multiple vessels related to the root.[162] Sacrifice of a small intraneural vein can be performed while PSRS is preferred over extensive mobilization of large vein.[141],[163] Wrapping techniques can better decompress intraneural artery.[163]

Prominent suprameatal tubercle should be drilled out for better exposure of entire TR N and vascular conflicts.[164] Laterally placed craniotomy helps to visualize the whole nerve root along with REZ. Dissection of the cerebellar horizontal fissure and rostral retraction of the superior semilunar lobule allows easy identification of the REZ with minimal traction. Supracerebellar route permit identification and dissection of the offending supracerebellar artery. Whole surface of the TR N can be observed easily by combining these two approaches.[165] Preservation of the vestibular nerve arachnoid minimizes complications and optimizes surgical outcome.[166]

Autologous muscle graft,[167] oxidized regenerated cellulose,[168] and fibrin glue alone[169] can be used to transpose vessel away from the nerve. Transposition of the offending vessel with Teflon wool or slings, especially in tortuous NVC, is a useful.[170],[171],[172],[173],[174] Aneurysm clip with or without unabsorbable dural sling can be used.[175],[176]

Adhesion between the trigeminal root and surrounding structures, secondary to fibrin glue or prosthesis, can stretch nerve,[172] which can cause recurrence.[177] Prosthesis if used should be lying in subarachnoid space or cistern avoiding contact to dura matter or tentorium.[178] Arachnoid membrane of CPA can be used as a sling to transpose the superior cerebellar artery.[179]

Combing[180],[181] or PSRS[4] can be combined with MVD when no vascular conflict is detected.[182] Muscle pieces interposition between the duramater, artificial dura mater, cranioplasty, sealing of mastoid sinus by bone wax and muscle can be effective technique for the prevention of CSF leak.[183],[184],[185] Re surgery is an effective and safe after failed MVD.[142] The preservation of the petrosal vein and its tributaries, lateral inversion vein of ventricle IV is important in preventing the postoperative vestibular and cerebellar disorders.[186]

Early outcome after MVD in typical TN with associated NVC is 90%–95% which drops to 75% at 1and 5 years follow up.[67],[187],[188],[189],[190] MVD is significantly superior to GKRS.[191] TR N combing has a much higher pain relief in patients without vascular compression than those with vascular compression.[180] 3D models by fusing CTA and FIESTA can be used to evaluate the translational and rotational shift of the compressive artery, and decompressed distance from the root after failed MVD.[192]

Immediate postoperative pain relief is a good predictor of better long-term outcome.[193] Type 2 TN,[194] presence of autonomic symptoms,[195] MS[196] are associated with poor prognosis. Shorter preoperative duration, older age, and typical features are good predictors of favorable outcome.[197] Subset of patients progressed from Type 1 to Type 2 TN over time also have good outcome resembling Type 1.[34] Low FA values can be reversed after successful MVD.[198] Significant reduction of FA value may predict an optimistic outcome of MVD.[199]

The trigemino-cardiac reflex due to stimulation of the TR N during MVD may result in about 50% fall in heart rate and mean arterial blood pressure, cessation of manipulation lead to normalization of parameters.[34] Facial nerve dysfunction, hearing abnormality,[200] and TR N dysfunction may be observed, especially after more dissection and mobilization of respective nerve. Brainstem auditory evoked potential monitoring and neuro-endoscopy during MVD can preserve hearing function.[201]

Recurrences, ranging from 18% to 34%, may be seen at long-term follow up.[202],[203] It is more common within 2 years of surgery and thereafter at a rate of 2%–3.5% per year.[202] Significant predictors of recurrence are younger age, and symptoms lasting longer than 10 years.[203] Recompression due to regrowth of new vein or artery[204] can cause TN. Hardened Teflon can pierce nerve and produce TN,[205] therefore the contact of prosthesis, if used, with the nerve should be avoided. Outcome can be improved by establishing center dealing TN.[206] Late communicating hydrocephalus may be a potential complication of MVD surgery.[207]


  Endoscopic Vascular Decompression Top


Endoscopic techniques are increasingly being used in spine,[208],[209],[210] skull base[211],[212],[213] and intracranial pathologies.[214],[215],[216] Endoscopic technique can be used alone in TN[217],[218] or as an adjuvant to microscope[219],[220],[221] It is a minimally invasive technique,[221],[222] allows better visualization of entire root from pons to ganglion[217],[222],[223] including ventral aspect.[223] The endoscope is a valuable tool during MVD, especially when a bony ridge hiding the direct microscopic view of vascular conflict.[224] Effectiveness and completeness of decompression can be better assessed.[217],[223] New nerve-vessel conflicts can be identified which may be missed by microscope in 7.5%–33% of patients.[225],[226],[227],[228] It is safe,[218],[229],[230],[231],[232] requires less brain retraction[217],[225],[233],[234],[235] and associated with improved pain relief with lower complications as compared to MVD.[236] The vascular conflict is mostly distributed in the medial side on second division while it is in lateral area for third division in TN.[237]

Our recommendations

Medical treatment with drugs should be tried in TN. With an availability of increasing number of drugs it is likely that surgical option may not be offered for many years. Microscopic or endoscopic vascular decompression is recommended because of nondestructive nature, especially when NVC is present in young adults or healthy elderly [Figure 1]. GKRS, RFTC, GR, and PBC can be used in elderly patients with medical comorbidity and without NVC.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zakrzewska JM, McMillan R. Trigeminal neuralgia: The diagnosis and management of this excruciating and poorly understood facial pain. Postgrad Med J 2011;87:410-6.  Back to cited text no. 1
    
2.
Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol 2008;15:1013-28.  Back to cited text no. 2
    
3.
Emril DR, Ho KY. Treatment of trigeminal neuralgia: Role of radiofrequency ablation. J Pain Res 2010;3:249-54.  Back to cited text no. 3
    
4.
Pollock BE. Surgical management of medically refractory trigeminal neuralgia. Curr Neurol Neurosci Rep 2012;12:125-31.  Back to cited text no. 4
    
5.
Thomas KL, Vilensky JA. The anatomy of vascular compression in trigeminal neuralgia. Clin Anat 2014;27:89-93.  Back to cited text no. 5
    
6.
Sindou M, Howeidy T, Acevedo G. Anatomical observations during microvascular decompression for idiopathic trigeminal neuralgia (with correlations between topography of pain and site of the neurovascular conflict). Prospective study in a series of 579 patients. Acta Neurochir (Wien) 2002;144:1-12.  Back to cited text no. 6
    
7.
Ishikawa M, Nishi S, Aoki T, Takase T, Wada E, Ohwaki H, et al. Operative findings in cases of trigeminal neuralgia without vascular compression: Proposal of a different mechanism. J Clin Neurosci 2002;9:200-4.  Back to cited text no. 7
    
8.
DosSantos MF, Martikainen IK, Nascimento TD, Love TM, Deboer MD, Maslowski EC, et al. Reduced basal ganglia μ-opioid receptor availability in trigeminal neuropathic pain: A pilot study. Mol Pain 2012;8:74.  Back to cited text no. 8
    
9.
Desouza DD, Moayedi M, Chen DQ, Davis KD, Hodaie M. Sensorimotor and pain modulation brain abnormalities in trigeminal neuralgia: A paroxysmal, sensory-triggered neuropathic pain. PLoS One 2013;8:e66340.  Back to cited text no. 9
    
10.
Dallel R, Villanueva L, Woda A, Voisin D. Neurobiology of trigeminal pain. Med Sci (Paris) 2003;19:567-74.  Back to cited text no. 10
    
11.
Devor M, Govrin-Lippmann R, Rappaport ZH. Mechanism of trigeminal neuralgia: An ultrastructural analysis of trigeminal root specimens obtained during microvascular decompression surgery. J Neurosurg 2002;96:532-43.  Back to cited text no. 11
    
12.
Jia DZ, Li G. Bioresonance hypothesis: A new mechanism on the pathogenesis of trigeminal neuralgia. Med Hypotheses 2010;74:505-7.  Back to cited text no. 12
    
13.
Peker S, Kurtkaya Ö, Üzün I, Pamir MN. Microanatomy of the central myelin-peripheral myelin transition zone of the trigeminal nerve. Neurosurgery 2006;59:354-9.  Back to cited text no. 13
    
14.
De Ridder D, Møller A, Verlooy J, Cornelissen M, De Ridder L. Is the root entry/exit zone important in microvascular compression syndromes? Neurosurgery 2002;51:427-33.  Back to cited text no. 14
    
15.
Adamczyk M, Bulski T, Sowinska J, Furmanek A, Bekiesinska-Figatowska M. Trigeminal nerve – Artery contact in people without trigeminal neuralgia – MR study. Med Sci Monit 2007;13 Suppl 1:38-43.  Back to cited text no. 15
    
