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BACKGROUND: This study aims to utilize the deep learning method of VB-Net to locate and segment the trigeminal nerve, and employ radiomics methods to distinguish between CTN patients and healthy individuals. METHODS: A total of 165 CTN patients and 175 healthy controls, matched for gender and age, were recruited. All subjects underwent magnetic resonance scans. VB-Net was used to locate and segment the bilateral trigeminal nerve of all subjects, followed by the application of radiomics methods for feature extraction, dimensionality reduction, feature selection, model construction, and model evaluation. RESULTS: On the test set for trigeminal nerve segmentation, our segmentation parameters are as follows: the mean Dice Similarity Coefficient (mDCS) is 0.74, the Average Symmetric Surface Distance (ASSD) is 0.64 mm, and the Hausdorff Distance (HD) is 3.34 mm, which are within the acceptable range. Analysis of CTN patients and healthy controls identified 12 features with larger weights, and there was a statistically significant difference in Rad_score between the two groups (p < 0.05). The Area Under the Curve (AUC) values for the three models (Gradient Boosting Decision Tree, Gaussian Process, and Random Forest) are 0.90, 0.87, and 0.86, respectively. After testing with DeLong and McNemar methods, these three models all exhibit good performance in distinguishing CTN from normal individuals. CONCLUSIONS: Radiomics can aid in the clinical diagnosis of CTN, and it is a more objective approach. It serves as a reliable neurobiological indicator for the clinical diagnosis of CTN and the assessment of changes in the trigeminal nerve in patients with CTN.

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Neurovascular compression syndrome (NVCS), characterized by cranial nerve compression due to adjacent blood vessels at the root entry zone, frequently presents as trigeminal neuralgia (TN), hemifacial spasm (HFS), or glossopharyngeal neuralgia (GN). Despite its prevalence in NVCS assessment, Magnetic Resonance Tomographic Angiography (MRTA)'s limited sensitivity to small vessels and veins poses challenges. This study aims to refine vessel localization and surgical planning for NVCS patients using a novel 3D multimodal fusion imaging (MFI) technique incorporating computed tomography angiography and venography (CTA/CTV). A retrospective analysis was conducted on 76 patients who underwent MVD surgery and were diagnosed with single-site primary TN, HFS, or GN. Imaging was obtained from MRTA and CTA/CTV sequences, followed by image processing and 3D-MFI using FastSurfer and 3DSlicer. The CTA/CTV-3D-MFI showed higher sensitivity than MRTA-3D-MFI in predicting responsible vessels (98.6% vs. 94.6%) and NVC severity (98.6% vs. 90.8%). Kappa coefficients revealed strong agreement with MRTA-3D-MFI (0.855 for vessels, 0.835 for NVC severity) and excellent agreement with CTA/CTV-3D-MFI (0.951 for vessels, 0.952 for NVC). Resident neurosurgeons significantly preferred CTA/CTV-3D-MFI due to its better correlation with surgical reality, clearer depiction of surgical anatomy, and optimized visualization of approaches (p < 0.001). Implementing CTA/CTV-3D-MFI significantly enhanced diagnostic accuracy and surgical planning for NVCS, outperforming MRTA-3D-MFI in identifying responsible vessels and assessing NVC severity. This innovative imaging modality can potentially improve outcomes by guiding safer and more targeted surgeries, particularly in cases where MRTA may not adequately visualize crucial neurovascular structures.

