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Update on Trigeminal Neuralgia

Current Treatment Options in Neurology volume 21, Article number: 42 (2019) Cite this article

Abstract

Purpose of review

To review current treatments for trigeminal neuralgia, with an emphasis on determining which patients may benefit from neurosurgical procedures.

Recent findings

A detailed history is the most helpful tool for diagnosing trigeminal neuralgia (TN) and predicting response to neurosurgical treatments. Patients with classic trigeminal neuralgia will describe severe, unilateral, intermittent facial pain that is triggered by innocuous sensory stimuli. In most cases, pain is caused by compression of the trigeminal nerve by a blood vessel near the brainstem. Magnetic resonance imaging is necessary to rule out TN secondary to multiple sclerosis or tumor. Modern high-resolution T2 images may demonstrate neurovascular contact, particularly when analyzed by a neurosurgeon with expertise in TN. Initial management involves a trial of medication, usually carbamazepine or oxcarbazepine. Microvascular decompression (MVD) is safe and effective surgery, for patients with classic TN related to neurovascular compression. For patients with TN secondary to multiple sclerosis, and for patients who are otherwise poor candidates for MVD, neurosurgical options include percutaneous trigeminal rhizotomy and radiosurgery. Neurosurgical procedures are less effective in relieving atypical facial pain.

Summary

In the clinical evaluation of a patient with facial pain, it is important to distinguish classic trigeminal neuralgia from atypical facial pain. A patient with classic trigeminal neuralgia would benefit from neurosurgical consultation. The advent of high-resolution MRI and MRA sequences now allows a neurosurgeon to detect when neurovascular compression is likely, and select the optimal procedure for treatment.

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Authors and Affiliations

  1. Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Rd NW, PHC 7, Washington, DC, 20007, USA

    Alexander X. Tai MD & Vikram V. Nayar MD, FAANS

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  1. Alexander X. Tai MD
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  2. Vikram V. Nayar MD, FAANS
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Correspondence to Vikram V. Nayar MD, FAANS.

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Alexander X. Tai and Vikram V. Nayar each declare no potential conflicts of interest.

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This article is part of the Topical Collection on Neurologic Ophthalmology and Otology

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Tai, A.X., Nayar, V.V. Update on Trigeminal Neuralgia. Curr Treat Options Neurol 21, 42 (2019). https://doi.org/10.1007/s11940-019-0583-0

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Keywords

  • Trigeminal neuralgia
  • Facial pain
  • Microvascular decompression
  • Percutaneous trigeminal rhizotomy
  • Radiosurgery