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of patients&#44; with impaired sensory discrimination on the affected side of the face&#46; They tend to be younger individuals in whom involvement of the ophthalmic division of the trigeminal nerve &#40;V1&#41; is less common&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The pathophysiology of idiopathic TN is usually related to mechanical vascular compression&#46; In MS&#44; it has traditionally been associated with a demyelinating plaque in the nerve root entry zone &#40;REZ&#41; or in the intrapontine segment of the trigeminal nerve&#44; between the trigeminal REZ and its nucleus&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;7&#44;8</span></a> The REZ represents a zone of reduced resistance&#44; where Schwann cells are replaced by oligodendrocytes without myelin&#46; These cells are hyperexcitable and can release high-frequency ectopic discharges through neighbouring healthy fibres&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> It is thought that there may sometimes be a double mechanism of inflammatory and compressive demyelination&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Initially&#44; cases of idiopathic TN are usually treated medically&#44; reserving surgical management for resistant cases or when medication is not well tolerated&#46; However&#44; these is no consensus on the treatment of neuralgia in MS&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> There are different surgical&#44; percutaneous or open treatment options that can be considered regardless of TN etiology&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Microvascular decompression &#40;MVD&#41; is considered the treatment of choice for primary TN with arterial or venous compression&#46; Although symptoms can recur in idiopathic TN&#44; it is more common in MS&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> A rarely used surgical option at present is partial sensory trigeminal rhizotomy &#40;PSTR&#41;&#46; Described by Dandy in 1929&#44; it is an option in the event of poor response to medication and surgery and radiosurgery &#40;RS&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;14</span></a> In its beginnings&#44; variable results were obtained in sensory disturbance&#44; pain relief and abnormal corneal reflex&#44; meaning it never became popular and was replaced by other approaches&#46; However&#44; thanks to current knowledge of anatomy and how the brainstem area works&#44; the technique can be approached with greater safety&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Given the recurrence of symptoms after conventional medical and surgical treatment&#44; as well as RS in particular patients&#44; such as those with MS&#44; we present our experience with this technique for pain control in difficult-to-manage TN&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patient data</span><p id="par0025" class="elsevierStylePara elsevierViewall">We retrospectively collected data on patients with primary or secondary TN who underwent surgery with PSTR at our centre from January 2018 to January 2023&#46; Individuals whose pain had not been satisfactorily controlled with previous medical and surgical treatment were selected for this procedure&#46; All were clinically assessed at the neurosurgery outpatient clinic and had at least one brain magnetic resonance imaging &#40;MRI&#41; scan&#46; They were evaluated with the Barrow Neurological Institute &#40;BNI&#41; pain intensity score to assess pain control &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Review</span><p id="par0030" class="elsevierStylePara elsevierViewall">A review of the literature on the use of PSTR in TN was performed in PubMed&#46; The key words were&#58; &#34;trigeminal neuralgia&#34; combined with &#34;multiple sclerosis&#44; microvascular decompression&#44; partial sensory rhizotomy&#44; radiosurgery and percutaneous radiofrequency thermocoagulation&#34;&#46; Articles in Spanish and English were considered for the literature review&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Surgical technique</span><p id="par0035" class="elsevierStylePara elsevierViewall">In the park-bench or supine position with the head lateralized&#44; through an incision of about 3&#8239;cm at the posterior border of the mastoid&#44; a retrosigmoid approach under the microscope is adopted to expose the cerebellopontine angle&#46; After durotomy&#44; the cerebellomedullary cistern is opened to release cerebrospinal fluid &#40;CSF&#41; and relieve tension&#46; The arachnoid adhesions with the seventh and eighth cranial nerves &#40;CN VII and CN VIII&#41; are then released and the fifth cranial nerve &#40;CN V&#41; is exposed&#46; The root of the fifth cranial nerve is located 0&#46;5&#8722;1&#8239;cm from the pons&#46; The ventrolateral two-thirds of the pars major of the nerve are identified and severed after coagulation&#46; All procedures were performed under neurophysiological monitoring to locate the seventh cranial nerve and the motor root of the fifth cranial nerve&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">We collected data on five patients&#59; three men and two women with a mean age of 53 years &#40;range 45&#8211;58&#41;&#46; Four &#40;80&#37;&#41; had been diagnosed with MS&#46; The