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This study aims to analyze and evaluate the comparative clinical outcomes associated with microvascular decompression (MVD) and gamma knife radiosurgery (GKRS), focusing on pain relief, pain recurrence, and complications encountered in the treatment of trigeminal neuralgia (TN). Among 155 surgical procedures performed for TN (90 GKRS, and 65 MVD) between March 1997 and December 2020, the exclusion criteria encompassed prior surgical interventions, the presence of other pathological conditions such as tumors, vascular diseases, and multiple sclerosis, as well as patients who were lost to follow-up. Ultimately, 101 patients received their initial treatment for primary TN (47 GKRS, and 54 MVD) and were followed up for more than 1 year. The MVD procedures utilized the suboccipital retrosigmoid sinus approach, whereas GKRS was conducted with MR imaging guidance, employing a single 4mm isocenter, with median GKRS doses of 80 Gy. We retrospectively analyzed patient characteristics, including sites of divisions, distributions of pain, and clinical outcomes. The assessment of outcomes was performed utilizing the Barrow Neurological Institute Pain Intensity Score and the Visual Analog Scale (VAS), with evaluations taking place preoperatively and after 1, 3, 6 and 12 months. Postoperative VAS scores for patients undergoing either MVD or GKRS demonstrated a significant improvement when compared with their preoperative counterparts. The reduction in postoperative VAS scores within the MVD group was significantly more substantial than that observed in patients who underwent GKRS at the initial postoperative evaluations (P = .037). The maintenance of pain relief after MVD proved significantly superior to that following GKRS (P < .01). Both MVD and GKRS present as safe and efficacious therapeutic options for individuals diagnosed with primary TN, though MVD displayed superior initial outcomes in terms of pain relief and its maintenance. However, for older patients or those with medical contraindications to invasive procedures, GKRS emerges as a viable and less invasive alternative for initial treatment in cases of primary TN.

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BACKGROUND AND OBJECTIVES: Patients undergoing percutaneous rhizotomy for trigeminal neuralgia (TN) may require several procedures to manage their pain. However, it is not fully understood whether repeat procedures influence postoperative complication rates. METHODS: We retrospectively reviewed patients undergoing rhizotomy at our institution from 2011 to 2022. Patients were included only if they had no history of prior interventions including microvascular decompression (MVD) or radiosurgery. We collected baseline patient information, pain characteristics, and postoperative complications for each patient. Patients were dichotomized into those undergoing primary rhizotomy versus those undergoing a repeat rhizotomy. Potential drivers of postoperative complications were included in a multivariate logistic regression model. RESULTS: Of the 1904 cases reviewed, 965 met our inclusion criteria. 392 patients underwent primary rhizotomy, and 573 patients underwent repeat rhizotomies. The repeat rhizotomy group was significantly older, p<0.001. Patients in the repeat rhizotomy group expressed higher frequencies of bilateral pain, p=0.01. Patients in the repeat rhizotomy group demonstrated a significantly higher rate of preoperative numbness and postoperative numbness, p<0.001. There were no significant differences in any of the considered complications between the single rhizotomy and repeat rhizotomy groups. On multivariate logistic regression, repeat rhizotomy did not predict an increased risk of any postoperative complications, p=0.14. CONCLUSIONS: Patients undergoing repeat rhizotomy may be at risk of postoperative numbness but are not at increased risk for postoperative complications. These results are of use to patients who are poor surgical candidates, and thus may require multiple rhizotomies to effectively manage their pain over time.

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BACKGROUND: Widespread neuropathic pain usually affects a wide range of body areas and inflicts huge suffering on patients. However, little is known about how it happens and effective therapeutic interventions are lacking. METHODS: Widespread neuropathic pain was induced by partial infraorbital nerve transection (p-IONX) and evaluated by measuring nociceptive thresholds. In vivo/vitro electrophysiology were used to evaluate neuronal activity. Virus tracing strategies, combined with optogenetics and chemogenetics, were used to clarify the role of remodeling circuit in widespread neuropathic pain. RESULTS: We found that in mice receiving p-IONX, along with pain sensitization spreading from the orofacial area to distal body parts, glutamatergic neurons in the ventral posteromedial nucleus of the thalamus (VPMGlu) were hyperactive and more responsive to stimulations applied to the hind paw or tail. Tracing experiments revealed that a remodeling was induced by p-IONX in the afferent circuitry of VPMGlu, notably evidenced by more projections from glutamatergic neurons in the dorsal column nuclei (DCNGlu). Moreover, VPMGlu receiving afferents from the DCN extended projections further to glutamatergic neurons in the posterior insular cortex (pIC). Selective inhibition of the terminals of DCNGlu in the VPM, the soma of VPMGlu or the terminals of VPMGlu in the pIC all alleviated trigeminal and widespread neuropathic pain. CONCLUSION: These results demonstrate that hyperactive VPMGlu recruit new afferents from the DCN and relay the extra-cephalic input to the pIC after p-IONX, thus hold a key position in trigeminal neuropathic pain and its spreading. This study provides novel insights into the circuit mechanism and preclinical evidence for potential therapeutic targets of widespread neuropathic pain.

