Skip to main content

Advertisement

SpringerLink
Log in

Familial trigeminal neuralgia treated with stereotactic radiosurgery: a case report and literature review

  • Rapid Communication
  • Published:
Journal of Radiation Oncology

Abstract

Background

Trigeminal neuralgia (TN) is a chronic pain condition characterized by brief episodes of lancinating pain in one or more distributions of the trigeminal nerve. Episodes of pain secondary to TN are triggered by certain stimuli, such as chewing, shaving, or touching the face. Although a common cause of TN is compression of the trigeminal nerve root entry zone by an artery or vein, many cases of TN are idiopathic. However, there have been limited reports in the literature of familial TN.

Case presentation

A 31-year-old male presented with classic TN symptoms in the right V1/V2 distribution that recently progressed to the V3 distribution, a case of familial TN. His father and brother both have TN. Carbamazepine, oxcarbazepine, and rhizotomy did not improve his symptoms. He was treated with stereotactic radiosurgery (SRS) with a dose of 85 Gy delivered to the proximal trigeminal root with improvement in his pain. We also review and summarize over 160 cases of familial TN found in the literature.

Conclusions

This is the first reported case of familial TN treated with SRS. Patients with familial TN are more likely to have bilateral disease, to present with earlier onset, and to become refractory to medical therapy and may require more aggressive approaches. We propose that SRS is a good treatment approach for these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Abbreviations

MVD:

Microvascular decompression

SRS:

Stereotactic radiosurgery

TN:

Trigeminal neuralgia

References

  1. Love S, Coakham HB (2001) Trigeminal neuralgia: pathology and pathogenesis. Brain 124:2347–2360

    Article  CAS  PubMed  Google Scholar 

  2. Bowsher D (1997) Trigeminal neuralgia: an anatomically oriented review. Clin Anat 10:409–415

    Article  CAS  PubMed  Google Scholar 

  3. Sindou M, Howeidy T, Acevedo G (2002) Anatomical observations during microvascular decompression for idiopathic trigeminal neuralgia (with correlations between topography of pain and site of the neurovascular conflict). Prospective study in a series of 579 patients. Acta Neurochir 144:1–12 discussion 12-13

    Article  CAS  PubMed  Google Scholar 

  4. Nurmikko TJ, Eldridge PR (2001) Trigeminal neuralgia—pathophysiology, diagnosis and current treatment. Br J Anaesth 87:117–132

    Article  CAS  PubMed  Google Scholar 

  5. Fleetwood IG, Innes AM, Hansen SR, Steinberg GK (2001) Familial trigeminal neuralgia. Case report and review of the literature. J Neurosurg 95:513–517

    Article  CAS  PubMed  Google Scholar 

  6. Manzoni GC, Torelli P (2005) Epidemiology of typical and atypical craniofacial neuralgias. Neurol Sci 26 Suppl 2:s65–s67

    Article  CAS  PubMed  Google Scholar 

  7. Patrick HT (1914) The symptomatology of trifacial neuralgia. JAMA 42:1519–1529

    Article  Google Scholar 

  8. Harris W (1939) An analysis of 1433 cases of paroxysmal trigeminal neuralgia (trigeminal-tic) and the end-results of Gasserian alcohol injection. Brain 63:209–224

    Article  Google Scholar 

  9. Lewy FH, Grant FC (1938) Physiopathologic and pathoanatomic aspects of major trigeminal neuralgia. Arch Neurol Psych 40:1126–1134

    Article  Google Scholar 

  10. Harris W (1936) Bilateral trigeminal tic. Its association with hereditary and disseminated sclerosis. Ann Surg 103:161–172

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Kirkpatrick DB (1989) Familial trigeminal neuralgia: case report. Neurosurgery 24:758–761

    Article  CAS  PubMed  Google Scholar 

  12. Savica R, Laganà A, Siracusano R, Calabrò RS, Ferlazzo E, Musolino R (2007) Idiopathic familial trigeminal neuralgia: a case report. Neurol Sci 28:196–198

    Article  CAS  PubMed  Google Scholar 

  13. Allan W, Charlotte NC (1938) Familial occurrence of tic douloureux. Arch of Neur & Psych 40:1019–1020

    Article  Google Scholar 

  14. Coffey RJ, Fromm GH (1991) Familial trigeminal neuralgia and Charcot-Marie-Tooth neuropathy. Report of two families and review. Surg Neurol 35:49–53

    Article  CAS  PubMed  Google Scholar 

  15. DiCorato MP, Pierce BA (1985) Familial trigeminal neuralgia. South Med J 78:353–354

    Article  CAS  PubMed  Google Scholar 

  16. Herzberg L (1980) Familial trigeminal neuralgia. Arch Neurol 37:285–286

    Article  CAS  PubMed  Google Scholar 

  17. Argenta G (1959) Trigeminal neuralgia in three brothers of which two were twins. Riv Neurol 29:471–476

    CAS  PubMed  Google Scholar 

  18. Gupta V, Singh AK, Kumar S, Sinha S (2002) Familial trigeminal neuralgia. Neurol India 50:87–89

    CAS  PubMed  Google Scholar 

  19. Braga FM, Bonatelli AP, Suriano I, Canteras M (1986) Familial trigeminal neuralgia. Surg Neurol 26:405–408

    Article  CAS  PubMed  Google Scholar 

  20. Duff JM, Spinner RJ, Lindor NM, Dodick DW, Atkinson JL (1999) Familial trigeminal neuralgia and contralateral hemifacial spasm. Neurology 53:216–218

