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Background: Gamma knife stereotactic radiosurgery (GKRS) is recognized as an effective and safe alternative treatment for skull base tumors and trigeminal neuralgia. This study aims to evaluate the efficacy of targeting both tumor and trigeminal nerve in a single procedure for patients with benign tumor-related trigeminal neuralgia. Methods: A retrospective study was conducted on 44 patients with benign tumor-related trigeminal neuralgia who underwent GKRS targeting both tumor and trigeminal nerve in a single procedure between December 2016 and December 2022. The cohort included 30 meningiomas, 9 vestibular schwannomas, and 5 trigeminal schwannomas. The median tumor volume was 3.62 mL (range: 0.14–20.74 mL). The median radiation dose was 12–13.4 Gy for the tumors and 88.9 Gy (range: 85–90 Gy) at the 100% isodose line for the trigeminal nerve. The facial pain before and after GKRS was assessed using the Barrow Neurological Institute (BNI) pain intensity scale. Results: Following GKRS, 38 patients (86.4%) experienced significant pain improvement, with a median latency period of 2 months (range: 0.3–12 months). Sixteen patients (36.4%) experienced a relapse at a median time of 6 months (range: 1–30 months) post-GKRS. After a median follow-up time of 31.9 months (12.1–77.3 months), 22 patients (50.0%) continued to experience durable pain relief. Fourteen patients (31.8%) developed GKRS-related complications, most of which fully resolved, except in 3 patients (6.8%) who experienced permanent facial hypoesthesia. Tumor control rate was 86.2%. Conclusions: GKRS targeting both the tumor and trigeminal nerve in a single session demonstrated favorable outcomes in terms of pain relief and tumor control in patients with benign tumor-related trigeminal neuralgia. [ABSTRACT FROM AUTHOR]

• Compared to sham stimulation, 120Hz-eTNS maintained alertness levels after nap-deprived and alleviates fatigue levels. • 120Hz-eTNS maintained alertness in a fatigued state by preventing autonomic shift toward parasympathetic dominance. • 120Hz-eTNS lowered cortisol in nap-deprived subjects, showing potential to maintain cognition by reducing stress levels. In the face of inevitable declines in alertness and fatigue resulting from sleep deprivation, effective countermeasures are essential for maintaining performance. External trigeminal nerve stimulation (eTNS) presents a potential avenue for regulating alertness by activating the locus coeruleus and reticular activating system. Here, we conducted a within-subject study with 66 habitual nappers, subjecting them to afternoon nap-deprivation and applying either 20-minute of 120 Hz eTNS or sham stimulation. We compared participants' performance in PVT and N-back tasks, subjective fatigue level and alertness ratings, and changes in heart rate variability, cortisol, and salivary alpha-amylase before and after stimulation. The results revealed a significant decline in PVT and N-back tasks performance, along with increased subjective fatigue levels in the sham stimulation group. In contrast, the eTNS stimulation group maintained behavioral performance, with lower post-stimulation fatigue levels than sham group. After stimulation, the eTNS group exhibited decreased mean R-R interval and elevated LF/HF ratios, i.e., a shift in autonomic nervous system activity towards sympathetic dominance, and a significant reduction in cortisol levels, indicating a state of relaxation alleviating drowsiness. These findings suggested that 120 Hz eTNS stimulation might induce a relaxing effect, and thereby alleviate fatigue while preserving alertness and cognitive performance. [ABSTRACT FROM AUTHOR]

