{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T04:15:08Z","timestamp":1782792908438,"version":"3.54.5"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T00:00:00Z","timestamp":1730419200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T00:00:00Z","timestamp":1730419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>Percutaneous lesioning-techniques for treating refractory Trigeminal Neuralgias not amenable to Micro-Vascular Decompression remain useful in neurosurgical practice. Success, avoidance of complications and reduction of side-effects depend on the accurate location of the lesion-maker especially for Radio-Frequency-Thermo-Rhizotomy (RF-Th-Rh).<\/jats:p>\n            <jats:p>Added to X-ray-guidance, Intra-Operative Neurophysiology can be of significant help to achieve optimal accuracy of the surgery.<\/jats:p>\n            <jats:p>Based on previous research, this article aims to describe the simplest way to use direct electrical stimulation of the trigeminal root to evoke clinically observable muscle responses allowing to precisely position the tip of the needle for accurate lesioning.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Technique to evoke specific localizing muscle responses<\/jats:title>\n            <jats:p>Masticatory twitches can be easily produced by stimulating the motor root, through orthodromic conduction to the masticatory muscles.<\/jats:p>\n            <jats:p>Evoked Muscle Responses (EMRs) can be elicited in the facial nerve territory by stimulating the sensory rootlets, through Trigemino-Facial Reflexes\u2019 pathways (TFRs). Responses in the Orbicularis Oculi is the well-known and readily used \u201cBlink reflex\u201d. On the contrary, TFRs in the lower territory of the facial nerve escaped clinical investigations not having been explored under direct stimulation of the trigeminal root. For both, stimulation at 5 c\/s produces better observable twitches (because saccadic) than at 50 c\/s which elicits tetanic contractions.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>The localizing-value of these facial EMRs (associated to evocation of paresthesias) and of the masticatory responses, justifies mapping the trigeminal root before lesioning. Their use could be extended to the other lesioning-techniques: not only Glycerol Neurolysis but also to Balloon Compression (to ascertain location of the trocar at the contact of the TGN inside the Meckel cave) and Open partial Rhizotomies (before deciding to cut the rootlets corresponding to the trigger-zone). This is of importance since lesioning-techniques are needed because not all trigeminal neuralgias are responsive to or even indications of Micro-Vascular Decompression.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00701-024-06323-4","type":"journal-article","created":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T02:01:58Z","timestamp":1730426518000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Technical report on intra-operative trigeminal root mapping in percutaneous lesioning for trigeminal neuralgias"],"prefix":"10.1007","volume":"166","author":[{"given":"Marc","family":"Sindou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrei","family":"Brinzeu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,11,1]]},"reference":[{"issue":"6","key":"6323_CR1","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1007\/s00276-019-02217-8","volume":"41","author":"F Bernard","year":"2019","unstructured":"Bernard F, Mercier P, Sindou M (2019) Morphological and functional anatomy of the trigeminal triangular plexus as an anatomical entity: a systematic review. Surg Radiol Anat 41(6):625\u2013637. https:\/\/doi.org\/10.1007\/s00276-019-02217-8","journal-title":"Surg Radiol Anat"},{"key":"6323_CR2","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1007\/s00701-024-06074-2","volume":"166","author":"A Brinzeu","year":"2024","unstructured":"Brinzeu A, Sindou M (2024) Retrogasserian trigeminal radiofrequency-thermorhizotomy for trigeminal neuralgia How I do it. Acta Neurochirurgica 166:209. https:\/\/doi.org\/10.1007\/s00701-024-06074-2","journal-title":"Acta Neurochirurgica"},{"key":"6323_CR3","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1136\/jnnp.49.4.411","volume":"49","author":"G Cruccu","year":"1986","unstructured":"Cruccu G (1986) Intracranial stimulation of the trigeminal nerve in man. I: Direct motor responses. J Neurol Neurosurg Psychiatry 49:411\u2013418","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"6323_CR4","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1136\/jnnp.49.4.419","volume":"49","author":"G Cruccu","year":"1986","unstructured":"Cruccu G, Bowsher D (1986) Intracranial stimulation of the trigeminal nerve in man. II: Reflex responses. J Neurol Neurosurg Psychiatry 49:419\u2013427","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"5","key":"6323_CR5","doi-asserted-by":"publisher","first-page":"592","DOI":"10.3171\/jns.1971.35.5.0592","volume":"35","author":"K Gudmundsson","year":"1971","unstructured":"Gudmundsson K, Rhoton A Jr, Rushton JG (1971) Detailed anatomy of the intracranial portion of the trigeminal nerve. J Neurosurg 35(5):592\u2013600","journal-title":"J Neurosurg"},{"issue":"6","key":"6323_CR6","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1227\/00006123-198112000-00005","volume":"9","author":"S H\u00e5kanson","year":"1981","unstructured":"H\u00e5kanson S (1981) Trigeminal neuralgia treated by the injection of glycerol into the trigeminal cistern. Neurosurgery 9(6):638\u2013646","journal-title":"Neurosurgery"},{"key":"6323_CR7","first-page":"627","volume":"100","author":"F Hartel","year":"1912","unstructured":"Hartel F (1912) Die Leitungsanasthese und Injecktionbehandlung des Ganglioni gasseri und der Trigeminusstamme. Arch Klin Chir 100:627\u2013638","journal-title":"Arch Klin Chir"},{"key":"6323_CR8","first-page":"613","volume":"16","author":"H Kawamura","year":"1988","unstructured":"Kawamura H, Amano K, Tanikawa T, Kawabatake H, Notani M, Iseki H, Shiwaku T, Nagao T, Taira T, Iwata Y (1988) Identification of location of electrode tip during percutaneous retrogasserian glycerol injection (PRGI) with blink reflexes elicited by direct stimulation of trigeminal complex (DBR) No Shinkei Geka. Neurol Surg 16:613\u2013620","journal-title":"Neurol Surg"},{"key":"6323_CR9","doi-asserted-by":"crossref","unstructured":"Mullan S, Lichtor (1983) Percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia. J Neurosurg 59(6):1007\u20131012","DOI":"10.3171\/jns.1983.59.6.1007"},{"issue":"14","key":"6323_CR10","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1159\/000029768","volume":"73","author":"MP Sindou","year":"1999","unstructured":"Sindou MP (1999) Neurophysiological navigation in the trigeminal nerve: use of masticatory responses and facial motor responses evoked by electrical stimulation of the trigeminal rootlets for RF-thermorhizotomy guidance. Stereotact Funct Neurosurg 73(14):117\u2013121. https:\/\/doi.org\/10.1159\/000029768","journal-title":"Stereotact Funct Neurosurg"},{"key":"6323_CR11","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1093\/brain\/awz407","volume":"143","author":"M Sindou","year":"2020","unstructured":"Sindou M, Brinzeu A (2020) Topography of the pain in classical trigeminal neuralgia: insights into somatotopic organization. Brain 143:531\u2013540","journal-title":"Brain"},{"issue":"1","key":"6323_CR12","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1007\/BF01400654","volume":"128","author":"M Sindou","year":"1994","unstructured":"Sindou M, Fobe JL, Berthier E, Vial C (1994) Facial motor responses evoked by direct electrical stimulation of the trigeminal root. Localizing value for radiofrequency thermorhizotomy. Acta Neurochir 128(1):57\u201367","journal-title":"Acta Neurochir"},{"issue":"3","key":"6323_CR13","first-page":"166","volume":"25","author":"M Sindou","year":"1979","unstructured":"Sindou M, Keravel Y (1979) Thermocoagulation percutan\u00e9e du trijumeau dans le traitement de la n\u00e9vralgie faciale essentielle R\u00e9sultats en fonction du si\u00e8ge de la thermol\u00e9sion [Trigeminal neuralgia Percutaneous thermocoagulation of the trigeminal nerve (author\u2019s transl)]. Neurochirurgie 25(3):166\u2013172","journal-title":"Neurochirurgie"},{"issue":"2","key":"6323_CR14","doi-asserted-by":"publisher","first-page":"143","DOI":"10.3171\/jns.1974.40.2.0143","volume":"40","author":"WH Sweet","year":"1974","unstructured":"Sweet WH, Wepsic JG (1974) Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers 1 Trigeminal neuralgia. 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