Trigeminal neuralgia is very common problem and early diagnosis is important

1. TRIGEMINAL NEURALGIA
DR ANURAG SINGH
CONSULTANT RADIOLOGIST

2. Trigeminal neuralgia is characterized by sudden
bursts (paroxysms) of face pain. These bursts are
often triggered by a light touch around the mouth
or face or by talking, eating, or brushing teeth

3. Pain distribution

4. TRIGGER ZONES
• These zones are
usually near the nose,
lips, eyes, ear, or
inside the mouth.

5. Kindling' theory : Pulsatile vessel
coming in contact with nerve
induces ectopic excitations which
travel retrogradely back to the
nucleus of nerve.

6. SEQUENCES USED
• CISS 3D
• TIW Postcontrast
• MR ANGIOGRAPHY

7. NORMAL ANATOMY

8. NORMAL ANATOMY

10. VASCULAR LOOPS

11. GAMMA KNIFE

12. GAMMA KNIFE MACHINE

16. What results can be expected
from GKRS?
• Good pain relief occurs in upto 90 percent
of patients. Onset of pain relief may occur
one day to four months after the
procedure.
• Patients with multiple sclerosis are less
likely to respond to GKRS.

17. The target can be either the
proximal root entry zone of the
trigeminal nerve or the distal
(retrogasserian) portion

18. What Are The Methods Other
than The Gamma Knife

19. Sensory rhizotomy
• irreversible cutting of
the trigeminal nerve
root at its connection
to the brainstem.

20. MICROVASCULAR
DECOMPRESSION
• a sponge is inserted
between the
trigeminal nerve and
the blood vessel to
relieve the
compression that
causes the painful
neuralgia attacks.

21. Percutaneous Stereotactic
Radiofrequency Rhizotomy
• The surgeon passes an
electrode introducer
(hollow needle) through
the skin of cheek into the
selected nerve at the
base of the skull. A
heating current, which is
passed through the
electrode, destroys some
of the nerve fibers. The
entire nerve is not
destroyed.

22. Summary
Gamma Knife radiosurgery relieves the
pain with fewer complications and should
be the treatment of choice.

23. • Depression is often seen in patients with
trigeminal neuralgia; thus, this underlying
depression should be adequately treated.

24. taking treatment for trigeminal neuralgia