Neurovascular compression of the tenth cranial nerve, the vagus nerve, can cause recognizable and neurosurgically treatable clinical conditions. This chapter will outline the clinical characteristics unique to vagus nerve compression and highlight both the definitive diagnostic protocol and neurosurgical treatment of these conditions. The vagus nerve has motor, sensory and autonomic components. Neurovascular compression of the motor component can cause hemi-laryngopharyngeal spasm (HELPS syndrome). Compression of the sensory component will cause a neurogenic cough called VANCOUVER syndrome – an acronym for Vagus Associated Neurogenic Cough Occurring due to Unilateral Vascular Compression of its Root. Both are caused by direct compression of the root of the tenth cranial nerve at the brainstem by a blood vessel and can be cured by microvascular decompression (MVD). Since the symptoms of choking and cough are common and blood vessels are often abutting the vagus nerve at the brainstem, it is vitally important to understand the definitive diagnostic protocol to avoid operating on false positives. Since the vagus nerve is far more susceptible to dysfunction during surgery than either the trigeminal or facial nerves, it is also important to understand the surgical nuances of this procedure. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. For trigeminal neuralgia (TN), a major role of imaging is to identify the causes, but recent studies demonstrated structural and microstructural changes in the affected nerve. Moreover, an increasing number of studies have reported central nervous system involvement in TN. In this systematic review, recent quantitative magnetic resonance imaging (MRI) studies of the trigeminal nerve and the brain in patients with TN were compiled, organized, and discussed, particularly emphasizing the possible background mechanisms and the interpretation of the results. A systematic search of quantitative MRI studies of the trigeminal nerve and the brain in patients with TN was conducted using PubMed. We included the studies of the primary TN published during 2013 to 2023, conducted for the assessment of the structural and microstructural analysis of the trigeminal nerve, and the structural, diffusion, and functional MRI analysis of the brain. Quantitative MRI studies of the affected trigeminal nerves and the trigeminal pathway demonstrated structural/microstructural alterations and treatment-related changes, which differentiated responders from nonresponders. Quantitative analysis of the brain revealed changes in the brain areas associated with pain processing/modulation and emotional networks. Studies of the affected nerve demonstrated evidence of demyelination and axonal damage, compatible with pathological findings, and have shown its potential value as a tool to assess treatment outcomes. Quantitative MRI has also revealed the possibility of dynamic microstructural, structural, and functional neuronal plasticity of the brain. Further studies are needed to understand these complex mechanisms of neuronal plasticity and to achieve a consensus on the clinical use of quantitative MRI in TN. [ABSTRACT FROM AUTHOR]

Linear incision was made for retrosigmoid craniotomy. Cerebrospinal fluid was drained from cerebellomedullary cistern. Using dynamic retraction, tumor was identified in trigeminal nerve with normal fibers spread circumferentially. Cisternal portion removed. Supra-meatal tubercle was drilled, and Meckel's cave exposed. Gross total resection performed. Patient discharged day after surgery with moderate hypoesthesia in trigeminal distribution which is improving gradually.By M. Salman Ali and Fernando ValeReported by Author; Author [Extracted from the article]

The article discusses a case of a 42-year-old male patient with a rare trigeminal schwannoma originating from the motor branch of the trigeminal nerve. The patient presented with gait disturbance as the main symptom, without facial nerve palsy or numbness. Surgical resection of the tumor was successful, but post-operatively, the patient experienced decreased masticatory function and malocclusion, requiring rehabilitation treatment. The authors emphasize the importance of carefully monitoring mastication function in cases of trigeminal schwannoma originating from the motor branch. [Extracted from the article]

The article in the Journal of Neurological Surgery. Part B discusses the extra-extended translabyrinthine approach for resection of large acoustic neuromas. This approach, conceptualized by the senior author, maximizes exposure of the tumor and early identification of cranial nerves. A case study of a 43-year-old woman with a large acoustic neuroma on the right side demonstrates successful complete resection without complications. The approach aims to improve functional outcomes of the facial nerve and enhance understanding of anatomy obscured by large tumors. [Extracted from the article]

The article discusses the surgical treatment of giant vestibular schwannomas, focusing on the goal of radical tumor removal while preserving facial nerve function. The study analyzed 30 patients with large VS, with most patients experiencing complete hearing loss on the tumor side. Results showed that total resection was achieved in 16% of patients, with 54% having good postoperative outcomes for facial nerve function. The use of modern neurosurgical technology and monitoring was highlighted as crucial for successful outcomes in treating these complex tumors. [Extracted from the article]

The article discusses a rare case of a patient with both trigeminal neuralgia and hemifacial spasm, caused by two offending vessels compressing the trigeminal nerve and ⅞ nerve complex. The patient underwent a dual microvascular decompression surgery, which successfully relieved her symptoms. The use of an endoscope during the surgery was crucial for better visualization and successful outcome. The article emphasizes the importance of careful dissection to prevent complications and highlights the effectiveness of endoscopic assisted microvascular decompression for patients who do not respond to medical treatment. [Extracted from the article]

The article discusses the short- and long-term neurologic outcomes of patients undergoing an endoscopic endonasal transpterygoid approach (EETPA) for tumor resection. It highlights the main neurologic deficits associated with the approach, such as trigeminal neuropathy, hearing loss, and trismus, and how they evolve over time. The study found that the type of approach, preoperative deficits, and postoperative radiation can impact the resolution of these neurologic deficits. The research aims to provide data-driven patient counseling and optimize the management of neurologic deficits in patients undergoing an EETPA. [Extracted from the article]

