UMEM Educational Pearls

Category: ENT

Title: Trigeminal Neuralgia

Keywords: Trigeminal Neuralgia, Microvascular decompression, treatment (PubMed Search)

Posted: 3/8/2008 by Michael Bond, MD (Updated: 10/18/2019)
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 Trigeminal Neuralgia

  • A neuropathic disorder of the trigeminal nerve that causes episodes of intense pain.
  • Also known as Tic Douloureux
  • Many cases are associated with vascular compression and subsequent demyelination of the trigeminal nerve, though other causes include compression by a tumor, and multiple sclerosis.
  • Classic Trigeminal Neuralgia is a clinical diagnosis that has the following criteria:
    • Paroxysmal attacks of pain lasting from a fraction of a second to two minutes that affect one or more divisions of the trigeminal nerve
    • Pain has at least one of the following characteristics: intense, sharp, superficial, or stabbing precipitated from trigger areas or by trigger factors
    • Attacks are similar in individual patients
    • No neurological deficit is clinically evident
    • Not attributed to another disorder
  • Treatment options include:
    • Medical:
      • Carbamazepine (most common and drug of choice)
      • Gabapentin (lacks evidence in trigeminal neuralgia but widely used for other neuropathic pain)
      • Lamotrigine
      • Baclofen
    • Surgical:
      • Microvascular decompression: posterior fossa is explored and the culprit blood vessel is moved off the trigeminal nerve. Typically the nerve is padded with a teflon sheet in order to provide additional protection. 80-90% successful with little or no facial numbness.
      • Ablative: Attempts are made to just incapacitate the pain fibers but these techniques can result in facial numbness as other sensory fibers can be damaged.  Common methods include:
        • Glycerol or alcohol injection
        • Radiofrequency rhizotomies
        • Stereotactic radiation therapy
        • Complete severing of the nerve.

References

  1. Wikipedia contributors. Trigeminal neuralgia. Wikipedia, The Free Encyclopedia. February 20, 2008, 22:44 UTC. Available at: http://en.wikipedia.org/w/index.php?title=Trigeminal_neuralgia&oldid=192904693. Accessed March 8, 2008
  2. Luke Bennetto, Nikunj K Patel and Geraint Fuller. Trigeminal neuralgia and its management. BMJ 2007;334;201-205