other had idiopathic TN&#46; In total&#44; 80&#37; of the patients had V2 and V3 or right-sided involvement&#46; According to the BNI pain intensity score&#44; all had a score of V with no improvement with medication or multiple prior surgical treatments&#44; including radiosurgery in four of the five cases &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The mean follow-up time was 22&#46;6 months &#40;range 6&#8722;60 months&#41;&#46; All patients were assessed by Neurology and Ophthalmology after surgery to rule out complications&#44; mainly possible corneal ulcer&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Pain relief was achieved in 80&#37; of the patients after surgery and they were able to discontinue their medication&#46; The remaining patient&#44; who had MS&#44; was the only one who required a second operation due to recurrence of symptoms during follow-up&#46; None of the four patients who originally achieved pain relief currently have neuralgia requiring treatment&#46; According to the BNI score&#44; two patients are currently grade I&#44; two are grade II and one is grade III &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Regarding complications arising from the procedure&#44; one patient suffered corneal keratitis&#46; The patient had MS and this was an unexpected complication&#46; Side effects were non-painful hypoaesthesia and in one case&#44; anaesthesia in the severed branches&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">At our centre&#44; young patients with idiopathic TN undergo surgery to explore the trigeminal &#40;fifth&#41; nerve root&#44; even if no vascular conflict is observed on MRI&#46; The aim is to relieve mechanical compression and remove any arachnoid adhesions&#46; For older adult patients&#44; percutaneous techniques are initially chosen&#44; although this is a subject of much debate&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Where symptoms are due to MS&#44; MVD is only performed if neurovascular conflict is observed on imaging tests&#46; In the absence of such compression&#44; percutaneous diathermocoagulation of Gasser&#39;s ganglion and radiosurgery are the techniques of choice&#46; If no significant improvement in pain is achieved despite the above treatments&#44; PSTR is offered&#46;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Anatomy and somatotopy of the trigeminal nerve</span><p id="par0060" class="elsevierStylePara elsevierViewall">Throughout history&#44; multiple surgical treatments for TN have been proposed&#46; Frazier&#44; Dandy and Kirschner described sensory disturbances and anaesthesia of the affected side of the face&#44; as well as the possible development of an ipsilateral corneal ulcer as a result of severing the sensory branch of the nerve&#46; Dandy performed rhizotomy at the caudal end of the sensory root&#44; close to the pons&#44; and thereby decreased the incidence of changes in the ipsilateral eye&#44; unlike the neurectomy procedure described by Frazier at the rostral end of the root&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;16&#44;17</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Thanks to the anatomical studies of Rhoton and Gudmundsson&#44; we know that the trigeminal fibres are topographically distributed posterior to the Gasser ganglion&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a> These authors described that the first branch of fibres tends to be dorsal and medial&#44; and the third branch caudal and lateral in the part close to the pons&#46; They explain&#44; however&#44; that the third division may vary from lateral to caudal from the first and explain the variability in sensory loss after partial nerve section&#46; Several anatomical studies show that fibres of similar function tend to group together near the pons&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#8211;20</span></a> Nociceptive fibres are preferentially found in the lateral area of the root close to the pons&#44; which is called the <span class="elsevierStyleItalic">pars major</span>&#44; and ends in the spinal nucleus of the fifth cranial nerve&#46; In contrast&#44; the epicritic and proprioceptive fibres are located in the <span class="elsevierStyleItalic">pars intermedia</span>&#46; The former reach the pontine nucleus &#40;main sensory nucleus&#41; and the latter the mesencephalic nucleus&#46; The motor nucleus is made up of axons that form the motor root and are located in the medial part of the trigeminal nerve&#44; which is called the <span class="elsevierStyleItalic">pars minor</span>&#46; Both our experience and the literature are consistent in observing that the <span class="elsevierStyleItalic">pars major</span> and the <span class="elsevierStyleItalic">pars intermedia</span> can be recognised in the area adjacent to their entrance into the pons&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> A functional analysis by Terrier et al&#46; found that the <span class="elsevierStyleItalic">pars major</span> is made up of nociceptive fibres&#46; This explains why patients achieve analgesia of the area without anaesthesia&#46; This topographical somatotopy also explains why patients do not show any loss of corneal sensitivity after the procedure&#46; Limiting rhizotomy to the ventrolateral two thirds of the <span