16.
Baliazina EV. Topographic anatomical relationship between the trigeminal nerve trunk and superior cerebellar artery in patients with trigeminal neuralgia. Morfologiia 2009;136:27-31.  Back to cited text no. 16
    
17.
Ramesh VG, Premkumar G. An anatomical study of the neurovascular relationships at the trigeminal root entry zone. J Clin Neurosci 2009;16:934-6.  Back to cited text no. 17
    
18.
Miller JP, Acar F, Hamilton BE, Burchiel KJ. Radiographic evaluation of trigeminal neurovascular compression in patients with and without trigeminal neuralgia. J Neurosurg 2009;110:627-32.  Back to cited text no. 18
    
19.
Dumot C, Brinzeu A, Berthiller J, Sindou M. Trigeminal neuralgia due to venous neurovascular conflicts: Outcome after microvascular decompression in a series of 55 consecutive patients. Acta Neurochir (Wien) 2017;159:237-49.  Back to cited text no. 19
    
20.
Conforti R, Parlato RS, De Paulis D, Cirillo M, Marrone V, Cirillo S, et al. Trigeminal neuralgia and persistent trigeminal artery. Neurol Sci 2012;33:1455-8.  Back to cited text no. 20
    
21.
Ladner TR, Ehtesham M, Davis BJ, Khan IS, Ghiassi M, Ghiassi M, et al. Resolution of trigeminal neuralgia by coil embolization of a persistent primitive trigeminal artery aneurysm. J Neurointerv Surg 2014;6:e22.  Back to cited text no. 21
    
22.
Ma X, Sun X, Yao J, Ni S, Gong J, Wang J, et al. Clinical analysis of trigeminal neuralgia caused by vertebrobasilar dolichoectasia. Neurosurg Rev 2013;36:573-7.  Back to cited text no. 22
    
23.
Ha SM, Kim SH, Yoo EH, Han IB, Shin DA, Cho KG, et al. Patients with idiopathic trigeminal neuralgia have a sharper-than-normal trigeminal-pontine angle and trigeminal nerve atrophy. Acta Neurochir (Wien) 2012;154:1627-33.  Back to cited text no. 23
    
24.
Parise M, Acioly MA, Ribeiro CT, Vincent M, Gasparetto EL. The role of the cerebellopontine angle cistern area and trigeminal nerve length in the pathogenesis of trigeminal neuralgia: A prospective case-control study. Acta Neurochir (Wien) 2013;155:863-8.  Back to cited text no. 24
    
25.
Rasche D, Kress B, Stippich C, Nennig E, Sartor K, Tronnier VM. Volumetric measurement of the pontomesencephalic cistern in patients with trigeminal neuralgia and healthy controls. Neurosurgery 2006;59:614-20.  Back to cited text no. 25
    
26.
Liu P, Zhong W, Liao C, Liu M, Zhang W. Narrow foramen ovale and rotundum: A role in the etiology of trigeminal neuralgia. J Craniofac Surg 2016;27:2168-70. [Epub ahead of print].  Back to cited text no. 26
    
27.
Marinkovic S, Gibo H, Todorovic V, Antic B, Kovacevic D, Milisavljevic M, et al. Ultrastructure and immunohistochemistry of the trigeminal peripheral myelinated axons in patients with neuralgia. Clin Neurol Neurosurg 2009;111:795-800.  Back to cited text no. 27
    
28.
Park SH, Hwang SK, Lee SH, Park J, Hwang JH, Hamm IS. Nerve atrophy and a small cerebellopontine angle cistern in patients with trigeminal neuralgia. J Neurosurg 2009;110:633-7.  Back to cited text no. 28
    
29.
Wang Y, Li D, Bao F, Guo C, Ma S, Zhang M. Microstructural abnormalities of the trigeminal nerve correlate with pain severity and concomitant emotional dysfunctions in idiopathic trigeminal neuralgia: A randomized, prospective, double-blind study. Magn Reson Imaging 2016;34:609-16.  Back to cited text no. 29
    
30.
Obermann M, Rodriguez-Raecke R, Naegel S, Holle D, Mueller D, Yoon MS, et al. Gray matter volume reduction reflects chronic pain in trigeminal neuralgia. Neuroimage 2013;74:352-8.  Back to cited text no. 30
    
31.
DeSouza DD, Hodaie M, Davis KD. Structural magnetic resonance imaging can identify trigeminal system abnormalities in classical trigeminal neuralgia. Front Neuroanat 2016;10:95.  Back to cited text no. 31
    
32.
Tian T, Guo L, Xu J, Zhang S, Shi J, Liu C, et al. Brain white matter plasticity and functional reorganization underlying the central pathogenesis of trigeminal neuralgia. Sci Rep 2016;6:36030.  Back to cited text no. 32
    
33.
Burchiel KJ, Slavin KV. On the natural history of trigeminal neuralgia. Neurosurgery 2000;46:152-4.  Back to cited text no. 33
    
34.
Miller JP, Acar F, Burchiel KJ. Classification of trigeminal neuralgia: Clinical, therapeutic, and prognostic implications in a series of 144 patients undergoing microvascular decompression. J Neurosurg 2009;111:1231-4.  Back to cited text no. 34
    
35.
Tallawy HN, Farghaly WM, Rageh TA, Shehata GA, Badry R, Metwally NA, et al. Door-to-door survey of major neurological disorders (project) in Al Quseir City, Red Sea Governorate, Egypt. Neuropsychiatr Dis Treat 2013;9:767-71.  Back to cited text no. 35
    
36.
Guclu B, Sindou M, Meyronet D, Streichenberger N, Simon E, Mertens P. Cranial nerve vascular compression syndromes of the trigeminal, facial and vago-glossopharyngeal nerves: Comparative anatomical study of the central myelin portion and transitional zone; correlations with incidences of corresponding hyperactive dysfunctional syndromes. Acta Neurochir (Wien) 2011;153:2365-75.  Back to cited text no. 36
    
37.
Mittal P, Mittal G. Painful tic convulsif syndrome due to vertebrobasilar dolichoectasia. J Neurosci Rural Pract 2011;2:71-3.  Back to cited text no. 37
[PUBMED]  [Full text]  
38.
Jia Y, Wenhua W, Quanbin Z. A single microvascular decompression surgery cures a patient with trigeminal neuralgia, hemifacial spasm, tinnitus, hypertension, and paroxysmal supraventricular tachycardia caused by the compression of a vertebral artery. Neurol India 2013;61:73-5.  Back to cited text no. 38
[PUBMED]  [Full text]  
39.
Oliveira CM, Baaklini LG, Issy AM, Sakata RK. Bilateral trigeminal neuralgia: Case report. Rev Bras Anestesiol 2009;59:476-80.  Back to cited text no. 39
    
40.
Bender MT, Pradilla G, James C, Raza S, Lim M, Carson BS. Surgical treatment of pediatric trigeminal neuralgia: Case series and review of the literature. Childs Nerv Syst 2011;27:2123-9.  Back to cited text no. 40
    
41.
Mikula I, Trkanjec Z, Negovetic R, Miskov S, Demarin V. Differences of blink-reflex abnormalities in patients suffering from idiopathic and symptomatic trigeminal neuralgia. Wien Klin Wochenschr 2005;117:417-22.  Back to cited text no. 41
    
42.
Flor H, Rasche D, Islamian AP, Rolko C, Yilmaz P, Ruppolt M, et al. Subtle sensory abnormalities detected by quantitative sensory testing in patients with trigeminal neuralgia. Pain Physician 2016;19:507-18.  Back to cited text no. 42
    
43.
Harsha KJ, Kesavadas C, Chinchure S, Thomas B, Jagtap S. Imaging of vascular causes of trigeminal neuralgia. J Neuroradiol 2012;39:281-9.  Back to cited text no. 43
    
44.
Antonini G, Di Pasquale A, Cruccu G, Truini A, Morino S, Saltelli G, et al. Magnetic resonance imaging contribution for diagnosing symptomatic neurovascular contact in classical trigeminal neuralgia: A blinded case-control study and meta-analysis. Pain 2014;155:1464-71.  Back to cited text no. 44
    
45.
Liu Y, Li J, Butzkueven H, Duan Y, Zhang M, Shu N, et al. Microstructural abnormalities in the trigeminal nerves of patients with trigeminal neuralgia revealed by multiple diffusion metrics. Eur J Radiol 2013;82:783-6.  Back to cited text no. 45
    
46.
Chen J, Guo ZY, Liang QZ, Liao HY, Su WR, Chen CX, et al. Structural abnormalities of trigeminal root with neurovascular compression revealed by high resolution diffusion tensor imaging. Asian Pac J Trop Med 2012;5:749-52.  Back to cited text no. 46
    