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Purpose. This work investigates the small-field dosimetric characteristics of a 2.5 MV sintered diamond target beam and its feasibility for use in linac-based intracranial stereotactic treatments. Due to the increased proportion of low energy photons in the low-Z beam, it was hypothesized that this novel beam would provide sharper dose fall-off compared to the 6 MV beam owing to the reduced energy, and therefore range, of secondary electrons.Methods. Stereotactic treatments of ocular melanoma and trigeminal neuralgia were simulated for 2.5 MV low-Z and 6 MV beams using Monte Carlo to calculate dose in a voxelized anatomical phantom. Two collimation methods were investigated, including a 5 × 3 mm2HDMLC field and a 4 mm cone to demonstrate isolated and combined effects of geometric and radiological contributions to the penumbral width.Results. The measured 2.5 MV low-Z dosimetric profiles demonstrated reduced penumbra by 0.5 mm in both the inline and crossline directions across all depths for both collimation methods, compared to 6 MV. In both treatment cases, the 2.5 MV low-Z beam collimated with the 4 mm cone produced the sharpest dose fall off in profiles captured through isocenter. This improved fall-off resulted in a 59% decrease to the maximum brainstem dose in the trigeminal neuralgia case for the 2.5 MV low-Z MLC collimated beam compared to 6 MV. Reductions to the maximum and mean doses to ipsilateral and contralateral OARs in the ocular melanoma case were observed for the 2.5 MV low-Z beam compared to 6 MV with both collimation methods.Conclusions. While the low dose rate of this novel beam prohibits immediate clinical translation, the results of this study support the further development of this prototype beam to decrease toxicity in intracranial SRS treatments.

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Structural covariance networks and causal effects within can provide critical information on gray matter reorganization and disease-related hierarchical changes. Based on the T1WI data of 43 classical trigeminal neuralgia patients and 45 controls, we constructed morphological similarity networks of cortical thickness, sulcal depth, fractal dimension, and gyrification index. Moreover, causal structural covariance network analyses were conducted in regions with morphological abnormalities or altered nodal properties, respectively. We found that patients showed reduced sulcal depth, gyrification index, and fractal dimension, especially in the salience network and the default mode network. Additionally, the integration of the fractal dimension and sulcal depth networks was significantly reduced, accompanied by decreased nodal efficiency of the bilateral temporal poles, and right pericalcarine cortex within the sulcal depth network. Negative causal effects existed from the left insula to the right caudal anterior cingulate cortex in the gyrification index map, also from bilateral temporal poles to right pericalcarine cortex within the sulcal depth network. Collectively, patients exhibited impaired integrity of the covariance networks in addition to the abnormal gray matter morphology in the salience network and default mode network. Furthermore, the patients may experience progressive impairment in the salience network and from the limbic system to the sensory system in network topology, respectively.

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AIM: To review our experience with patients presenting with recurrent trigeminal neuralgia (TN) and who have undergone repeat microvascular decompression surgery (rMVD). MATERIAL AND METHODS: This retrospective observational study was conducted at the Department of Neurosurgery at a university hospital. Patients who initially experienced complete pain relief after the first MVD but later had a recurrence of TN symptoms which required an rMVD were included in the study. Pain control outcomes were evaluated based on the Barrow Neurological Institute (BNI) scale score. RESULTS: Of the 375 patients who underwent MVD for TN over a 20-year period, 19 patients (6 females and 13 males) with a mean age of 57.68 ± 9.78 years developed symptom recurrence which necessitated an rMVD (5.06%). The average duration of the symptoms before the rMVD was 16.1 ± 19.36 months. The mean BNI score of the patients before the rMVD was 4.5 ± 0.5. Recurrence was primarily attributed to compression by a new offending vessel (n=9, 47.4%) or a Teflon granuloma (n=8, 42.1%). Two patients (10.5%) did not have any identifiable compression. During a follow-up period of 106.3 ± 58.3 months, excellent pain relief (BNI-I) was achieved in 10 patients (52.6%). Eight patients (42.1%) experienced a good outcome (BNI-III), and one patient (5.3%) experienced a poor outcome (BNI-IV). CONCLUSION: Recurrence of TN symptoms can occur even after an initially successful MVD. Subsequent MVDs should be considered as the primary treatment option for recurrent TN, as it significantly controls pain with low morbidity.

