Comparison of Cryosurgery and Peripheral Glycerol Injection in Treatment of Trigeminal Neuralgia

Background: Trigeminal neuralgia (TN) is a unique debilitating ailment due to its typical symptoms and wide array of surgical treatment modalities available for TN and it is important to select the most appropriate surgical procedure. Aim: To compare the efficacy of peripheral glycerol injection and cryosurgery in the remission of pain in the treatment of trigeminal neuralgia. Methodology: A randomized controlled trial (RCT) study was started after taking ethical approval, total of 80 patients of both gender were included in this study at Department of Oral and Maxillofacial Surgery, Nishtar Institute of Dentistry Multan from July 2017-January 2018. Patients were divided in two equal groups randomly, group A was treated with peripheral glycerol injection and group B with cryosurgery. Patients were followed up for 3rd month to evaluate the efficacy. All results were entered and analyzed in SPSS 24 version. Outcome variables were presented as mean and SD and qualitative variables were presented as frequency/percentages. Probability value ≤0.05 was considered as significant. Results: The efficacy of cryosurgery was observed as (75%), while the efficacy of anhydrous glycerol was noted as (37.5%). This study results support the cryosurgery rather than peripheral glycerol injection in the treatment of trigeminal neuralgia as cryosurgery has higher efficacy and low recurrence rate in controlling pain than peripheral glycerol injection. Efficacy in both groups with age in 40-65 years (p=0.003) was significant. Efficacy in both groups with type of nerve in mental nerve (p=0.030) and inferior alveolar (p=0.039) were significant and infraorbital (p=0.197) and lingual nerve (p=0.386) were not significant. Conclusion: Our study results were supported to the cryosurgery rather than the injection of peripheral glycerol for treatment of trigeminal neuralgia. Keywords; Trigeminal Neuralgia, Peripheral Glycerol injection, Cryosurgery.

Refractory cluster-tic syndrome: The Hickam’s dictum

A 50-year-old man debuted with right trigeminal neuralgia. In the following years, it became refractory to medical treatment and ipsilateral cluster headache appeared. He was diagnosed with cluster-tic syndrome. A brain magnetic resonance with high-spatialresolution 3D T2 sequences (FIESTA) excluded the existence of neurovascular conflict, but a surgical exploration was indicated due to its torpid evolution. A venous contact with the right trigeminal nerve was confirmed in the surgery and microvascular decompression was performed. The patient’s evolution was favorable, improving the trigeminal neuralgia as well as the cluster headache. Keywords: Trigeminal neuralgia; cluster headache; cluster-tic syndrome; microvascular decompression.

The Profile of Pharmacological Treatment in Trigeminal Neuralgia Patients in The Period of January 2018-December 2018

Trigeminal neuralgia is a condition that affects the trigeminal nerve, that manifests in a series of stabbing like pain, and often described like electricity. Its treatment guideline is to prioritize pharmacotherapy until patient is well. The gold standard treatment for trigeminal neuralgia is pharmacotherapy of Carbamazepine. However, carbamazepine is proven to cause allergic reaction to some patients. This research aims to describe the pharmacotherapy that is given to patients. The regiments of pharmacotherapy in trigeminal neuralgia shows that CBZ is the main pharmacotherapy given, as it is the gold standard treatment. GBP is the is the second most pharmacotherapy given and a concoction medication of Paracetamol, Diazepam and Amitriptyline being the third most favored therapy. Neurotropic B Vitamins plays a big role, as a support in the therapy to maintain the health of the overall nervous system. The pain scale data shows that almost all patients have significant pain relieve. The therapy of trigeminal neuralgia in this study shows that CBZ is most favored as it is the gold standard, however not all AEDs are accessible. Almost all patients have significant pain relieve eventhough not using gold standard treatment. Keywords: trigeminal neuralgia; pharmacotherapy