47.
Lutz J, Linn J, Mehrkens JH, Thon N, Stahl R, Seelos K, et al. Trigeminal neuralgia due to neurovascular compression: High-spatial-resolution diffusion-tensor imaging reveals microstructural neural changes. Radiology 2011;258:524-30.  Back to cited text no. 47
    
48.
Kanoto M, Hosoya T, Oda A, Honma T, Sugai Y. Focal deformity of the cranial nerves observed on multislice motion-sensitized driven equilibrium (MSDE) in patients with neurovascular compression. J Comput Assist Tomogr 2012;36:121-4.  Back to cited text no. 48
    
49.
Prieto R, Pascual JM, Yus M, Jorquera M. Trigeminal neuralgia: Assessment of neurovascular decompression by 3D fast imaging employing steady-state acquisition and 3D time of flight multiple overlapping thin slab acquisition magnetic resonance imaging. Surg Neurol Int 2012;3:50.  Back to cited text no. 49
[PUBMED]  [Full text]  
50.
Zeng Q, Zhou Q, Liu Z, Li C, Ni S, Xue F. Preoperative detection of the neurovascular relationship in trigeminal neuralgia using three-dimensional fast imaging employing steady-state acquisition (FIESTA) and magnetic resonance angiography (MRA). J Clin Neurosci 2013;20:107-11.  Back to cited text no. 50
    
51.
Zhou Q, Liu Z, Li C, Qu C, Ni S, Zeng Q. Preoperative evaluation of neurovascular relationship by using contrast-enhanced and unenhanced 3D time-of-flight MR angiography in patients with trigeminal neuralgia. Acta Radiol 2011;52:894-8.  Back to cited text no. 51
    
52.
Leal PR, Hermier M, Souza MA, Cristino-Filho G, Froment JC, Sindou M. Visualization of vascular compression of the trigeminal nerve with high-resolution 3T MRI: A prospective study comparing preoperative imaging analysis to surgical findings in 40 consecutive patients who underwent microvascular decompression for trigeminal neuralgia. Neurosurgery 2011;69:15-25.  Back to cited text no. 52
    
53.
Leal PR, Hermier M, Froment JC, Souza MA, Cristino-Filho G, Sindou M. Preoperative demonstration of the neurovascular compression characteristics with special emphasis on the degree of compression, using high-resolution magnetic resonance imaging: A prospective study, with comparison to surgical findings, in 100 consecutive patients who underwent microvascular decompression for trigeminal neuralgia. Acta Neurochir (Wien) 2010;152:817-25.  Back to cited text no. 53
    
54.
Anqi X, Ding L, Jiahe X, Zhenlin L, Chunchao X, Chao Y. MR cisternography in the posterior fossa: The evaluation of trigeminal neurovascular compression. Turk Neurosurg 2013;23:218-25.  Back to cited text no. 54
    
55.
Oishi M, Fukuda M, Noto Y, Kawaguchi T, Hiraishi T, Fujii Y. Trigeminal neuralgia associated with the specific bridging pattern of transverse pontine vein: Diagnostic value of three-dimensional multifusion volumetric imaging. Stereotact Funct Neurosurg 2011;89:226-33.  Back to cited text no. 55
    
56.
Guo ZY, Chen J, Yang G, Tang QY, Chen CX, Fu SX, et al. Characteristics of neurovascular compression in facial neuralgia patients by 3D high-resolution MRI and fusion technology. Asian Pac J Trop Med 2012;5:1000-3.  Back to cited text no. 56
    
57.
Chen J, Guo ZY, Yang G, Wang X, Tang QY, Cheng YQ, et al. Characterization of neurovascular compression in facial neuralgia patients by 3D high-resolution MRI and image fusion technique. Asian Pac J Trop Med 2012;5:476-9.  Back to cited text no. 57
    
58.
Granata F, Vinci SL, Longo M, Bernava G, Caffo M, Cutugno M, et al. Advanced virtual magnetic resonance imaging (MRI) techniques in neurovascular conflict: Bidimensional image fusion and virtual cisternography. Radiol Med 2013;118:1045-54.  Back to cited text no. 58
    
59.
Cha J, Kim ST, Kim HJ, Choi JW, Kim HJ, Jeon P, et al. Trigeminal neuralgia: Assessment with T2 VISTA and FLAIR VISTA fusion imaging. Eur Radiol 2011;21:2633-9.  Back to cited text no. 59
    
60.
Satoh T, Omi M, Nabeshima M, Onoda K, Date I. Severity analysis of neurovascular contact in patients with trigeminal neuralgia: Assessment with the inner view of the 3D MR cisternogram and angiogram fusion imaging. AJNR Am J Neuroradiol 2009;30:603-7.  Back to cited text no. 60
    
61.
Shimizu M, Imai H, Kagoshima K, Umezawa E, Shimizu T, Yoshimoto Y. Detection of compression vessels in trigeminal neuralgia by surface-rendering three-dimensional reconstruction of 1.5- and 3.0-T magnetic resonance imaging. World Neurosurg 2013;80:378-85.  Back to cited text no. 61
    
62.
Garcia M, Naraghi R, Zumbrunn T, Rösch J, Hastreiter P, Dörfler A. High-resolution 3D-constructive interference in steady-state MR imaging and 3D time-of-flight MR angiography in neurovascular compression: A comparison between 3T and 1.5T. AJNR Am J Neuroradiol 2012;33:1251-6.  Back to cited text no. 62
    
63.
Wang QP, Bai M. Topiramate versus carbamazepine for the treatment of classical trigeminal neuralgia: A meta-analysis. CNS Drugs 2011;25:847-57.  Back to cited text no. 63
    
64.
Shaikh S, Yaacob HB, Abd Rahman RB. Lamotrigine for trigeminal neuralgia: Efficacy and safety in comparison with carbamazepine. J Chin Med Assoc 2011;74:243-9.  Back to cited text no. 64
    
65.
Tate R, Rubin LM, Krajewski KC. Treatment of refractory trigeminal neuralgia with intravenous phenytoin. Am J Health Syst Pharm 2011;68:2059-61.  Back to cited text no. 65
    
66.
Ariyawardana A, Pallegama R, Sitheeque M, Ranasinghe A. Use of single- and multi-drug regimens in the management of classic (idiopathic) trigeminal neuralgia: An 11-year experience at a single Sri Lankan institution. J Investig Clin Dent 2012;3:98-102.  Back to cited text no. 66
    
67.
Zakrzewska JM, Coakham HB. Microvascular decompression for trigeminal neuralgia: Update. Curr Opin Neurol 2012;25:296-301.  Back to cited text no. 67
    
68.
Arai YC, Hatakeyama N, Nishihara M, Ikeuchi M, Kurisuno M, Ikemoto T. Intravenous lidocaine and magnesium for management of intractable trigeminal neuralgia: A case series of nine patients. J Anesth 2013;27:960-2.  Back to cited text no. 68
    
69.
Nalamachu S, Wieman M, Bednarek L, Chitra S. Influence of anatomic location of lidocaine patch 5% on effectiveness and tolerability for postherpetic neuralgia. Patient Prefer Adherence 2013;7:551-7.  Back to cited text no. 69
    
70.
Wagner T, Poole C, Roth-Daniek A. The capsaicin 8% patch for neuropathic pain in clinical practice: A retrospective analysis. Pain Med 2013;14:1202-11.  Back to cited text no. 70
    
71.
Macianskyte D, Janužis G, Kubilius R, Adomaitiene V, Š ciupokas A. Associations between chronic pain and depressive symptoms in patients with trigeminal neuralgia. Medicina (Kaunas) 2011;47:386-92.  Back to cited text no. 71
    
72.
Anand KS, Dhikav V, Prasad A, Shewtengna. Efficacy, safety and tolerability of duloxetine in idiopathic trigeminal neuralgia. J Indian Med Assoc 2011;109:264-6.  Back to cited text no. 72
    
73.
Wu CJ, Lian YJ, Zheng YK, Zhang HF, Chen Y, Xie NC, et al. Botulinum toxin type A for the treatment of trigeminal neuralgia: Results from a randomized, double-blind, placebo-controlled trial. Cephalalgia 2012;32:443-50.  Back to cited text no. 73
    
74.
Shiiba S, Tanaka T, Sakamoto E, Oda M, Kito S, Ono K, et al. Can the neurovascular compression volume of the trigeminal nerve on magnetic resonance cisternography predict the success of local anesthetic block after initial treatment by the carbamazepine? Oral Surg Oral Med Oral Pathol Oral Radiol 2014;117:e15-21.  Back to cited text no. 74
    
75.
Liu H, Li H, Xu M, Chung KF, Zhang SP. A systematic review on acupuncture for trigeminal neuralgia. Altern Ther Health Med 2010;16:30-5.  Back to cited text no. 75
    