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BACKGROUND: Percutaneous balloon compression (PBC) is an effective, low-cost, and simple treatment for primary trigeminal neuralgia (TN). However, PBC has poor efficacy and no better solution for the third branch (V3) of TN. METHODS: Clinical data of 52 patients with trigeminal neuralgia treated with PBC were retrospectively analyzed. Postoperative numbness of the patient was evaluated by facial numbness at the Barrow Neurological Institute (BNI-N). The main observation was the incidence of higher numbness in the V3 than in the other two branches or equally strong numbness in the three branches in the immediate postoperative period. RESULTS: The efficacy values in the pear-shaped balloon group at the first postoperative day (T1), the first month (T2), in the third month (T3), and the sixth month (T4) were 96.7%, 93.3%, 93.3%, and 90%, respectively, and 1 patient (3.3%) had recurrence. The efficacy value for the extracapsular capsule group was 95.5% at all times and there were no patients with recurrence within 6 months after surgery. In the immediate postoperative period, the effective compression rate of V3 in the pear-shaped balloon group was 43.3%, and 86.4% in the extracapsular capsule group (P = 0.020). At six months of follow-up, the effective compression rate of V3 was higher in the extracapsular capsule group than in the pear-shaped balloon group. CONCLUSIONS: The riveted structure of the extracapsular capsule can effectively compress V3, thus performing PBC with a balloon shaped as an extracapsular capsule is a new, effective, and safe treatment option for TN V3. TRIAL REGISTRATION: ClinicalTrials.gov ChiCTR2300067313.

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AIMS: Trigeminal neuralgia (TN) is a type of chronic orofacial pain evoked by trivial stimuli that manifests as episodes of excruciating and sudden, recurrent paroxysmal pain. Most patients are refractory to pharmacological therapy used for the treatment of TN. Mononuclear cells (MNC) and mesenchymal stem/stromal cells (MSC) have shown therapeutic potential in painful neuropathies, but their mechanism of action is not fully understood. The present work aimed to investigate the antinociceptive effect and mechanism of action of MNC and MSC in experimental TN. MATERIALS AND METHODS: Mice submitted to the chronic constriction injury of the infraorbital nerve (CCI-ION) mouse model of TN received a single intravenous injection of saline, MNC, or MSC (1 × 106 cells/mouse). The effect of the treatments on the behavioral signs of painful neuropathy, morphological aspects of the infraorbital nerve, and inflammatory and oxidative stress markers in the infraorbital nerve were assessed. KEY FINDINGS: MNC and MSC improved behavioral painful neuropathy, activated key cell signaling antioxidant pathways by increasing Nrf2 expression, and reduced the proinflammatory cytokines IL-1ß and TNF-α. However, treatment with MSC, but not MNC, was associated with a sustained increase of IL-10 and with the re-establishment of the morphometric pattern of the infraorbital nerve, indicating a difference in the mechanism of action between MNC and MSC. In line with this result, in IL-10 knockout mice, MSC transplantation did not induce an antinociceptive effect. SIGNIFICANCE: Importantly, these data suggest an IL-10-induced disease-modifying profile related to MSC treatment and reinforce cell therapy's potential in treating trigeminal neuralgia.

