trigeminal neurologia
TRANSCRIPT
Trigeminal Neuralgia
Roderick Agbuya
Definition
Sudden, usually unilateral, severe brief stabbing pain in the distribution of one of more branches of the V nerve (IASP)
Anatomy of Trigeminal nerve
There are three divisions of V nerve: ▪ The ophthalmic (V1) supplies sensation to upper
face including eyes. ▪ The maxillary (V2) supplies sensation to middle
face including upper teeth. ▪ The mandibular (V3) supplies sensation to lower
jaw including anterior two-thirds of tongue. All divisions come from the trigeminal ganglion,
also known as Gasserian ganglion. From the gasserian ganglion, sensory input is
conducted to the trigeminal nuclear complex.
Anatomy of Trigeminal NerveAnatomy of Trigeminal Nerve
Anatomy of Trigeminal NerveAnatomy of Trigeminal Nerve
Anatomy of Trigeminal NerveAnatomy of Trigeminal Nerve
Etiology and Pathophysiology
TN may be idiopathic (primary) or symptomatic (secondary).
Most cases of idiopathic TN are the result of vascular compression of V nerve near its entry into the pons
Symptomatic causes include: multiple sclerosis, tumors, and basilar artery aneurysm or ectasia.
Pathophysiology is not fully elucidated. Demyelinative lesions of trigeminal fibers appear to set up ectopic generation of spontaneous nerve impulses and their ephaptic conduction to adjacent fibers. This may disinhibit pain pathways in the spinal trigeminal nucleus.
Normal Trigeminal NerveNormal Trigeminal Nerve
Vascular compression of V nerveVascular compression of V nerve
Vascular irritation of V NerveVascular irritation of V Nerve
Tumor of V NerveTumor of V Nerve
Diagnosis
TN remains a clinical diagnosis.A careful search for ipsilateral dental
pathology should be undertaken.Routine imaging is generally not
indicated.MRI and MRA can be performed if
there is suspicion of underlying pathology.
Treatment
Medical treatment
Invasive treatment
Medical Treatment of TNMedical Treatment of TN
Trigeminal Nerve Block
Mandibular Nerve BlockMandibular Nerve Block
Mandibular Nerve BlockMandibular Nerve Block
Maxillary Nerve BlockMaxillary Nerve Block
Maxillary Nerve BlockMaxillary Nerve Block
Peripheral Block of V nerve Peripheral Block of V nerve
Percutaneous Radiofrequency Rhizotomy (Gasserian Ganglion
Block)It is widely used technique for
treatment of TN.Needle is introduced percutaneously
and passed through the foramen ovale
Then RF lesion is applied (Heating or Pulsed lesion)
Success rate reported more than 75%.
Percutaneous Radiofrequency RhizotomyPercutaneous Radiofrequency Rhizotomy
Glycerol Rhizotomy
Injection of 0.1 - 0.2 ml of glycerol into the Meckel’s cave, through a percutaneous needle placement.
High success rate with low morbidity has been reported
This procedure has a relatively high recurrence rate
Percutaneous Glycerol RhizotomyPercutaneous Glycerol Rhizotomy
Microvascular Decompression
Involves a craniotomy via the posterior fossa
This presumes the demonstration of vascular compression by MRI/MRA
High long-term success rate (above 70%) has been reported
Morbidity includes facial dysaesthesia, cerebellar injuries and hearing loss.
Microvascular Decompression of V nerveMicrovascular Decompression of V nerve
Microvascular Decompression of V nerveMicrovascular Decompression of V nerve
Microvascular Decompression of V nerveMicrovascular Decompression of V nerve
Microvascular Decompression of V NerveMicrovascular Decompression of V Nerve
Microvascular Decompression of V nerveMicrovascular Decompression of V nerve
Gamma Knife
Single high dose radiotherapy delivered with exquisite precision to a radiographically defined target, at the junction of trigeminal nerve and brain stem.
Several series of small numbers of patients report high rates of pain relief, with low rates of morbidity, mostly facial numbness.
Gamma KnifeGamma Knife
Gamma KnifeGamma Knife
Balloon Compression of Trigeminal Ganglion
It is done by introduction of a balloon via the percutaneous route
The balloon is then inflated with small volumes 0.5-1 ml of contrast until it occupies Meckel’s cave
Compression times vary from 1 to 6 minutes
Success rate are not dissimilar to other techniques.
Balloon Compression of Trigeminal GanglionBalloon Compression of Trigeminal Ganglion
Balloon Compression of Trigeminal GanglionBalloon Compression of Trigeminal Ganglion
Nursing Diagnosis
FearRisk for injuryPainAltered nutrition, less than body
requirements
Nursing Interventions
Instruct the client to avoid factors that can trigger the attack and result in exhaustion and fatigue.
Avoid foods that are too cold or too hot.
Chew foods in the affected side.Use cotton pads gently, wash face
and for oral hygiene.Provide teaching to clients who have
sensory loss as a result of a treatment.
Inspection of the eye for foreign bodies, which the client will not be able to feel, should be done several times a day.
Warm normal saline irrigation of the affected eye two to three times a day is helpful in preventing corneal infection.
Dental check ups every 6 months is encouraged, since dental caries will not produce pain.
Explain to the client and his family the disease and its treatments.