The Patient with Trigeminal Neuralgia

  • Zenaida Aurellano-Hoh

Abstract

A 33-year-old white female was admitted for a posterior fossa craniectomy for microvascular decompression of the trigeminal nerve. The patient had been suffering for eight years from brief, extremely intense paroxysms of pain, which she described as lightning-like stabbing sensations on her right cheek and around her lips, precipitated by chewing, brushing her teeth, talking, washing her face, and applying make-up. The pain would last seconds to minutes and rarely occurred at night. For the past year, she had been experiencing attacks several times daily, despite carbamazepine 1200mg by mouth daily in four divided doses.

Keywords

Sponge Diazepam Fentanyl Propranolol Lidocaine 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Walker A.E.: A History of Neurological Surgery. New York, Hafner Pub Co., 1967, pp 309–313.Google Scholar
  2. 2.
    Victor M., Adams R.D.: Diseases of cranial nerves, in Harrison T.R. (ed): Principles of Internal Medicine. New York, McGraw-Hill Book Co, 1980, p 2023.Google Scholar
  3. 3.
    Voorhies R., Patterson R.H.: Management of trigeminal neuralgia (tic douloureux). JAMA 245: 2521–2523, 1981.PubMedCrossRefGoogle Scholar
  4. 4.
    Greenberg C., Papper E.M.: The indications for Gasserian ganglion block for trigeminal neuralgia. Anesthesiology 31: 566–573, 1969.PubMedCrossRefGoogle Scholar
  5. 5.
    Fromm G.H., Terrence D.F., Chattha A.S.: Baclofen in the treatment of trigeminal neuralgia: Double-blind study and long-term follow-up. Ann Neurol 15: 240–244, 1984.PubMedCrossRefGoogle Scholar
  6. 6.
    Killian J.M., Fromm G.H.: Carbamazepine in the treatment of neuralgia. Arch Neurol 19: 129–136, 1968.PubMedGoogle Scholar
  7. 7.
    Loeser J.D.: The management of tic douloureux. Pain 3: 155–161, 1977.PubMedCrossRefGoogle Scholar
  8. 8.
    Apfelbaum R.I.: Surgery for tic douloureux. Clin Neurosurg 31: 667–683, 1984.Google Scholar
  9. 9.
    Lundsford L.D., Apfelbaum R.I.: Choice of surgical therapeutic modalities for treatment of trigeminal neuralgia: microvascular decompression, percutaneous retrogasserian thermal, or glycerol rhizotomy. Clin Neurosurg 31: 319–333, 1984.Google Scholar
  10. 10.
    Janetta P.J.: Treatment of trigeminal neuralgia by suboccipital and transtentorial cranial operations. Clin Neurosurg 23: 538–549, 1976.Google Scholar
  11. 11.
    Penman J.: Trigeminal neuralgia, in Vinken P.K., Bruyn G.W. (eds): Handbook of Clinical Neurology, New York, Elsevier Publishing Co, 1968, p 296.Google Scholar
  12. 12.
    Apfelbaum R.I.: Surgical management of disorders of the lower cranial nerve, in Schmidek H.H., Sweet W.H. (eds): Operative Neurosurgical Techniques, vol 2. New York, Grune & Strutton, 1982, pp 1063–1082.Google Scholar
  13. 13.
    Lundsford L.D.: Treatment of tic douloureux by percutaneous retrogasserian glycerol injection. JAMA 248:449–453, 1982.CrossRefGoogle Scholar
  14. 14.
    Melmon K.L., Gilman A.G.: Drug interactions, in Goodman L.S., Gilman A.G. (eds): The Pharmacological Basis of Therapeutics. New York, Macmillan, 1980, pp 1739–1740.Google Scholar
  15. 15.
    Sill J.C., Schumacher K., Southorn P.A., et al: Bradycardia and hypotension associated with baclofen used during general anesthesia. Anesthesiology 64:255–258, 1986.PubMedCrossRefGoogle Scholar
  16. 16.
    Brodsky J.B., Samuels S.I., Britt R.H., et al: Anesthesia for trigeminal nerve thermocoagulation, correspondance. Anaesthesia 38: 912–913, 1983.PubMedGoogle Scholar
  17. 17.
    Lowe S.S., Meurer M., Ingram O., et al: Anesthesia for trigeminal nerve thermocoagulation. Anaesthesia 38:152–154, 1983.PubMedCrossRefGoogle Scholar
  18. 18.
    Apfelbaum R.I.: Technical considerations for facilitation of selective percutaneous radiofrequency neurolysis of the trigeminal nerve. Neurosurgery 3:396–399, 1978.PubMedCrossRefGoogle Scholar
  19. 19.
    Cucchiara R.F.: Positioning the neurosurgical patient: Special considerations. ASA Annual Refresher Course Lectures, 116, 1984.Google Scholar
  20. 20.
    Mogos B., Phillips P.L., Apfelbaum R.I., et al: Is right artrial catheterization always indicated for anesthesia in the sitting position? Anesth Analg 61: 205, 1982.Google Scholar
  21. 21.
    Frost E.A.M., Rubin R.C.: Posterior Cranial Fossa Surgery, in Frost E.A.M. (ed): Clinical Anesthesia in Neurosurgery. Boston, Butterworth, 1984, pp 155–185.Google Scholar

Copyright information

© Birkhäuser Boston 1988

Authors and Affiliations

  • Zenaida Aurellano-Hoh

There are no affiliations available

Personalised recommendations