76.
Stidd DA, Wuollet AL, Bowden K, Price T, Patwardhan A, Barker S, et al. Peripheral nerve stimulation for trigeminal neuropathic pain. Pain Physician 2012;15:27-33.  Back to cited text no. 76
    
77.
Cordella R, Franzini A, La Mantia L, Marras C, Erbetta A, Broggi G. Hypothalamic stimulation for trigeminal neuralgia in multiple sclerosis patients: Efficacy on the paroxysmal ophthalmic pain. Mult Scler 2009;15:1322-8.  Back to cited text no. 77
    
78.
Franzini A, Messina G, Cordella R, Marras C, Broggi G. Deep brain stimulation of the posteromedial hypothalamus: Indications, long-term results, and neurophysiological considerations. Neurosurg Focus 2010;29:E13.  Back to cited text no. 78
    
79.
Raslan AM, Nasseri M, Bahgat D, Abdu E, Burchiel KJ. Motor cortex stimulation for trigeminal neuropathic or deafferentation pain: An institutional case series experience. Stereotact Funct Neurosurg 2011;89:83-8.  Back to cited text no. 79
    
80.
Gnanalingham K, Joshi SM, Lopez B, Ellamushi H, Hamlyn P. Trigeminal neuralgia secondary to Chiari's malformation – Treatment with ventriculoperitoneal shunt. Surg Neurol 2005;63:586-8.  Back to cited text no. 80
    
81.
Gorgulho A. Radiation mechanisms of pain control in classical trigeminal neuralgia. Surg Neurol Int 2012;3 Suppl 1:S17-25.  Back to cited text no. 81
    
82.
Hodaie M, Chen DQ, Quan J, Laperriere N. Tractography delineates microstructural changes in the trigeminal nerve after focal radiosurgery for trigeminal neuralgia. PLoS One 2012;7:e32745.  Back to cited text no. 82
    
83.
Brisman R. Constant face pain in typical trigeminal neuralgia and response to γ knife radiosurgery. Stereotact Funct Neurosurg 2013;91:122-8.  Back to cited text no. 83
    
84.
Sheehan JP, Ray DK, Monteith S, Yen CP, Lesnick J, Kersh R, et al. Gamma knife radiosurgery for trigeminal neuralgia: The impact of magnetic resonance imaging-detected vascular impingement of the affected nerve. J Neurosurg 2010;113:53-8.  Back to cited text no. 84
    
85.
Park KJ, Kondziolka D, Berkowitz O, Kano H, Novotny J Jr, Niranjan A, et al. Repeat gamma knife radiosurgery for trigeminal neuralgia. Neurosurgery 2012;70:295-305.  Back to cited text no. 85
    
86.
Dhople AA, Adams JR, Maggio WW, Naqvi SA, Regine WF, Kwok Y. Long-term outcomes of gamma knife radiosurgery for classic trigeminal neuralgia: Implications of treatment and critical review of the literature. Clinical article. J Neurosurg 2009;111:351-8.  Back to cited text no. 86
    
87.
Elaimy AL, Hanson PW, Lamoreaux WT, Mackay AR, Demakas JJ, Fairbanks RK, et al. Clinical outcomes of gamma knife radiosurgery in the treatment of patients with trigeminal neuralgia. Int J Otolaryngol 2012;2012:919186.  Back to cited text no. 87
    
88.
Kano H, Kondziolka D, Yang HC, Zorro O, Lobato-Polo J, Flannery TJ, et al. Outcome predictors after gamma knife radiosurgery for recurrent trigeminal neuralgia. Neurosurgery 2010;67:1637-44.  Back to cited text no. 88
    
89.
Li P, Wang W, Liu Y, Zhong Q, Mao B. Clinical outcomes of 114 patients who underwent γ-knife radiosurgery for medically refractory idiopathic trigeminal neuralgia. J Clin Neurosci 2012;19:71-4.  Back to cited text no. 89
    
90.
Matsuda S, Serizawa T, Nagano O, Ono J. Comparison of the results of 2 targeting methods in gamma knife surgery for trigeminal neuralgia. J Neurosurg 2008;109 Suppl:185-9.  Back to cited text no. 90
    
91.
Park SH, Hwang SK, Kang DH, Park J, Hwang JH, Sung JK. The retrogasserian zone versus dorsal root entry zone: Comparison of two targeting techniques of gamma knife radiosurgery for trigeminal neuralgia. Acta Neurochir (Wien) 2010;152:1165-70.  Back to cited text no. 91
    
92.
Kim YH, Kim DG, Kim JW, Kim YH, Han JH, Chung HT, et al. Is it effective to raise the irradiation dose from 80 to 85 Gy in gamma knife radiosurgery for trigeminal neuralgia? Stereotact Funct Neurosurg 2010;88:169-76.  Back to cited text no. 92
    
93.
Young B, Shivazad A, Kryscio RJ, St Clair W, Bush HM. Long-term outcome of high-dose γ knife surgery in treatment of trigeminal neuralgia. J Neurosurg 2013;119:1166-75.  Back to cited text no. 93
    
94.
Fraioli MF, Strigari L, Fraioli C, Lecce M, Lisciani D. Preliminary results of 45 patients with trigeminal neuralgia treated with radiosurgery compared to hypofractionated stereotactic radiotherapy, using a dedicated linear accelerator. J Clin Neurosci 2012;19:1401-3.  Back to cited text no. 94
    
95.
Latorzeff I, Debono B, Sol JC, Ménégalli D, Mertens P, Redon A, et al. Treatment of trigeminal neuralgia with radiosurgery. Cancer Radiother 2012;16 Suppl: S57-69.  Back to cited text no. 95
    
96.
Attia A, Tatter SB, Weller M, Marshall K, Lovato JF, Bourland JD, et al. CT-only planning for gamma knife radiosurgery in the treatment of trigeminal neuralgia: Methodology and outcomes from a single institution. J Med Imaging Radiat Oncol 2012;56:490-4.  Back to cited text no. 96
    
97.
Tuleasca C, Carron R, Resseguier N, Donnet A, Roussel P, Gaudart J, et al. Patterns of pain-free response in 497 cases of classic trigeminal neuralgia treated with gamma knife surgery and followed up for least 1 year. J Neurosurg 2012;117 Suppl:181-8.  Back to cited text no. 97
    
98.
Lee JK, Kim DR, Huh YH, Kim JK, Namgung WC, Hong SH. Long-term outcome of gamma knife surgery using a retrogasserian petrous bone target for classic trigeminal neuralgia. Acta Neurochir Suppl 2013;116:127-35.  Back to cited text no. 98
    
99.
Lee JK, Choi HJ, Ko HC, Choi SK, Lim YJ. Long term outcomes of gamma knife radiosurgery for typical trigeminal neuralgia-minimum 5-year follow-up. J Korean Neurosurg Soc 2012;51:276-80.  Back to cited text no. 99
    
100.
Tang X, Wang Y, Shu Z, Hou Y. Efficacy and prognosis of trigeminal neuralgia treated with surgical excision or gamma knife surgery. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2012;37:616-20.  Back to cited text no. 100
    
101.
Dos Santos MA, Pérez de Salcedo JB, Gutiérrez Diaz JA, Nagore G, Calvo FA, Samblás J, et al. Outcome for patients with essential trigeminal neuralgia treated with linear accelerator stereotactic radiosurgery. Stereotact Funct Neurosurg 2011;89:220-5.  Back to cited text no. 101
    
102.
Riesenburger RI, Hwang SW, Schirmer CM, Zerris V, Wu JK, Mahn K, et al. Outcomes following single-treatment gamma knife surgery for trigeminal neuralgia with a minimum 3-year follow-up. J Neurosurg 2010;112:766-71.  Back to cited text no. 102
    
103.
Park KJ, Kondziolka D, Kano H, Berkowitz O, Ahmed SF, Liu X, et al. Outcomes of gamma knife surgery for trigeminal neuralgia secondary to vertebrobasilar ectasia. J Neurosurg 2012;116:73-81.  Back to cited text no. 103
    
104.
Henson CF, Goldman HW, Rosenwasser RH, Downes MB, Bednarz G, Pequignot EC, et al. Glycerol rhizotomy versus gamma knife radiosurgery for the treatment of trigeminal neuralgia: An analysis of patients treated at one institution. Int J Radiat Oncol Biol Phys 2005;63:82-90.  Back to cited text no. 104
    
105.
Sanchez-Mejia RO, Limbo M, Cheng JS, Camara J, Ward MM, Barbaro NM. Recurrent or refractory trigeminal neuralgia after microvascular decompression, radiofrequency ablation, or radiosurgery. Neurosurg Focus 2005;18:e12.  Back to cited text no. 105
    
106.
Loescher AR, Radatz M, Kemeny A, Rowe J. Stereotactic radiosurgery for trigeminal neuralgia: Outcomes and complications. Br J Neurosurg 2012;26:45-52.  Back to cited text no. 106
    