The article titled "The Transzygomatic Transmandibular Approach: A Step-By-Step Cadaveric Study and Review of the Literature" in the Journal of Neurological Surgery explores a surgical approach that provides access to the infratemporal fossa and parapharyngeal space. The study includes a detailed dissection of the approach on a cadaveric specimen and a systematic review of relevant literature. The approach is useful for resecting large lesions such as clivus chordomas, meningiomas, and trigeminal schwannomas, offering improved vascular control and management of complex lesions. Postoperative morbidity may include trigeminal and facial nerve dysfunction, as well as mastication complications. [Extracted from the article]

The article discusses the indications and outcomes of endoscopic endonasal approaches for trigeminal schwannoma based on tumor characteristics. A multicenter case series study of 20 cases was conducted, analyzing factors such as modified Samii classification, extracranial extension, internal carotid artery displacement, and sphenoid sinus pneumatization. The study found that gross or near-total resection was achieved in 70% of cases, with GNTR decreasing significantly in the absence of specific tumor characteristics. The authors suggest that endoscopic transorbital approaches should be considered in cases where certain factors are not present. [Extracted from the article]

The study published in the Journal of Neurological Surgery. Part B. Skull Base explores whether the type of endoscopic drill shaft used during skull base surgery affects the risk of nasoseptal flap (NSF) necrosis. The research compared rates of flap necrosis when using a rotating shaft drill versus a non-rotating shaft drill and found no significant difference in necrosis rates between the two types of drills. The study suggests that factors such as patient history, wound healing, and complex skull base pathology may play a more significant role in NSF necrosis than the choice of instrumentation. [Extracted from the article]

The article discusses two cases of vestibular nerve hybrid nerve sheath tumors at a tertiary care referral center, which were initially presumed to be vestibular Schwannomas. The cases were diagnosed as hybrid tumors upon pathological analysis. A literature review revealed a limited number of reported cases of hybrid tumors affecting cranial nerves, indicating that such tumors may be underreported in the cranial region. The study highlights the importance of recognizing hybrid nerve sheath tumors as a distinct entity in the classification of central nervous system tumors. [Extracted from the article]

The article discusses a case of trigeminal neuralgia (TN) where there was a significant difference between preoperative MRI findings and intraoperative observations of neurovascular compression (NVC). While MRI is commonly used to detect NVC, it may not always accurately predict the presence of compression, leading to potential missed opportunities for surgical intervention. The case study highlights the importance of thorough interpretation of imaging studies and the use of advanced techniques, such as post-contrast imaging, to improve visualization and treatment outcomes for patients with TN. [Extracted from the article]

The article "Transorbital Transcavernous Approach: Key Steps and Anatomical Landmarks" in the Journal of Neurological Surgery provides a detailed surgical guide for the microscopic transorbital transcavernous approach. The study focuses on identifying key anatomical targets and surgical steps for accessing the cavernous sinus via a modified eyebrow transorbital approach. The research findings highlight three stepwise-surgical phases that allow for adequate exposure, accessibility, and maneuverability to reach specific targets within the cavernous sinus. Surgeons can use this guide to enhance their surgical techniques for treating skull base pathologies. [Extracted from the article]

This article in the Journal of Neurological Surgery. Part B. Skull Base explores a rare case of a Vidian nerve schwannoma in a 45-year-old woman who underwent successful endoscopic endonasal surgery for tumor resection. The surgery required a transpterygoid approach due to the challenging location of the mass in the lateral recess of the sphenoid sinus. The article highlights the difficulty in diagnosing Vidian nerve schwannomas and the importance of utilizing extended endoscopic skull base approaches for better outcomes. The authors emphasize the potential morbidity associated with these benign tumors due to their impact on surrounding structures like the optic nerve. [Extracted from the article]

The patient is a 68-year-old man presenting with bilateral hearing loss and left trigeminal neuralgia. Imaging revealed several nerve sheath tumors including a left cerebellopontine angle tumor. Due to unrelenting facial pain, the patient underwent resection of his left cerebellopontine angle tumor, a cochlear schwannoma. He was also found to have vascular compression of his left trigeminal nerve, for which a microvascular decompression was performed. Postoperatively, the patient had complete resolution of his facial pain.By Ellina Hattar; Gregory P. Lekovic and William H. SlatteryReported by Author; Author; Author [Extracted from the article]