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OBJECTIVE: To analyse the knowledge level and attitude of Saudi dentists regarding trigeminal neuralgia. METHODS: The cross-sectional study was conducted from 17/12/ 2020 - 9/2/2021 at Prince Sat t am Bin Abdulaziz University, Al-Kharj, Riyadh Elm University, Riyadh, and Dar Al-Uloom University, Riyadh, Kingdom of Saud i Arabia. The sample comprised dentists and postgraduate dental students from every speciality. Data was collected online using a predesigned self-structured questionnaire consisting of three par ts, assessing knowledge, practice and attitude of the subjects. Data was analysed using SPSS 22. RESULTS: A total of 202 questionnaire about the knowledge level and attitude of Saudi dentists regarding trigeminal neuralgia were completed. The knowledge level was significantly higher in those senior age group compared to the young dentists with respect to the type of pain observed in TN, the unilateral pain of TN, and the abrupt, unexpected and transient nature of TN pain, local anaesthetic, the first-line treatment for TN, and the effect of TN on oral hygiene. CONCLUSIONS: Older and experienced dentists had more knowledge than younger and less experienced ones.

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BACKGROUND: Microvascular decompression (MVD) is a well-established and effective treatment for primary trigeminal neuralgia (TN). Endoscopy has been implemented to provide a comprehensive view of neurovascular conflict and minimizes the damages of brain retraction during MVD. OBJECTIVES: To preliminarily evaluate the surgical safety and efficacy of fully endoscopic microvascular decompression (EMVD) for primary TN with surgeon performing two-hand manipulation and assistant holding endoscope. METHODS: Retrospective clinical analysis of 189 patients with primary TN underwent EMVD between June 2019 and August 2022 was performed. By analyzing the intraoperative situation, the outcomes of postoperative symptoms and the main complications, we evaluated the reliability and effectivity of the operative technique in the treatment of primary TN. RESULTS: We summarized the standard operating procedure of EMVD for primary TN with surgeon performing two-hand manipulation and assistant holding endoscope. In addition, acicular bipolar electrocoagulation technique was developed to handle venous compression. During the follow-up period, good pain relief was achieved in 178 patients (94.2%) and recurrence of pain was observed in 4 patients (2.1%). Postoperative temporary complications included trigeminal dysesthesias (7 patients, 4.8%), cerebrospinal fluid leak (2 patients, 1.1%), hearing difficulty (3 patient, 1.6%), facial paresis (2 patients, 1.1%) and vertigo (5 patients, 2.7%). There were no cases of intracranial hemorrhage, cerebellar swelling and death. CONCLUSION: This EMVD technique is reliable and effective, and can be used as a routine surgical procedure for primary TN.

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Microvascular decompression (MVD) is the preferred treatment for hemifacial spasm (HFS) and trigeminal neuralgia (TN), and fully endoscopic microvascular decompression (E-MVD) has been widely discussed in recent years. Considering the endoscopic diving technique used in endoscopic transsphenoidal pituitary adenoma resection, we developed the endoscopic semidiving technique. This technique involves preserving some cerebrospinal fluid (CSF) and positioning the endoscope at an appropriate distance from it; the potential advantages include reducing cerebellar retraction, accurately identifying the responsible vessels and minimizing mechanical damage. This study aimed to preliminarily evaluate the safety and feasibility of the semidiving technique in E-MVD. A total of 359 patients with HFS and TN scheduled to undergo E-MVD were included in the study. Patients with each disease were divided into a nonsemidiving technique group and a semidiving technique group. Surgical data, postoperative outcomes, complications, and recurrence rates were compared between the groups. In patients with HFS, the effective rate was 95.6% (nonsemidiving)and 92.9% (semidiving) respectively, with no statistically significant difference. The semidiving technique group had a lower incidence of postoperative permanent hearing loss compared with the nonsemidiving technique group (0% vs. 5.9%). In TN patients, no significant differences in effectiveness or postoperative complications were observed. The application of the semidiving technique in E-MVD for HFS not only ensures surgical quality and postoperative efficacy but also reduces the incidence of postoperative hearing loss, shortens the surgical duration and reduces the number of postoperative hospitalization days, aligning with the concept of enhanced recovery after surgery (ERAS).