107.
Marshall K, Chan MD, McCoy TP, Aubuchon AC, Bourland JD, McMullen KP, et al. Predictive variables for the successful treatment of trigeminal neuralgia with gamma knife radiosurgery. Neurosurgery 2012;70:566-72.  Back to cited text no. 107
    
108.
Park YS, Kim JP, Chang WS, Kim HY, Park YG, Chang JW. Gamma knife radiosurgery for idiopathic trigeminal neuralgia as primary vs. secondary treatment option. Clin Neurol Neurosurg 2011;113:447-52.  Back to cited text no. 108
    
109.
Lallemand F, Janvary ZL, Jansen N, Coucke P. Cyberknife and benign pathologies. Rev Med Liege 2011;66:568-74.  Back to cited text no. 109
    
110.
Sudahar H, Kurup PG, Murali V, Velmurugan J. Dosimetric analysis of trigeminal nerve, brain stem doses in CyberKnife radiosurgery of trigeminal neuralgia. J Med Phys 2012;37:124-8.  Back to cited text no. 110
[PUBMED]  [Full text]  
111.
Lazzara BM, Ortiz O, Bordia R, Witten MR, Haas JA, Katz AJ, et al. Cyberknife radiosurgery in treating trigeminal neuralgia. J Neurointerv Surg 2013;5:81-5.  Back to cited text no. 111
    
112.
Soboleva OI, Golanov AV, Gorlachev GE, Galkin MV, Kadasheva AB, Antipina NA, et al. CyberKnife stereotactic radiosurgery in the treatment of patients with trigeminal neuralgia. Zh Vopr Neirokhir Im N N Burdenko 2012;76:79-83.  Back to cited text no. 112
    
113.
Chen MJ, Shao ZY, Zhang WJ, Wang ZH, Zhang WH, Hu HS. X-knife stereotactic radiosurgery on the trigeminal ganglion to treat trigeminal neuralgia: A preliminary study. Minim Invasive Neurosurg 2010;53:223-8.  Back to cited text no. 113
    
114.
Brown JA. Percutaneous balloon compression for trigeminal neuralgia. Clin Neurosurg 2009;56:73-8.  Back to cited text no. 114
    
115.
Revuelta-Gutierrez R, Martinez-Anda JJ, Coll JB, Campos-Romo A, Perez-Peña N. Efficacy and safety of root compression of trigeminal nerve for trigeminal neuralgia without evidence of vascular compression. World Neurosurg 2013;80:385-9.  Back to cited text no. 115
    
116.
Chen JF, Tu PH, Lee ST. Repeated percutaneous balloon compression for recurrent trigeminal neuralgia: A long-term study. World Neurosurg 2012;77:352-6.  Back to cited text no. 116
    
117.
Kouzounias K, Lind G, Schechtmann G, Winter J, Linderoth B. Comparison of percutaneous balloon compression and glycerol rhizotomy for the treatment of trigeminal neuralgia. J Neurosurg 2010;113:486-92.  Back to cited text no. 117
    
118.
Van Gompel JJ, Kallmes DF, Morris JM, Fode-Thomas NC, Atkinson JL. Dyna-CT as an imaging adjunct to routine percutaneous balloon compression for trigeminal neuralgia. Stereotact Funct Neurosurg 2009;87:330-3.  Back to cited text no. 118
    
119.
Chen JF, Tu PH, Lee ST. Long-term follow-up of patients treated with percutaneous balloon compression for trigeminal neuralgia in Taiwan. World Neurosurg 2011;76:586-91.  Back to cited text no. 119
    
120.
Montano N, Papacci F, Cioni B, Di Bonaventura R, Meglio M. Percutaneous balloon compression for the treatment of trigeminal neuralgia in patients with multiple sclerosis. Analysis of the potentially prognostic factors. Acta Neurochir (Wien) 2012;154:779-83.  Back to cited text no. 120
    
121.
Asplund P, Linderoth B, Bergenheim AT. The predictive power of balloon shape and change of sensory functions on outcome of percutaneous balloon compression for trigeminal neuralgia. J Neurosurg 2010;113:498-507.  Back to cited text no. 121
    
122.
Skirving DJ, Dan NG. A 20-year review of percutaneous balloon compression of the trigeminal ganglion. J Neurosurg 2001;94:913-7.  Back to cited text no. 122
    
123.
Trojnik T, Smigoc T. Percutaneous trigeminal ganglion balloon compression rhizotomy: Experience in 27 patients. ScientificWorldJournal 2012;2012:328936.  Back to cited text no. 123
    
124.
Chroni E, Constantoyannis C, Prasoulis I, Kargiotis O, Kagadis GC, Georgiopoulos M, et al. Masseter muscle function after percutaneous balloon compression of trigeminal ganglion for the treatment of trigeminal neuralgia: A neurophysiological follow-up study. Clin Neurophysiol 2011;122:410-3.  Back to cited text no. 124
    
125.
Bergenheim AT, Asplund P, Linderoth B. Percutaneous retrogasserian balloon compression for trigeminal neuralgia: Review of critical technical details and outcomes. World Neurosurg 2013;79:359-68.  Back to cited text no. 125
    
126.
Xu-Hui W, Chun Z, Guang-Jian S, Min-Hui X, Guang-Xin C, Yong-Wen Z, et al. Long-term outcomes of percutaneous retrogasserian glycerol rhizotomy in 3370 patients with trigeminal neuralgia. Turk Neurosurg 2011;21:48-52.  Back to cited text no. 126
    
127.
Chen L, Xu M, Zou Y. Treatment of trigeminal neuralgia with percutaneous glycerol injection into Meckel's cavity: Experience in 4012 patients. Cell Biochem Biophys 2010;58:85-9.  Back to cited text no. 127
    
128.
Fransen P. Cost-effectiveness in the surgical treatments for trigeminal neuralgia. Acta Neurol Belg 2012;112:245-7.  Back to cited text no. 128
    
129.
Bender M, Pradilla G, Batra S, See A, Bhutiani N, James C, et al. Effectiveness of repeat glycerol rhizotomy in treating recurrent trigeminal neuralgia. Neurosurgery 2012;70:1125-33.  Back to cited text no. 129
    
130.
Bozkurt M, Al-Beyati ES, Ozdemir M, Kahilogullari G, Elhan AH, Savas A, et al. Management of bilateral trigeminal neuralgia with trigeminal radiofrequency rhizotomy: A treatment strategy for the life-long disease. Acta Neurochir (Wien) 2012;154:785-91.  Back to cited text no. 130
    
131.
Ishii A, Kubota Y, Okamoto S, Matsuoka G, Yato S, Hori T, et al. Electrical neurocoagulation may be effective for intractable trigeminal neuralgia caused by vertebrobasilar dolichoectasia. Neurosurg Rev 2013;36:657-60.  Back to cited text no. 131
    
132.
Weng Z, Halawa MA, Liu X, Zhou X, Yao S. Analgesic effects of preoperative peripheral nerve block in patients with trigeminal neuralgia undergoing radiofrequency thermocoagulation of gasserian ganglion. J Craniofac Surg 2013;24:479-82.  Back to cited text no. 132
    
133.
Hart MG, Nowell M, Coakham HB. Radiofrequency thermocoagulation for trigeminal neuralgia without intra-operative patient waking. Br J Neurosurg 2012;26:392-6.  Back to cited text no. 133
    
134.
Fang L, Ying S, Tao W, Lan M, Xiaotong Y, Nan J. 3D CT-guided pulsed radiofrequency treatment for trigeminal neuralgia. Pain Pract 2014;14:16-21.  Back to cited text no. 134
    
135.
Luo F, Meng L, Wang T, Yu X, Shen Y, Ji N. Pulsed radiofrequency treatment for idiopathic trigeminal neuralgia: A retrospective analysis of the causes for ineffective pain relief. Eur J Pain 2013;17:1189-92.  Back to cited text no. 135
    
136.
Li X, Ni J, Yang L, Wu B, He M, Zhang X, et al. A prospective study of gasserian ganglion pulsed radiofrequency combined with continuous radiofrequency for the treatment of trigeminal neuralgia. J Clin Neurosci 2012;19:824-8.  Back to cited text no. 136
    
137.
Yao P, Hong T, Zhu YQ, Li HX, Wang ZB, Ding YY, et al. Efficacy and safety of continuous radiofrequency thermocoagulation plus pulsed radiofrequency for treatment of V1 trigeminal neuralgia: A prospective cohort study. Medicine (Baltimore) 2016;95:e5247.  Back to cited text no. 137
    