Schwannomas of the trigeminal nerve may arise anywhere from the cisternal to extradural segments of the nerve, and that location impacts their radiographic appearance and compartments of extension. Here we present an extradural trigeminal schwannoma with erosion of the middle fossa floor and extension into the infratemporal fossa in a 62 year-old male who presented with conductive hearing loss due to eustachian tube dysfunction.By Muhammad Waqas; Hussain Shallwani; Jaims Lim; N Hanna and Algattas AlgattasReported by Author; Author; Author; Author; Author [Extracted from the article]

A 56-year-old woman with severe mucormycosis had previously undergone multiple debridements by the ENT and oculoplastic surgery team leading to a "frozen eye." She presented with intracranial invasion in the orbital apex, cavernous sinus, and the trigeminal nerve. She underwent embolization of the ICA after confirming collateral flow and complete cavernous sinus exenteration. The patient recovered well from surgery and is now 9 months free of disease.By Vera Vigo; Reza Arifianto Muhammad; Yuanzhi Xu; Christine K. Lee; Jayakar V. Nayak and Juan Carlos Fernandez-MirandaReported by Author; Author; Author; Author; Author; Author [Extracted from the article]

Linear incision followed by retrosigmoid craniotomy was performed. Tumor was internally debulked. Tumor dissection away from petrous bone and tentorium. 7/8 complex was preserved along with lower cranial nerves. Tentorium was coagulated and cut and removed along with supratentorial portion of the tumor. 4th cranial nerve identified in the depth along with 3rd nerve. Trigeminal nerve could be seen medial to the tumor and 6th nerve in the ventral aspect. Gross total resection was achieved.By M. Salman Ali and Fernando ValeReported by Author; Author [Extracted from the article]

The article in the Journal of Neurological Surgery discusses the challenges and techniques involved in accessing the lateral compartment of the cavernous sinus using the extended endoscopic endonasal approach (EEA). The study outlines a step-by-step surgical technique, based on cadaveric dissections and institutional clinical experiences, for approaching lesions in the lateral cavernous sinus compartment. The results of the approach in 18 patients with various pathologies show improvements in safety and effectiveness, with a reduced complication rate over time, emphasizing the importance of appropriate case selection and intra-operative decision-making. [Extracted from the article]

The article "Analog Clock as a Road Map to the Cranial Nerves of the Cerebellopontine Angle" published in the Journal of Neurological Surgery explores the relationship between the position of cranial nerves and the internal auditory canal (IAC) in the posterior fossa. Through dissections of anatomical specimens, the study found that the position of cranial nerves IV to XI can be accurately located using the IAC as a reference point, aiding surgeons in navigating the complex cisternal anatomy of the posterior fossa during resections of cerebellopontine angle tumors. The findings suggest that the IAC can serve as a valuable landmark for identifying cranial nerves in surgical procedures. [Extracted from the article]

The article published in the Journal of Neurological Surgery. Part B. Skull Base explores the use of blink reflex neuromonitoring during skull base surgery to predict changes in House Brackmann scores. The study focuses on applying machine learning algorithms to intraoperative neurophysiological monitoring (IONM) data to detect warning signals for facial nerve injury earlier than standard methods allow. Initial results show potential patterns in blink reflex responses that could enhance intraoperative monitoring of facial nerve function, with plans for further investigation using a larger cohort and robust IONM protocols. The study aims to eventually influence intraoperative strategies and improve postoperative facial nerve outcomes. [Extracted from the article]

The article published in the Journal of Neurological Surgery compares the standard retrosigmoid suboccipital (RSSO) approach to the extended RSSO approach for accessing the petroclival region in skull base surgeries. Using cadaveric specimens, the study quantitatively measured the surgical exposure, maneuverability, and angles of attack provided by each approach. Results showed that the extended RSSO approach offered significantly greater brainstem exposure, improved surgical freedom to the petroclival region, and wider angles of attack to the ventral brainstem compared to the standard RSSO approach. The findings aim to assist surgeons in making informed decisions when choosing the most appropriate approach for lesions in the petroclival and ventral brainstem regions, potentially enhancing patient outcomes. [Extracted from the article]

The article "Minimal Anterior and Posterior Combined Petrosal Approach to Large Petroclival Meningiomas" published in the Journal of Neurological Surgery discusses a surgical technique called the minimal APC (MAPC) transpetrosal approach for treating large petroclival meningiomas (PCMs). The study, conducted between 2014 and 2023, involved 45 patients with benign PCMs, with a mean age of 55 years. The results showed a mean extent of tumor resection of 97.4% with postoperative impairments such as facial numbness and nerve palsies. The authors concluded that the MAPC transpetrosal approach is a suitable surgical option for the treatment of large PCMs. [Extracted from the article]