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According to the literature, cerebellopontine angle tumors cause secondary trigeminal neuralgia and other symptoms of neurovascular compression in 1-9.9% of cases. We present a 58-year-old patient with left-sided secondary trigeminal neuralgia caused by ipsilateral posterior petrous meningioma. Stereotactic irradiation was followed by effective tumor growth control. However, residual trigeminal pain paroxysms significantly reduced the quality of life and required subsequent microsurgery. Trigeminal facial pain regressed after total resection of tumor. Considering this clinical case, we would like to discuss several issues: follow-up of meningioma requiring radiosurgery, course of secondary trigeminal neuralgia in a patient with apical petrous meningioma, characteristics of pain before and after radiosurgery, the best treatment option for these patients. Stereotactic radiosurgery seems unreasonable for CPA tumors with secondary trigeminal neuralgia. Indeed, persistent pain is possible even after tumor shrinkage. Moreover, primary stereotactic irradiation significantly complicates subsequent resection of tumor.

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INTRODUCTION: Trigeminal neuralgia (TN), marked by chronic pain from neural damage, is closely associated with inflammation. The role of OTULIN, a key regulator in inflammation and autophagy, is not fully understood in TN. The regulatory mechanism of OTULIN, a key protein involved in modulating inflammatory responses and autophagy processes, remains incompletely elucidated, particularly in the context of TN and neuroinflammation. METHODS: An infraorbital nerve ligation-induced rat model of TN was used. OTULIN's expression was modulated using adenovirus vectors and short hairpin RNA. The impact on pain and inflammatory responses was assessed via quantitative real-time polymerase chain reaction, western blot, immunofluorescence, and transcriptomic analysis. RESULTS: Enhanced OTULIN expression significantly increased head withdrawal thresholds and reduced pain sensitivity and neuroinflammatory markers in the model. Conversely, silencing OTULIN exacerbated pain and inflammation. Transcriptomic data revealed OTULINs influence on both inflammatory and autophagy pathways, specifically in suppressing NLR family pyrin domain containing 3 (NLRP3) inflammasome and promoting autophagy. In vitro experiments demonstrated OTULIN's inhibition of inflammatory markers in microglia and neurons. CONCLUSION: OTULIN is crucial in modulating TN, reducing neuropathic pain and neuroinflammation by activating the autophagy pathway and inhibiting the NLRP3 inflammasome.

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BACKGROUND: The classic percutaneous balloon compression (PBC) technique is used to complete an operation under the guidance of C-arm radiography under general anesthesia, making communication with patients during the operation impossible. It is not accurate or objective to predict the classic technique's curative effect solely by determining whether the projection of the x-ray lateral image of the filled balloon is pear-shaped. OBJECTIVES: This study aimed to upgrade classic PBC to awake computed tomography (CT)-guided PBC technology under conscious local anesthesia and analgesia monitoring. STUDY DESIGN: Prospective clinical study. SETTING: Department of Anesthesiology and Pain Medical Center, Jiaxing, People's Republic of China. METHODS: Puncture was designed and guided by CT scanning, and the curative effect was assessed by asking the patients about what they are feeling during the operation. RESULTS: CT can design the puncture path and accurately guide puncture, observe the position and shape of the balloon through 3-dimensional reconstruction during the operation, and judge the curative effect according to the patient's chief concern. LIMITATIONS: Local anesthetic analgesia is not perfect, resulting in some patients experiencing pain during surgery. CONCLUSIONS: PBC can be completed under conscious local anesthesia and analgesia. Its curative effect and operative end standard can be determined according to the patient's chief concern. Under CT guidance, the puncture path can be designed to complete an accurate puncture and to intuitively understand the position and shape of the balloon.

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Temporary, sudden, shooting and recurrent unilateral facial pain in the supply area of one or more trigeminal nerve branches characterises trigeminal neuralgia. Innocuous stimuli trigger the pain, e.g. chewing, speaking or brushing teeth. In some patients, paroxysms superimpose on continuous pain. In aetiological terms, idiopathic, classic (due to neurovascular compression) and secondary trigeminal neuralgia (e.g. due to multiple sclerosis, brainstem ischaemia and space-occupying lesions) are defined. Many drugs may be efficacious, with carbamazepine being first-choice therapy. However, non-pharmacological and invasive procedures may also help. To reach the correct diagnosis and determine the best therapeutic measures, adequate pain characterisation and interdisciplinary collaboration are essential. We hereby present our experience of an interdisciplinary approach for the diagnosis and treatment of trigeminal neuralgia.

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