class="elsevierStyleItalic">pars major</span> preserves the corneal nociceptive fibres and prevents corneal ulcer&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The use of NFG in MVD and PSTR is a subject of much debate due to the difficulty in sensory monitoring and the integrity of the surgical anatomy&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> In our centre&#44; motor monitoring with direct electromyography &#40;EMG&#41; on the motor branch of the fifth nerve and on the seventh cranial nerve is routinely used&#46; Although there are some studies on sensory monitoring of the pars major&#44; mainly in recurrences&#44; its use is not yet widespread and it is not applied by our group&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> In our experience&#44; this tool has proved useful for locating the motor branch of the fifth cranial nerve and makes the procedure safer&#44; although we do not consider it to be essential with adequate anatomical knowledge of the area &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Treatment of TN</span><p id="par0075" class="elsevierStylePara elsevierViewall">There are multiple treatment options for TN&#46; MVD is reported to be the most effective technique&#46; According to a recent meta-analysis&#44; the postoperative relief resulting in a BNI score of I is 82&#46;9&#37;&#44; dropping to 64&#46;7&#37; in the long term&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Although it can be considered a very effective technique&#44; recurrent pain can be poorly controlled with BNI grades of III and IV&#46; Unfortunately&#44; all treatment options are less effective in MS&#46; <span class="elsevierStyleSup">24</span> Due to the high recurrence rate in these patients&#44; the short pain-free time intervals and the large number of treatments they will need throughout their lives&#44; each procedure must be carefully chosen&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The use of PSTR has been described in patients with and without MS&#46; In primary TN&#44; it has been used alone or in combination with MVD when no clear intraoperative mechanical compression was observed&#44; with clinical relief achieved in 95&#37; of patients&#44; although with a recurrence rate close to 30&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;25</span></a> In one study&#44; MVD and PSTR outcomes in primary TN were randomly compared&#44; finding no differences in pain control but a greater number of complications and a higher recurrence rate with PSTR than with MVD&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Zhang&#39;s group published a comparison between MVD and MVD&#8239;&#43;&#8239;PSTR&#46; The MVD&#8239;&#43;&#8239;PSTR group recorded a higher rate of freedom from pain for two years&#44; although the difference was not statistically significant&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Ruiz-Juretschke F et al&#46; published an idiopathic TN surgical treatment series&#44; in which PSTR was performed on four patients with favourable outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> According to the literature&#44; the risk of hypoaesthesia in patients with primary TN varies from 16&#37; to 67&#37;&#44; and the risk of corneal reflex involvement from 0&#37; to 32&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;28&#44;29</span></a> with an incidence of 100&#37; in cases where the sensory part of the nerve was completely severed&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#8211;32</span></a> Due to the high incidence of recurrences of this condition&#44; PSTR is more commonly performed in repeat surgeries&#44; and the risk of corneal involvement is greater when this procedure is repeated&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> The procedure described is destructive and altered sensation on the same side of the face as the severed nerve is the most common side effect&#46; PSTR can cause very severe side effects&#44; and they have to be weighed up by the patient and the surgeon&#46; Despite this&#44; in our experience and in line with the findings of other authors&#44; patients who undergo this procedure accept both the risks and the side effects in favour of symptomatic improvement in pain &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;31</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Patients with MS experience a high rate of symptom recurrence with standard therapy&#44; ranging from 67&#37; to 100&#37; for percutaneous treatments and 39&#37;&#8211;67&#37; for radiosurgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">33&#44;34</span></a> Furthermore&#44; with RS&#44; pain does not improve until two to six months after the procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> A study conducted by an MS referral centre found that patients who underwent PSTR &#40;12 patients&#41; experienced pain relief of between 87&#37; and 100&#37; and a recurrence rate of 15&#8211;37&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> In this study&#44; this technique was offered to patients with a BNI score of IV or V or to those who could not tolerate the side effects of the medications&#46; Based on the time taken for symptoms to recur&#44; the authors found a statistically significant difference compared to percutaneous treatments &#40;percutaneous rhizotomy&#44; glycerol injection&#44; balloon compression&#41; in favour of PSTR&#44; as well as when analysing comparatively with RS&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In our study&#44; this procedure was performed in patients with BNI scores of V with very poor pain control and who had previously undergone multiple procedures&#44; and at best with only transient improvements in symptoms &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The main limitations of our study pertain to its retrospective nature and very small sample size&#44; so the level of evidence of this study is that of a case series&#46; However&#44; it does provide information on the results of an underused technique that may be considered in patients with recurrent TN which is resistant to standard treatments&#46; It is an additional surgical option&#44; especially in MS patients who are on multiple medications&#44; have long-term poor symptom control and undergo multiple minimally-invasive procedures&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0100" class="elsevierStylePara elsevierViewall">According to the available indexed literature&#44; we are one of the few centres in Spain to publish our experience with PSTR in cases of difficult-to-control TN in the last ten years&#46; In our series&#44; we observed good pain control outcomes&#44; with medication being reduced and even withdrawn&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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              "titulo" => "Anatomy and somatotopy of the trigeminal nerve"
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              "titulo" => "Treatment of TN"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Trigeminal Neuralgia &#40;NT&#41; is a common pathology in Neurosurgery&#46; It can be classified as idiopathic or secondary to other pathologies&#44; such as Multiple Sclerosis &#40;MS&#41;&#46; Several surgical treatments have been described&#44; some of them being replaced by more modern techniques&#46; Partial sensory rhizotomy &#40;PSR&#41;&#44; described by Dandy is a technique replaced by other techniques due to its permanent side effects&#46; We present our experience with this technique in patients with recurrent NT&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods and materials</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A retrospective review is carried out on five patients who underwent surgery at our center from 2018 to 2023 using the PSR technique&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">All the patients intervened showed significant clinical improvement&#44; except one patient who required reintervention due to uncontrolled pain&#46; According to the Barrow Neurological Institute &#40;BNI&#41; scale&#44; 80&#37; &#40;4&#47;5&#41; of patients showed improvement from grade V to grades I&#47;II except for one of them&#46; This patient suffered from MS&#46; Additionally&#44; one patient presented a corneal ulcer after surgery due to impairment of the corneal reflex&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">In our experience&#44; PSR is a valid treatment option in selected patients with recurrent TN&#46; It has a low incidence of complications with an adequate surgical technique and anatomical knowledge of the region&#46; To the best of our knowledge&#44; we are one of the few centers in Spain to publish our results with PSR in the last ten years&#46; We report good results in pain control withdrawing medication in 80&#37; &#40;4&#47;5&#41; of the operated patients&#46;</p></span>"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La Neuralgia del Trig&#233;mino &#40;NT&#41; es una patolog&#237;a com&#250;n para los neurocirujanos&#44; pudiendo clasificarse en idiop&#225;tica o secundaria a otras patolog&#237;as como la esclerosis m&#250;ltiple &#40;EM&#41;&#46; Se han descrito m&#250;ltiples tratamientos quir&#250;rgicos que han ido evolucionando a lo largo del tiempo&#46; Los efectos secundarios permanentes de la rizotom&#237;a parcial sensitiva &#40;RPS&#41; descrita por Dandy&#44; hicieron que esta t&#233;cnica fuera sustituida por otras menos agresivas&#46; Exponemos nuestra experiencia con esta t&#233;cnica en pacientes con NT recurrente&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se realiza una revisi&#243;n retrospectiva de cinco pacientes intervenidos en nuestro centro desde el a&#241;o 2018 hasta el 2023 mediante la t&#233;cnica de la RPS del trig&#233;mino&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Todos los pacientes operados presentaron mejor&#237;a cl&#237;nica significativa&#44; siendo necesario reintervenir a uno de ellos por persistencia del dolor&#46; Seg&#250;n la escala del Barrow Neurological Institute &#40;BNI&#41;&#44; un 80&#37; de los pacientes &#40;4&#47;5&#41; mejoraron de un grado V a un grado I&#47;II&#46; El restante presentaba EM&#46; Como complicaci&#243;n inesperada&#44; un paciente present&#243; una &#250;lcera corneal tras la cirug&#237;a por afectaci&#243;n del reflejo corneal&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">En nuestra experiencia&#44; la RPS es una opci&#243;n v&#225;lida de tratamiento en pacientes seleccionados&#46; Presenta baja incidencia de complicaciones con una adecuada t&#233;cnica quir&#250;rgica y conocimiento anat&#243;mico de la zona&#46; Seg&#250;n la literatura disponible&#44; somos uno de los pocos centros en Espa&#241;a que publica sus resultados con la RPS en la &#250;ltima d&#233;cada&#46; En nuestra serie observamos buenos resultados en el control del dolor&#44; pudiendo retirar la medicaci&#243;n en el 80&#37; &#40;4&#47;5&#41; de los casos&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Antecedentes y objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0115" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0065"