The article "Parasympathetic Innervation of the Lacrimal Gland: A Microsurgical Cadaver Study" published in the Journal of Neurological Surgery explores the innervation of the lacrimal gland and its potential implications for dry eye syndrome. The study suggests that there may be parasympathetic innervation to the lacrimal gland outside the traditional pathway via the vidian nerve, possibly through the lacrimal nerve. Through histopathological analysis of cadaver specimens, the researchers found evidence of parasympathetic fibers in the lacrimal nerve, indicating a more complex innervation pattern than previously understood. [Extracted from the article]

The article "Comparison of Two Surgical Approaches and Outcomes for Petroclival Meningiomas: A Single-Surgeon Series of Consecutive Cases" published in the Journal of Neurological Surgery. Part B. Skull Base compares outcomes between the retrolabyrinthine posterior petrosectomy and retrosigmoid approaches for treating petroclival meningiomas. The study included 47 patients with no significant differences in tumor size or preoperative volume between the two groups. The retrosigmoid approach showed shorter operative times and hospital stays compared to posterior petrosectomy, with comparable rates of progression-free survival. [Extracted from the article]

The article discusses a surgical technique for preserving the V and VI nerves during the resection of meningiomas at the clivus and petrous apex to avoid facial numbness and abducens nerve palsy. The study analyzed 55 cases and found that opening Meckel's cave during the transpetrosal approach reduced severe facial paresthesia. It also highlighted the importance of identifying the abducens nerve near the brainstem for effective preservation during surgery. The authors suggest that advancements in surgical approaches have improved outcomes, but facial numbness and abducens nerve palsy remain common and impact patients' quality of life. [Extracted from the article]

The article in the Journal of Neurological Surgery explores the use of augmented reality (AR) in trigeminal rhizotomy for treating trigeminal neuralgia. The study used a cadaveric head and a novel AR system to guide participants in inserting a rhizotomy needle towards the target at V3 with high accuracy. Results showed successful canulation of the foramen ovale and accurate targeting of the trigeminal nerve, highlighting the efficiency and potential of AR in neurosurgical procedures. Further research is recommended to validate these findings and optimize AR systems for wider clinical use. [Extracted from the article]

This article in the Journal of Neurological Surgery introduces a minimally invasive endoscopic approach to the infratemporal fossa (ITF) for treating trigeminal neuralgia, known as the transoral paramaxillary approach. The study includes detailed anatomical dissections on human cadaveric heads to demonstrate the procedure and identify critical neurovascular structures within the ITF. The innovative technique was successfully applied in a clinical case, resulting in the treatment of a patient with minimal morbidity, specifically facial numbness. This approach provides a new access route for lesions in the ITF, including those around the foramen ovale, with reduced morbidities. [Extracted from the article]

This article from the Journal of Neurological Surgery compares the surgical exposure, angle of attack, and volume of operative maneuverability provided by the combined petrosal approach, extended RSSO approach, and standard Kawase approach for accessing the petroclival region and ventral brainstem. Using cadaveric specimens, the study found that the combined petrosal approach offered the greatest exposure and maneuverability, while the extended RSSO approach had superior angles of attack to the ventral brainstem. The Kawase approach provided a direct route to Meckel's cave and the upper clivus. The results aim to assist surgeons in making informed decisions for complex skull base lesions in these regions. [Extracted from the article]

The article discusses the surgical management of recurrent trigeminal neuralgia caused by Teflon granuloma formation following microvascular decompression (MVD) surgery. The study analyzed 10 cases of recurrent TN due to granulomas, representing 0.9% of MVD procedures. Surgical removal of the granulomas and nerve re-exploration led to significant symptom relief in 90% of cases, emphasizing the importance of careful Teflon placement to prevent granuloma formation. Further research is needed to optimize techniques for preventing granuloma recurrence. [Extracted from the article]

Trigeminal neuralgia (TN) is an excruciating neurological disorder characterized by intense, stimulus-induced, and transient facial stabbing pain. The classification of TN has changed as a result of new discoveries in the last decade regarding its symptomatology, pathogenesis, and management. Because different types of facial pain have different clinical therapy and neuroimaging interpretations, a precise diagnosis is essential. Diagnosis should include magnetic resonance imaging with specific sequences to rule out secondary causes and to identify possible neurovascular contact. The purpose of demonstrating a neurovascular contact is to aid in surgical decision making, not to validate a diagnosis. Microvascular decompression is the first-line procedure for individuals who do not respond to medical management, whereas carbamazepine and oxcarbazepine are the preferred medications for long-term care. New developments in animal models and neuroimaging methods will shed more light on the biology and etiology of TN. This paper reviews the pathogenesis, the clinical features, the diagnosis, and the management of TN. Furthermore, the potential role of low-intensity pulsed ultrasound in neurological disorders is discussed. [ABSTRACT FROM AUTHOR]