138.
Ali FM, Prasant M, Pai D, Aher VA, Kar S, Safiya T. Peripheral neurectomies: A treatment option for trigeminal neuralgia in rural practice. J Neurosci Rural Pract 2012;3:152-7.  Back to cited text no. 138
[PUBMED]  [Full text]  
139.
Zhu S, Rong Q, Chen S, Li X. Pterygopalatine fossa segment neurectomy of maxillary nerve through maxillary sinus route in treating trigeminal neuralgia. J Craniomaxillofac Surg 2013;41:652-6.  Back to cited text no. 139
    
140.
Abhinav K, Love S, Kalantzis G, Coakham HB, Patel NK. Clinicopathological review of patients with and without multiple sclerosis treated by partial sensory rhizotomy for medically refractory trigeminal neuralgia: A 12-year retrospective study. Clin Neurol Neurosurg 2012;114:361-5.  Back to cited text no. 140
    
141.
Helbig GM, Callahan JD, Cohen-Gadol AA. Variant intraneural vein-trigeminal nerve relationships: An observation during microvascular decompression surgery for trigeminal neuralgia. Neurosurgery 2009;65:958-61.  Back to cited text no. 141
    
142.
Fernández-Carballal C, García-Salazar F, Pérez-Calvo J, García-Leal R, Gutiérrez FA, Carrillo R. Management of recurrent trigeminal neuralgia after failed microvascular decompression. Neurocirugia (Astur) 2004;15:345-52.  Back to cited text no. 142
    
143.
Kang IH, Park BJ, Park CK, Malla HP, Lee SH, Rhee BA. A clinical analysis of secondary surgery in trigeminal neuralgia patients who failed prior treatment. J Korean Neurosurg Soc 2016;59:637-42.  Back to cited text no. 143
    
144.
Young JN, Wilkins RH. Partial sensory trigeminal rhizotomy at the pons for trigeminal neuralgia. J Neurosurg 1993;79:680-7.  Back to cited text no. 144
    
145.
Sandell T, Eide PK. Effect of microvascular decompression in trigeminal neuralgia patients with or without constant pain. Neurosurgery 2008;63:93-9.  Back to cited text no. 145
    
146.
Zacest AC, Magill ST, Miller J, Burchiel KJ. Preoperative magnetic resonance imaging in type 2 trigeminal neuralgia. J Neurosurg 2010;113:511-5.  Back to cited text no. 146
    
147.
Han-Bing S, Wei-Guo Z, Jun Z, Ning L, Jian-Kang S, Yu C. Predicting the outcome of microvascular decompression for trigeminal neuralgia using magnetic resonance tomographic angiography. J Neuroimaging 2010;20:345-9.  Back to cited text no. 147
    
148.
Sandell T, Eide PK. The effect of microvascular decompression in patients with multiple sclerosis and trigeminal neuralgia. Neurosurgery 2010;67:749-53.  Back to cited text no. 148
    
149.
Sekula RF, Frederickson AM, Jannetta PJ, Bhatia S, Quigley MR, Abdel Aziz KM. Microvascular decompression in patients with isolated maxillary division trigeminal neuralgia, with particular attention to venous pathology. Neurosurg Focus 2009;27:E10.  Back to cited text no. 149
    
150.
Yang XS, Li ST, Zhong J, Zhu J, Du Q, Zhou QM, et al. Microvascular decompression on patients with trigeminal neuralgia caused by ectatic vertebrobasilar artery complex: Technique notes. Acta Neurochir (Wien) 2012;154:793-7.  Back to cited text no. 150
    
151.
Chen JC. Microvascular decompression for trigeminal neuralgia in patients with and without prior stereotactic radiosurgery. World Neurosurg 2012;78:149-54.  Back to cited text no. 151
    
152.
Sekula RF Jr., Frederickson AM, Jannetta PJ, Quigley MR, Aziz KM, Arnone GD. Microvascular decompression for elderly patients with trigeminal neuralgia: A prospective study and systematic review with meta-analysis. J Neurosurg 2011;114:172-9.  Back to cited text no. 152
    
153.
Rughani AI, Dumont TM, Lin CT, Tranmer BI, Horgan MA. Safety of microvascular decompression for trigeminal neuralgia in the elderly. Clinical article. J Neurosurg 2011;115:202-9.  Back to cited text no. 153
    
154.
Ferroli P, Acerbi F, Tomei M, Tringali G, Franzini A, Broggi G. Advanced age as a contraindication to microvascular decompression for drug-resistant trigeminal neuralgia: Evidence of prejudice? Neurol Sci 2010;31:23-8.  Back to cited text no. 154
    
155.
Takao T, Oishi M, Fukuda M, Ishida G, Sato M, Fujii Y. Three-dimensional visualization of neurovascular compression: Presurgical use of virtual endoscopy created from magnetic resonance imaging. Neurosurgery 2008;63 1 Suppl 1:ONS139-45.  Back to cited text no. 155
    
156.
Oishi M, Fukuda M, Hiraishi T, Yajima N, Sato Y, Fujii Y. Interactive virtual simulation using a 3D computer graphics model for microvascular decompression surgery. J Neurosurg 2012;117:555-65.  Back to cited text no. 156
    
157.
Du ZY, Gao X, Zhang XL, Wang ZQ, Tang WJ. Preoperative evaluation of neurovascular relationships for microvascular decompression in the cerebellopontine angle in a virtual reality environment. J Neurosurg 2010;113:479-85.  Back to cited text no. 157
    
158.
von Eckardstein KL, Mielke D, Akhavan-Sigari R, Rohde V. Enlightening the cerebellopontine angle: Intraoperative indocyanine green angiography in microvascular decompression for trigeminal neuralgia. J Neurol Surg A Cent Eur Neurosurg 2017;78:161-6. [Epub ahead of print].  Back to cited text no. 158
    
159.
Zhong J, Li ST, Zhu J, Guan HX, Zhou QM, Jiao W, et al. A clinical analysis on microvascular decompression surgery in a series of 3000 cases. Clin Neurol Neurosurg 2012;114:846-51.  Back to cited text no. 159
    
160.
Hong W, Zheng X, Wu Z, Li X, Wang X, Li Y, et al. Clinical features and surgical treatment of trigeminal neuralgia caused solely by venous compression. Acta Neurochir (Wien) 2011;153:1037-42.  Back to cited text no. 160
    
161.
Dumot C, Sindou M. Trigeminal neuralgia due to neurovascular conflicts from venous origin: An anatomical-surgical study (consecutive series of 124 operated cases). Acta Neurochir (Wien) 2015;157:455-66.  Back to cited text no. 161
    
162.
Choudhari KA. Quadruple vessel involvement at root entry zone in trigeminal neuralgia. Clin Neurol Neurosurg 2007;109:203-5.  Back to cited text no. 162
    
163.
Zheng X, Feng B, Hong W, Zhang W, Yang M, Tang Y, et al. Management of intraneural vessels during microvascular decompression surgery for trigeminal neuralgia. World Neurosurg 2012;77:771-4.  Back to cited text no. 163
    
164.
Oiwa Y, Hirohata Y, Okumura H, Yamaga H, Takayama M, Terui K, et al. Bone drilling in microvascular decompression for trigeminal neuralgia: High morphological variety of the petrous bone. No Shinkei Geka 2013;41:601-7.  Back to cited text no. 164
    
165.
Fujimaki T, Kirino T. Combined transhorizontal-supracerebellar approach for microvascular decompression of trigeminal neuralgia. Br J Neurosurg 2000;14:531-4.  Back to cited text no. 165
    
166.
Bond AE, Zada G, Gonzalez AA, Hansen C, Giannotta SL. Operative strategies for minimizing hearing loss and other major complications associated with microvascular decompression for trigeminal neuralgia. World Neurosurg 2010;74:172-7.  Back to cited text no. 166
    
167.
Jagannath PM, Venkataramana NK, Bansal A, Ravichandra M. Outcome of microvascular decompression for trigeminal neuralgia using autologous muscle graft: A five-year prospective study. Asian J Neurosurg 2012;7:125-30.  Back to cited text no. 167
[PUBMED]  [Full text]  
168.
Broggi G, Broggi M, Ferroli P, Franzini A. Surgical technique for trigeminal microvascular decompression. Acta Neurochir (Wien) 2012;154:1089-95.  Back to cited text no. 168
    
169.
Ryu H, Yamamoto S. A simple technique for neurovascular decompression of the cranial nerves. Br J Neurosurg 2000;14:132-4.  Back to cited text no. 169
    
170.
Matsushima T, Yamaguchi T, Inoue TK, Matsukado K, Fukui M. Recurrent trigeminal neuralgia after microvascular decompression using an interposing technique. Teflon felt adhesion and the sling retraction technique. Acta Neurochir (Wien) 2000;142:557-61.  Back to cited text no. 170
    
171.
Masuoka J, Matsushima T, Kawashima M, Nakahara Y, Funaki T, Mineta T. Stitched sling retraction technique for microvascular decompression: Procedures and techniques based on an anatomical viewpoint. Neurosurg Rev 2011;34:373-9.  Back to cited text no. 171
    