          ]
        ]
      ]
    ]
    "multimedia" => array:5 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Exposure of the trigeminal root&#46; &#40;b&#41; Root coagulation&#46; &#40;c&#41; Partial rhizotomy of the ventrolateral two-thirds&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Table "
            "rol" => "short"
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        "tabla" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pain description&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No pain&#44; no medication needed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Occasional pain&#44; no medication needed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Occasional pain&#44; controlled with medication&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Occasional pain&#44; not controlled with medication&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Severe pain or no pain relief&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3645916.png"
              ]
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Barrow Neurological Institute &#40;BNI&#41; pain intensity score&#46;</p>"
        ]
      ]
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        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Table "
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">PR&#58; percutaneous rhizotomy&#59; PB&#58; botulinum toxin peripheral nerve blocks or mental nerve blocks&#59; MS&#58; multiple sclerosis&#59; MVD&#58; microvascular decompression&#59; RS&#58; radiosurgery&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Branch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Previous treatments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Side&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sequelae&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Preop&#46; BNI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Postop&#46; BNI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Follow-up &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 PR&#44; MVD&#44; RS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ulcer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V2&#44; V3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 PR&#44; RS&#44; PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V2&#44; V3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 PR&#44; PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V2&#44; V3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 PR&#44; RS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V2&#44; V3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MVD&#44; PR&#44; RS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anaesthesia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">N&#58; sample&#59; MS&#58; multiple sclerosis&#59; BNI I&#58; Barrow Neurological Institute pain intensity score I&#59; PSTR&#58; partial sensory trigeminal rhizotomy&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BNI I&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Corneal ulcer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sensory deficit&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Terrier et al&#46; &#40;2018&#41;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;27&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;81&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;22&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bigder et al&#46; &#40;2019&#41;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;85&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;21&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Krishnan et al&#46; &#40;2018&#41;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fern&#225;ndez-Carballal et al&#46; &#40;2004&#41;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;12&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gao et al&#46; &#40;2017&#41;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;58&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;21&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diaz et al&#46; &#40;this study&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;80&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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Journal Information
Vol. 35. Issue 5.
Pages 247-252 (September - October 2024)
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Vol. 35. Issue 5.
Pages 247-252 (September - October 2024)
Clinical Research
Partial sensory rhizotomy in recurrent trigeminal neuralgia. Our experience and literature review
La rizotomia parcial sensitiva en la neuralgia del trigémino recurrente. Nuestra experiencia y revisión de la literatura
Jorge Díaz-Molinaa,
Corresponding author
jdiazmolina1@gmail.com