The study aims to evaluate the efficacy of neuromodulatory strategies for people who have drug-resistant epilepsy (DRE). We searched electronic repositories, including PubMed, Web of Science, Embase, and the Cochrane Library, for randomized controlled trials, their ensuing open-label extension studies, and prospective studies focusing on surgical or neuromodulation interventions for people with DRE. We used seizure frequency reduction as the primary outcome. A single-arm meta-analysis synthesized data across all studies to assess treatment effectiveness at multiple time points. A network meta-analysis evaluated the efficacy of diverse therapies in randomized controlled trials. Grading of Recommendations, Assessment, Development, and Evaluations was applied to evaluate the overall quality of the evidence. Twenty-eight studies representing 2936 individuals underwent 10 treatments were included. Based on the cumulative ranking in the network meta-analysis, the top 3 neuromodulatory options were deep brain stimulation (DBS) with 27% probability, responsive neurostimulation (RNS) with 22.91%, and transcranial direct current stimulation with 24.31%. In the single-arm meta-analysis, in the short-to-medium term, seizure control is more effective with RNS than with invasive vagus nerve stimulation (inVNS), which in turn is slightly more effective than DBS, though the differences are minimal. However, in the long term, inVNS appears to be less effective than both DBS and RNS. Trigeminal nerve stimulation, transcranial magnetic stimulation, and transcranial alternating current stimulation did not demonstrate significant seizure frequency reduction. Regarding long-term efficacy, RNS and DBS outperformed inVNS. While transcranial direct current stimulation and transcutaneous auricular VNS showed promise for treating DRE, further studies are needed to confirm their long-term efficacy. [ABSTRACT FROM AUTHOR]

Reactivation of latent varicella zoster virus in the trigeminal ganglion with involvement of the ophthalmic division of the trigeminal nerve causes herpes zoster ophthalmicus. This is rare in children and imaging is seldom performed since the diagnosis is primarily clinical. As a result, descriptions of the associated imaging abnormalities are sparse, particularly in the paediatric literature. We present the case of a previously healthy child with herpes zoster ophthalmicus who underwent a magnetic resonance imaging scan that demonstrated enlargement and enhancement of the ipsilateral trigeminal nerve and its branches. Our aim is to highlight this finding as a potential imaging feature of herpes zoster ophthalmicus, which, to our knowledge, has not previously been reported in children. [ABSTRACT FROM AUTHOR]

Objective: To describe long-term outcomes and complications following mandibular distraction osteogenesis (MDO) in a diverse patient cohort Design: Cross-sectional study Setting: Single tertiary-care pediatric center Patients: Forty-eight patients previously undergoing MDO with minimum 4-year follow-up Main Outcome Measures: Respiratory outcomes, feeding patterns, dental development, motor/sensory nerve function, temporo-mandibular joint function, and postsurgical scarring Results: Forty-six patients with a median age of 7 years were evaluated. Of 20 nonsyndromic patients, none required additional airway procedures, none required continuous positive airway pressure (CPAP) during sleep, and 19 (95%) fed exclusively by mouth. Among 26 syndromic patients, 7 (27%) required CPAP and 8 (31%) were tube fed. Permanent first molar differences were seen in the majority of subjects; patterns of damage interfering with function were more common in syndromic (13/28, 46%) compared to nonsyndromic (5/24, 21%; P =.014) subjects. MDO prior to age two was associated with more frequent and worse dental damage (P =.001). Inferior alveolar nerve and marginal mandibular nerve function were fully intact in 37 (80%) and 39 (85%) of patients, respectively. Three patients (6%), all with associated genetic syndromes, demonstrated severe nerve impairment. By the Vancouver scar scale, ≥ 80% of surgical scars were rated in the most favorable category for each quality assessed. Temporomandibular joint dysfunction was rare. Conclusions: MDO shows highly favorable long-term respiratory, feeding, nerve, and scar outcomes in nonsyndromic patients, although permanent molar changes not precluding tooth viability are commonly seen. Patients with associated syndromes demonstrate respiratory and feeding benefits, but higher rates of dental and nerve abnormalities. [ABSTRACT FROM AUTHOR]

