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Mariani L. Godoy N. Seiler RW.

Neurochirurgische Klinik, Inselspital Bern.

[Surgical versus medical treatment of idiopathic trigeminal neuralgia]. [Review] [16 refs] [German]

Original Chirurgische versus medikamentöse Behandlung der idiopathischen Trigeminusneuralgie ("tic douloureux").

Schweizerische Medizinische Wochenschrift. Journal Suisse de Medecine.

128(40):1512-8, 1998 Oct 3.


The primary treatment of idiopathic trigeminal neuralgia is medical. Surgery is reserved for unresponsive patients or in case of long lasting, tedious or dangerous side effects of the medication. The surgeon has to inform the patient about risks and benefits of the different surgical methods and consider the patient's expectations and fears in order to choose the best surgical alternative. We describe the clinical picture of trigeminal neuralgia, the steps leading to the diagnosis. We also discuss the pathogenesis and the different treatment modalities with emphasis on surgical methods.

[References: 16]

Higa K. Hori K. Harasawa I. Hirata K. Dan K.

Department of Anesthesiology, School of Medicine, Fukuoka University, Japan.

High thoracic epidural block relieves acute herpetic pain involving the trigeminal and cervical regions: comparison with effects of stellate ganglion block.

Regional Anesthesia & Pain Medicine. 23(1):25-9, 1998 Jan-Feb.


BACKGROUND AND OBJECTIVES: Stellate ganglion block can promptly relieve acute herpetic pain (AHP) involving the trigeminal and cervical regions. However, repeated blocks are needed to maintain pain relief in most patients with severe AHP. Because continuous epidural block is easily performed using an indwelling catheter, we compared the effect of high thoracic epidural block with that of stellate ganglion block to relieve moderate-to-severe AHP involving these regions.

METHODS: Six patients received stellate ganglion blocks and seven patients received high thoracic epidural blocks. Six milliliters 1% of mepivacaine was given to each patient. Acute herpetic pain was evaluated before and up to 60 minutes after the blocks, using a visual analog scale (VAS) of pain.

RESULTS: There was no significant difference in VAS pain scores before the blocks between the groups, but there were significant (P < .05) decreases in VAS pain scores for both groups between 10 and 60 minutes after the blocks. There were no significant differences in VAS pain scores between the groups after the blocks.

CONCLUSIONS: High thoracic epidural block was as effective as stellate ganglion block in relieving moderate-to-severe AHP involving the trigeminal and cervical regions.

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