Corresponding author.
, Javier Ordunab, David Riveroa, Paula Alcázara, Luis Manuel Gonzáleza
a Hospital Universitario Miguel Servet, Zaragoza, Spain
b Hospital MAZ, Zaragoza, Spain
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Tables (3)
Table 1. Barrow Neurological Institute (BNI) pain intensity score.
Table 2. Descriptive table of patients.
Table 3. Summary of PSTR in the literature.
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Abstract
Background and objective

Trigeminal Neuralgia (NT) is a common pathology in Neurosurgery. It can be classified as idiopathic or secondary to other pathologies, such as Multiple Sclerosis (MS). Several surgical treatments have been described, some of them being replaced by more modern techniques. Partial sensory rhizotomy (PSR), described by Dandy is a technique replaced by other techniques due to its permanent side effects. We present our experience with this technique in patients with recurrent NT.

Methods and materials

A retrospective review is carried out on five patients who underwent surgery at our center from 2018 to 2023 using the PSR technique.

Results

All the patients intervened showed significant clinical improvement, except one patient who required reintervention due to uncontrolled pain. According to the Barrow Neurological Institute (BNI) scale, 80% (4/5) of patients showed improvement from grade V to grades I/II except for one of them. This patient suffered from MS. Additionally, one patient presented a corneal ulcer after surgery due to impairment of the corneal reflex.

Conclusion

In our experience, PSR is a valid treatment option in selected patients with recurrent TN. It has a low incidence of complications with an adequate surgical technique and anatomical knowledge of the region. To the best of our knowledge, we are one of the few centers in Spain to publish our results with PSR in the last ten years. We report good results in pain control withdrawing medication in 80% (4/5) of the operated patients.

Keywords:
Trigeminal neuralgia
Multiple sclerosis
Partial sensory rhizotomy
Resumen
Antecedentes y objetivo

La Neuralgia del Trigémino (NT) es una patología común para los neurocirujanos, pudiendo clasificarse en idiopática o secundaria a otras patologías como la esclerosis múltiple (EM). Se han descrito múltiples tratamientos quirúrgicos que han ido evolucionando a lo largo del tiempo. Los efectos secundarios permanentes de la rizotomía parcial sensitiva (RPS) descrita por Dandy, hicieron que esta técnica fuera sustituida por otras menos agresivas. Exponemos nuestra experiencia con esta técnica en pacientes con NT recurrente.

Material y métodos

Se realiza una revisión retrospectiva de cinco pacientes intervenidos en nuestro centro desde el año 2018 hasta el 2023 mediante la técnica de la RPS del trigémino.

Resultados

Todos los pacientes operados presentaron mejoría clínica significativa, siendo necesario reintervenir a uno de ellos por persistencia del dolor. Según la escala del Barrow Neurological Institute (BNI), un 80% de los pacientes (4/5) mejoraron de un grado V a un grado I/II. El restante presentaba EM. Como complicación inesperada, un paciente presentó una úlcera corneal tras la cirugía por afectación del reflejo corneal.

Conclusión

En nuestra experiencia, la RPS es una opción válida de tratamiento en pacientes seleccionados. Presenta baja incidencia de complicaciones con una adecuada técnica quirúrgica y conocimiento anatómico de la zona. Según la literatura disponible, somos uno de los pocos centros en España que publica sus resultados con la RPS en la última década. En nuestra serie observamos buenos resultados en el control del dolor, pudiendo retirar la medicación en el 80% (4/5) de los casos.

Palabras clave:
Neuralgia trigeminal
Esclerosis múltiple
Rizotomía parcial sensitiva

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