172.
Shigeno T, Kumai J, Endo M, Oya S, Hotta S. Snare technique of vascular transposition for microvascular decompression – Technical note. Neurol Med Chir (Tokyo) 2002;42:184-9.  Back to cited text no. 172
    
173.
Komatsu F, Imai M, Hirayama A, Hotta K, Hayashi N, Oda S, et al. Endoscopic microvascular decompression with transposition for trigeminal neuralgia and hemifacial spasm: Technical note. J Neurol Surg A Cent Eur Neurosurg 2016. [Epub ahead of print].  Back to cited text no. 173
    
174.
Meybodi AT, Habibi Z, Miri M, Tabatabaie SA. Microvascular decompression for trigeminal neuralgia using the 'stitched sling retraction' technique in recurrent cases after previous microvascular decompression. Acta Neurochir (Wien) 2014;156:1181-7.  Back to cited text no. 174
    
175.
Lin CF, Chen HH, Hernesniemi J, Lee CC, Liao CH, Chen SC, et al. An easy adjustable method of ectatic vertebrobasilar artery transposition for microvascular decompression. Clin Neurol Neurosurg 2012;114:951-6.  Back to cited text no. 175
    
176.
Attabib N, Kaufmann AM. Use of fenestrated aneurysm clips in microvascular decompression surgery. Technical note and case series. J Neurosurg 2007;106:929-31.  Back to cited text no. 176
    
177.
Ohta M, Komatsu F, Abe H, Sakamoto S, Tsugu H, Oshiro S, et al. Complication caused by use of fibrin glue in vessel transposition for trigeminal neuralgia. Neurol Med Chir (Tokyo) 2008;48:30-2.  Back to cited text no. 177
    
178.
Sindou M, Leston JM, Decullier E, Chapuis F. Microvascular decompression for trigeminal neuralgia: The importance of a noncompressive technique – Kaplan-Meier analysis in a consecutive series of 330 patients. Neurosurgery 2008;63 4 Suppl 2:341-50.  Back to cited text no. 178
    
179.
Skrap M, Tuniz F. Use of the arachnoid membrane of the cerebellopontine angle to transpose the superior cerebellar artery in microvascular decompression for trigeminal neuralgia: Technical note. Neurosurgery 2010;66 (3 Suppl Operative):88-91.  Back to cited text no. 179
    
180.
Jie H, Xuanchen Z, Deheng L, Kun G, Fengyang X, Xiang C, et al. The long-term outcome of nerve combing for trigeminal neuralgia. Acta Neurochir (Wien) 2013;155:1703-8.  Back to cited text no. 180
    
181.
Zhao H, Zhang X, Tang D, Li S. Nerve combing for trigeminal neuralgia without vascular compression. J Craniofac Surg 2017;28:e15-6.  Back to cited text no. 181
    
182.
Zhang L, Zhang Y, Li C, Zhu S. Surgical treatment of primary trigeminal neuralgia: Comparison of the effectiveness between MVD and MVD PSR in a series of 210 patients. Turk Neurosurg 2012;22:32-8.  Back to cited text no. 182
    
183.
Park JS, Kong DS, Lee JA, Park K. Intraoperative management to prevent cerebrospinal fluid leakage after microvascular decompression: Dural closure with a “plugging muscle” method. Neurosurg Rev 2007;30:139-42.  Back to cited text no. 183
    
184.
Li N, Zhao WG, Pu CH, Shen JK. Clinical application of artificial dura mater to avoid cerebrospinal fluid leaks after microvascular decompression surgery. Minim Invasive Neurosurg 2005;48:369-72.  Back to cited text no. 184
    
185.
Tanrikulu L, Buchfelder M, Naraghi R. Fleece-bound tissue sealing in microvascular decompression. Turk Neurosurg 2016. doi: 10.5137/1019-5149.JTN.17462-16.2. [Epub ahead of print].  Back to cited text no. 185
    
186.
Baliazin VA, Baliazina EV. Methods of reducing the number of complications and relapses after microvascular decompression in patients with trigeminal neuralgia. Zh Vopr Neirokhir Im N N Burdenko 2003;2:6-9.  Back to cited text no. 186
    
187.
Zhang H, Lei D, You C, Mao BY, Wu B, Fang Y. The long-term outcome predictors of pure microvascular decompression for primary trigeminal neuralgia. World Neurosurg 2013;79:756-62.  Back to cited text no. 187
    
188.
Jo KW, Kong DS, Hong KS, Lee JA, Park K. Long-term prognostic factors for microvascular decompression for trigeminal neuralgia. J Clin Neurosci 2013;20:440-5.  Back to cited text no. 188
    
189.
Shibahashi K, Morita A, Kimura T. Surgical results of microvascular decompression procedures and patient's postoperative quality of life: Review of 139 cases. Neurol Med Chir (Tokyo) 2013;53:360-4.  Back to cited text no. 189
    
190.
Zhong J, Zhu J, Sun H, Dou NN, Wang YN, Ying TT, et al. Microvascular decompression surgery: Surgical principles and technical nuances based on 4000 cases. Neurol Res 2014;36:882-93.  Back to cited text no. 190
    
191.
Linskey ME, Ratanatharathorn V, Peñagaricano J. A prospective cohort study of microvascular decompression and Gamma Knife surgery in patients with trigeminal neuralgia. J Neurosurg 2008;109 Suppl:160-72.  Back to cited text no. 191
    
192.
Christiano LD, Singh R, Sukul V, Prestigiacomo CJ, Gandhi CD. Microvascular decompression for trigeminal neuralgia: Visualization of results in a 3D stereoscopic virtual reality environment. Minim Invasive Neurosurg 2011;54:12-5.  Back to cited text no. 192
    
193.
Oesman C, Mooij JJ. Long-term follow-up of microvascular decompression for trigeminal neuralgia. Skull Base 2011;21:313-22.  Back to cited text no. 193
    
194.
Degn J, Brennum J. Surgical treatment of trigeminal neuralgia. Results from the use of glycerol injection, microvascular decompression, and rhizotomia. Acta Neurochir (Wien) 2010;152:2125-32.  Back to cited text no. 194
    
195.
Simms HN, Honey CR. The importance of autonomic symptoms in trigeminal neuralgia. Clinical article. J Neurosurg 2011;115:210-6.  Back to cited text no. 195
    
196.
Broggi G, Ferroli P, Franzini A, Nazzi V, Farina L, La Mantia L, et al. Operative findings and outcomes of microvascular decompression for trigeminal neuralgia in 35 patients affected by multiple sclerosis. Neurosurgery 2004;55:830-8.  Back to cited text no. 196
    
197.
Sarsam Z, Garcia-Fiñana M, Nurmikko TJ, Varma TR, Eldridge P. The long-term outcome of microvascular decompression for trigeminal neuralgia. Br J Neurosurg 2010;24:18-25.  Back to cited text no. 197
    
198.
Herweh C, Kress B, Rasche D, Tronnier V, Tröger J, Sartor K, et al. Loss of anisotropy in trigeminal neuralgia revealed by diffusion tensor imaging. Neurology 2007;68:776-8.  Back to cited text no. 198
    
199.
Chen F, Chen L, Li W, Li L, Xu X, Li W, et al. Pre-operative declining proportion of fractional anisotropy of trigeminal nerve is correlated with the outcome of micro-vascular decompression surgery. BMC Neurol 2016;16:106.  Back to cited text no. 199
    
200.
Thirumala P, Meigh K, Dasyam N, Shankar P, Sarma KR, Sarma DR, et al. The incidence of high-frequency hearing loss after microvascular decompression for trigeminal neuralgia, glossopharyngeal neuralgia, or geniculate neuralgia. J Neurosurg 2015;123:1500-6.  Back to cited text no. 200
    
201.
Lee CC, Liao CH, Lin CF, Yang TF, Hsu SP, Yen YS, et al. Brainstem auditory evoked potential monitoring and neuro-endoscopy: Two tools to ensure hearing preservation and surgical success during microvascular decompression. J Chin Med Assoc 2014;77:308-16.  Back to cited text no. 201
    
202.
Olson S, Atkinson L, Weidmann M. Microvascular decompression for trigeminal neuralgia: Recurrences and complications. J Clin Neurosci 2005;12:787-9.  Back to cited text no. 202
    
203.
Theodosopoulos PV, Marco E, Applebury C, Lamborn KR, Wilson CB. Predictive model for pain recurrence after posterior fossa surgery for trigeminal neuralgia. Arch Neurol 2002;59:1297-302.  Back to cited text no. 203
    
204.
Inoue H, Kondo A, Shimano H, Yasuda S. Recurrent trigeminal neuralgia at 20 years after surgery: Case report. Neurol Med Chir (Tokyo) 2013;53:37-9.  Back to cited text no. 204
    