Introduction: Pain at the buccal mucosal graft (BMG) harvest site in the immediate postoperative period is common and delays resumption of oral intake. This study compares the time for resumption of pain-free solid and liquid diets and postoperative pain scores at harvest site following the administration of inferior-alveolar nerve-block plus buccal-nerve block (IANB + BNB) versus placebo. We hypothesize that the intervention could decrease pain and aid in early food intake. Methods: A single-center, placebo-controlled, double-blinded randomized-control trial was conducted from September 2022 to August 2023 (CTRI). All individuals > 18 years undergoing BMG harvest were included. Patients with contraindications for BMG harvest and diabetes were excluded. Furthermore, patients requiring additional lingual/labial graft, bilateral BMG, or a history of prior BMG harvest were also excluded. IANB + BNB was performed with a 10 ml mixture comprising lignocaine, bupivacaine, and dexamethasone, while normal saline was administered in the control group. Both groups received submucosal local anesthetic infiltration. Results: After randomization (n = 28 in each group), patients who received IANB + BNB had an early return to pain-free liquid (median 1 vs. 2 days; P ≤ 0.001) and solid diet (median 2 vs. 3 days; P = 0.001) 1 day quicker than those who received placebo. In the intervention arm, Visual Analog Scale scores at harvest site were lower from 2 to 48 h postoperatively, had reduced paracetamol requirement (median 7 g vs. 9 g; P = 0.001), and fewer necessitated opioids for breakthrough pain (14.4% vs. 53.3%; P = 0.002). Conclusion: Patients who received IANB + BNB resumed a pain-free diet in the postoperative period quicker, reported lower pain scores, and there were lesser postoperative analgesic requirements. [ABSTRACT FROM AUTHOR]

This study reports a rare case of referred pain in the trigeminal nerve distribution caused by entrapment of the greater occipital nerve (GON). Notably, the pain extended to the ipsilateral tongue, an unusual intraoral involvement. GON entrapment can lead to sensitization in secondary nociceptive neurons within the trigeminocervical complex (TCC), which receives signals from both trigeminal and occipital nerves, causing referred facial pain. A 55‐year‐old female presented with chronic left temporo‐occipital pain, along with pain in her left periorbital area, ear canal, gum, and a 20‐year history of atypical facial pain on her left tongue and lower lip. Following GON decompression, her temporo‐occipital pain and facial symptoms improved, with a significant reduction in burning pain on her tongue and resolution of lip tingling. The TCC, comprising convergent inputs from trigeminal and occipital nerves, is the anatomical basis of referred craniofacial pain. Chronic GON entrapment can sensitize second‐order neurons in the TCC and medullary dorsal horn, explaining this unusual referred pain to the intraoral structures. [ABSTRACT FROM AUTHOR]

Cold allodynia is a debilitating symptom of orofacial neuropathic pain resulting from trigeminal nerve damage. The molecular and neural bases of this sensory alteration are still poorly understood. Here, using chronic constriction injury (CCI) of the infraorbital nerve (IoN) (IoN-CCI) in mice, combined with behavioral analysis, Ca2+ imaging and patch-clamp recordings of retrogradely labeled IoN neurons in culture, immunohistochemistry, and adeno-associated viral (AAV) vector-based delivery in vivo , we explored the mechanisms underlying the altered orofacial cold sensitivity resulting from axonal damage in this trigeminal branch. We found that cold allodynia induced by IoN-CCI is linked to an increase in the proportion of cold-sensitive neurons (CSNs) contributing to this branch and a shift in their thermal thresholds to higher temperatures. These changes are correlated to a reduction of the Kv1.1-1.2-dependent brake potassium current IKD in IoN CSNs and a rise in the percentage of trigeminal neurons expressing TRPM8. The analysis of the electrophysiological properties of CSNs contributing to the IoN suggests that painful cold hypersensitivity involves the recruitment of silent nociceptive afferents that become sensitive to mild cold in response to nerve damage. Notably, pharmacological suppression of TRPM8 channels and AAV-based transduction of trigeminal neurons with the Kv1.1 channel in vivo effectively reverted the nociceptive phenotype in injured animals. Altogether, our results unveil a crucial role of TRPM8 and Kv1 channels in orofacial cold allodynia, suggesting that both the specific TRPM8-blocking and the AAV-driven expression of potassium channels underlying IKD in trigeminal neurons can be effective tools to revert this damage-triggered sensory alteration. [ABSTRACT FROM AUTHOR]