205.
Vitali AM, Sayer FT, Honey CR. Recurrent trigeminal neuralgia secondary to teflon felt. Acta Neurochir (Wien) 2007;149:719-22.  Back to cited text no. 205
    
206.
Kalkanis SN, Eskandar EN, Carter BS, Barker FG 2nd. Microvascular decompression surgery in the United States, 1996 to 2000: Mortality rates, morbidity rates, and the effects of hospital and surgeon volumes. Neurosurgery 2003;52:1251-61.  Back to cited text no. 206
    
207.
Muratorio F, Tringali G, Levi V, Ligarotti GK, Nazzi V, Franzini AA. Hydrocephalus: An underrated long-term complication of microvascular decompression for trigeminal neuralgia. A single institute experience. Acta Neurochir (Wien) 2016;158:2203-6.  Back to cited text no. 207
    
208.
Yadav YR, Parihar V, Namdev H, Agarwal M, Bhatele PR. Endoscopic interlaminar management of lumbar disc disease. J Neurol Surg A Cent Eur Neurosurg 2013;74:77-81.  Back to cited text no. 208
    
209.
Yadav YR, Parihar V, Kher Y, Bhatele PR. Endoscopic inter laminar management of lumbar disease. Asian J Neurosurg 2016;11:1-7.  Back to cited text no. 209
[PUBMED]  [Full text]  
210.
Yadav YR, Madhariya SN, Parihar VS, Namdev H, Bhatele PR. Endoscopic transoral excision of odontoid process in irreducible atlantoaxial dislocation: Our experience of 34 patients. J Neurol Surg A Cent Eur Neurosurg 2013;74:162-7.  Back to cited text no. 210
    
211.
Yadav YR, Parihar V, Janakiram N, Pande S, Bajaj J, Namdev H. Endoscopic management of cerebrospinal fluid rhinorrhea. Asian J Neurosurg 2016;11:183-93.  Back to cited text no. 211
  [Full text]  
212.
Zada G, Woodmansee WW, Iuliano S, Laws ER. Perioperative management of patients undergoing transsphenoidal pituitary surgery. Asian J Neurosurg 2010;5:1-6.  Back to cited text no. 212
  [Full text]  
213.
Charalampaki P, Igressa A, Mahvash M, Pechlivanis I, Schick B. Optimal invasive key-hole neurosurgery with a miniaturized 3D chip on the tip: Microendoscopic device. Asian J Neurosurg 2013;8:125-31.  Back to cited text no. 213
[PUBMED]  [Full text]  
214.
Yadav YR, Parihar VS, Todorov M, Kher Y, Chaurasia ID, Pande S, et al. Role of endoscopic third ventriculostomy in tuberculous meningitis with hydrocephalus. Asian J Neurosurg 2016;11:325-9.  Back to cited text no. 214
[PUBMED]  [Full text]  
215.
Diyora B, Nayak N, Kukreja S, Sharma A. Hemorrhagic colloid cyst: Case report and review of the literature. Asian J Neurosurg 2013;8:162.  Back to cited text no. 215
[PUBMED]  [Full text]  
216.
Zohdi AZ, El Damaty AM, Aly KB, El Refaee EA. Success rate of endoscopic third ventriculostomy in infants below six months of age with congenital obstructive hydrocephalus (a preliminary study of eight cases). Asian J Neurosurg 2013;8:147-52.  Back to cited text no. 216
[PUBMED]  [Full text]  
217.
Jarrahy R, Eby JB, Cha ST, Shahinian HK. Fully endoscopic vascular decompression of the trigeminal nerve. Minim Invasive Neurosurg 2002;45:32-5.  Back to cited text no. 217
    
218.
Yadav YR, Parihar V, Agarwal M, Sherekar S, Bhatele P. Endoscopic vascular decompression of the trigeminal nerve. Minim Invasive Neurosurg 2011;54:110-4.  Back to cited text no. 218
    
219.
Rak R, Sekhar LN, Stimac D, Hechl P. Endoscope-assisted microsurgery for microvascular compression syndromes. Neurosurgery 2004;54:876-81.  Back to cited text no. 219
    
220.
Miyazaki H, Deveze A, Magnan J. Neuro-otologic surgery through minimally invasive retrosigmoid approach: Endoscope assisted microvascular decompression, vestibular neurotomy, and tumor removal. Laryngoscope 2005;115:1612-7.  Back to cited text no. 220
    
221.
Charalampaki P, Kafadar AM, Grunert P, Ayyad A, Perneczky A. Vascular decompression of trigeminal and facial nerves in the posterior fossa under endoscope-assisted keyhole conditions. Skull Base 2008;18:117-28.  Back to cited text no. 221
    
222.
El-Garem HF, Badr-El-Dine M, Talaat AM, Magnan J. Endoscopy as a tool in minimally invasive trigeminal neuralgia surgery. Otol Neurotol 2002;23:132-5.  Back to cited text no. 222
    
223.
Abdeen K, Kato Y, Kiya N, Yoshida K, Kanno T. Neuroendoscopy in microvascular decompression for trigeminal neuralgia and hemifacial spasm: Technical note. Neurol Res 2000;22:522-6.  Back to cited text no. 223
    
224.
Sandell T, Ringstad GA, Eide PK. Usefulness of the endoscope in microvascular decompression for trigeminal neuralgia and MRI-based prediction of the need for endoscopy. Acta Neurochir (Wien) 2014;156:1901-9.  Back to cited text no. 224
    
225.
Duntze J, Litré CF, Eap C, Théret E, Bazin A, Chays A, et al. Adjunctive use of endoscopy during microvascular decompression in the cerebellopontine angle: 27 case reports. Neurochirurgie 2011;57:68-72.  Back to cited text no. 225
    
226.
Chen MJ, Zhang WJ, Yang C, Wu YQ, Zhang ZY, Wang Y. Endoscopic neurovascular perspective in microvascular decompression of trigeminal neuralgia. J Craniomaxillofac Surg 2008;36:456-61.  Back to cited text no. 226
    
227.
Jarrahy R, Berci G, Shahinian HK. Endoscope-assisted microvascular decompression of the trigeminal nerve. Otolaryngol Head Neck Surg 2000;123:218-23.  Back to cited text no. 227
    
228.
Teo C, Nakaji P, Mobbs RJ. Endoscope-assisted microvascular decompression for trigeminal neuralgia: Technical case report. Neurosurgery 2006;59 4 Suppl 2:ONSE489-90.  Back to cited text no. 228
    
229.
Artz GJ, Hux FJ, Larouere MJ, Bojrab DI, Babu S, Pieper DR. Endoscopic vascular decompression. Otol Neurotol 2008;29:995-1000.  Back to cited text no. 229
    
230.
Lang SS, Chen HI, Lee JY. Endoscopic microvascular decompression: A stepwise operative technique. ORL J Otorhinolaryngol Relat Spec 2012;74:293-8.  Back to cited text no. 230
    
231.
Kher Y, Yadav N, Yadav YR, Parihar V, Ratre S, Bajaj J. Endoscopic vascular decompression in trigeminal neuralgia. Turk Neurosurg 2016. doi: 10.5137/1019-5149.JTN.17046-16.1. [Epub ahead of print].  Back to cited text no. 231
    
232.
Bohman LE, Pierce J, Stephen JH, Sandhu S, Lee JY. Fully endoscopic microvascular decompression for trigeminal neuralgia: Technique review and early outcomes. Neurosurg Focus 2014;37:E18.  Back to cited text no. 232
    
233.
King WA, Wackym PA, Sen C, Meyer GA, Shiau J, Deutsch H. Adjunctive use of endoscopy during posterior fossa surgery to treat cranial neuropathies. Neurosurgery 2001;49:108-15.  Back to cited text no. 233
    
234.
Balansard ChF, Meller R, Bruzzo M, Chays A, Girard N, Magnan J. Trigeminal neuralgia: Results of microsurgical and endoscopic-assisted vascular decompression. Ann Otolaryngol Chir Cervicofac 2003;120:330-7.  Back to cited text no. 234
    
235.
Huang H, Hu ZQ, Zhu GT, Guan F, Dai B, Mao BB, et al. Endoscopic microvacular decompression for trigeminal neuralgia. Zhonghua Yi Xue Za Zhi 2011;91:2491-3.  Back to cited text no. 235
    
236.
Kabil MS, Eby JB, Shahinian HK. Endoscopic vascular decompression versus microvascular decompression of the trigeminal nerve. Minim Invasive Neurosurg 2005;48:207-12.  Back to cited text no. 236
    
237.
Zhang W, Chen M, Zhang W, Chai Y. Trigeminal neuralgia: Evaluation of the relationship between the region of neuralgic manifestation and the site of neurovascular compression under endoscopy. J Craniofac Surg 2015;26:1596-9.  Back to cited text no. 237
    


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