Background: Classical trigeminal neuralgia (TN) is characterized by sudden, severe facial pain, typically resulting from a neurovascular conflict affecting the trigeminal nerve. In rare cases, both nerves are affected simultaneously causing bilateral TN (BTN), increasing the complexity of the treatment. Microvascular decompression (MVD) is a well-established treatment for TN; however, the experience with immediate consecutive bilateral MVD procedures is limited and requires further evaluation. Objective: To evaluate the safety and efficacy of immediate consecutive bilateral MVD in patients with severe BTN compared to non-consecutive bilateral MVD procedures. Methods: A retrospective analysis was conducted on 15 patients with BTN who underwent bilateral MVD. The data on clinical presentation, surgical technique, perioperative findings, complications, and follow-up outcomes of three cases of BTN treated with consecutive bilateral MVD surgeries were analyzed and compared to 12 who received separated procedures. Moreover, a detailed presentation of the three cases of consecutive MVD is provided to illustrate clinical decision-making, surgical nuances, and individual outcomes. Results: Both groups achieved significant pain relief (p < 0.001) without notable differences in Barrow Neurological Institute (BNI) pain intensity score (p = 0.305), indicating that both approaches were equally effective. The consecutive MVD group experienced a shorter total surgical duration (p = 0.025), while postoperative complications were comparable (p = 0.077), mostly transient with no major adverse events or mortality. At the last follow-up, the patients remained pain-free without recurrence of TN symptoms. Conclusion: Consecutive bilateral MVD is a safe and effective option, comparable to non-consecutive procedures for treating BTN. This approach provides a viable alternative for patients with severe bilateral symptoms or when medical constraints limit the possibility of two separate surgeries. Further studies with larger cohorts and extended follow-up periods are needed to support these results. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionTo assess the trigeminal blink reflex in chronic orbital pain and its modification by orbital anesthetic injections using a novel blink reflexometer.The EyeStat (Generation 3, Blinktbi, Inc. Charleston, SC) is a device that triggers and analyzes the carbon dioxide puff-evoked trigeminal blink response. In this prospective study, CO2 puffs were delivered to each eye of 6 patients with unilateral, chronic orbital pain at baseline and 30 minutes after unilateral orbital anesthetic injections consisting of lidocaine and bupivacaine. Ten healthy subjects underwent the testing once without injections. Main outcome measures were comparison of the average of the right and left eyelid responses to stimuli given to the right or left eye (to assess afferent response in the right vs left eye) and comparison of the right eyelid to left eyelid responses to both the right and left stimuli (to assess efferent response in the right vs left eye).In 10 healthy patients, direct blink response of the stimulated eyelid exceeded the consensual response of the opposite eyelid (latency p = .001, excursion p = .04, time to close p = .03). Among the 6 pain patients, eyelid kinematics for afferent trigeminal input were similar between the affected eye and the fellow eye. However, after injection, the afferent latency of the affected eye was significantly prolonged relative to the unaffected eye (p = .006). Efferent blink responses were similar between the two eyelids at all time points.Peribulbar anesthetic injections modulate mechanical afferent input to the trigeminal blink reflex. [ABSTRACT FROM AUTHOR]

Objective: Multiple techniques have been used to treat trigeminal neuralgia (TGN), including pharmacotherapy, radiosurgery, rhizotomy and microvascular decompression (MVD). Blood vessels are considered to be the most common cause of offense and compression to trigeminal nerve. We aimed to determine the causes of classic TGN and efficacy of MVD. Methods: This retrospective, cross-sectional study assessed the data of 53 patients, who underwent MVD at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan, from May, 2022 to December, 2023. Information regarding patient demographics, clinical presentation, Barrow Neurological Institute Facial Pain Score (BNI-FPS), intra-operative findings, and postoperative complications were analyzed. Results: The mean age at presentation was 44.33±11.71 years. Unilateral facial pain was the consistent clinical presentation among all patients, with right-sided involvement in 67.92% patients. All patients had involvement of at least two divisions of trigeminal nerve; maxillary and mandibular nerve in 84.91% and 71.70% cases, respectively. BNI-FPS Grade-IVb was found among 49.09% patients on presentation. Arachnoid adhesions, superior cerebellar artery and superior petrosal vein were the most common causes of compression in 71.70%, 50.94% and 43.40% cases, respectively. About 94% patients were discharged home on first post-operative day without complications and with BNI-FPS Grade-I. Conclusions: Microvascular decompression is highly advocated in classic cases of TGN. In the absence of grossly visible offending vascular structure, arachnoid adhesions should be the thorough focus of address. [ABSTRACT FROM AUTHOR]