    Article  CAS  PubMed  Google Scholar 

  21. Castaner-Vendrell E, Barraquer-Bordas L (1949) Not available. Monatsschr Psychiatr Neurol 118:77–80

    Article  CAS  PubMed  Google Scholar 

  22. Ebner FH, Tatagiba M, Roser F (2010) Familial trigeminal neuralgia—microsurgical experience and psychological observations. Acta Neurochir 152:381–382

    Article  PubMed  Google Scholar 

  23. Smyth P, Greenough G, Stommel E (2003) Familial trigeminal neuralgia: case reports and review of the literature. Headache 43:910–915

    Article  PubMed  Google Scholar 

  24. El Otmani H, Moutaouakil F, Fadel H, Slassi I (2008) Familial trigeminal neuralgia. Rev Neurol (Paris) 164:384–387

    Article  CAS  Google Scholar 

  25. Testa D, Milanese C, La Mantia L, Mastrangelo M, Crenna P, Negri S (1981) Familial trigeminal neuralgia in Charcot-Marie-Tooth disease. J Neurol 225:283–287

    Article  CAS  PubMed  Google Scholar 

  26. Cruse RP, Conomy JP, Wilbourn AJ, Hanson MR (1977) Hereditary hypertrophic neuropathy combining features of tic douloureux, Charcot-Marie-Tooth disease, and deafness. Cleve Clin Q 44:107–111

    Article  CAS  PubMed  Google Scholar 

  27. Jannetta PJ (1977) Treatment of trigeminal neuralgia by suboccipital and transtentorial cranial operations. Clin Neurosurg 24:538–549

    CAS  PubMed  Google Scholar 

  28. Auld AW, Buermann A (1965) Trigeminal neuralgia in six members of one generation. Arch Neurol 13:194

    Article  CAS  PubMed  Google Scholar 

  29. Knuckey NW, Gubbay SS (1979) Familial trigeminal and glossopharyngeal neuralgia. Clin Exp Neurol 16:315–319

    CAS  PubMed  Google Scholar 

  30. Bracale C, Graziussi G, Avella F (1982) Familial essential trigeminal neuralgia. Riv Neurobiol 28:299–302

    CAS  PubMed  Google Scholar 

  31. Katusic S, Beard CM, Bergstralh E, Kurland LT (1990) Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945-1984. Ann Neurol 27:89–95

    Article  CAS  PubMed  Google Scholar 

  32. Daly RF, Sajor EE (1973) Inherited tic douloureux. Neurology 23:937–939

    Article  CAS  PubMed  Google Scholar 

  33. Pollack IF, Jannetta PJ, Bissonette DJ (1988) Bilateral trigeminal neuralgia: a 14-year experience with microvascular decompression. J Neurosurg 68:559–565

    Article  CAS  PubMed  Google Scholar 

  34. Knight YE, Bartsch T, Kaube H, Goadsby PJ (2002) P/Q-type calcium-channel blockade in the periaqueductal gray facilitates trigeminal nociception: a functional genetic link for migraine? J Neurosci 22:RC213

    PubMed  Google Scholar 

  35. Meunier A, Latrémolière A, Mauborgne A et al (2005) Attenuation of pain-related behavior in a rat model of trigeminal neuropathic pain by viral-driven enkephalin overproduction in trigeminal ganglion neurons. Mol Ther 11:608–616

    Article  CAS  PubMed  Google Scholar 

  36. Tronnier VM, Rasche D, Hamer J, Kienle AL, Kunze S (2001) Treatment of idiopathic trigeminal neuralgia: comparison of long-term outcome after radiofrequency rhizotomy and microvascular decompression. Neurosurgery 48:1261–1267 discussion 1267-1268

    CAS  PubMed  Google Scholar 

  37. Li ST, Pan Q, Liu N, Shen F, Liu Z, Guan Y (2004) Trigeminal neuralgia: what are the important factors for good operative outcomes with microvascular decompression. Surg Neurol 62:400–404 discussion 404-405

    Article  PubMed  Google Scholar 

  38. Li ST, Wang X, Pan Q et al (2005) Studies on the operative outcomes and mechanisms of microvascular decompression in treating typical and atypical trigeminal neuralgia. Clin J Pain 21:311–316

    Article  PubMed  Google Scholar 

  39. Xia L, Zhong J, Zhu J et al (2014) Effectiveness and safety of microvascular decompression surgery for treatment of trigeminal neuralgia: a systematic review. J Craniofac Surg 25:1413–1417

    Article  PubMed  Google Scholar 

  40. Singh R, Davis J, Sharma S (2016) Stereotactic radiosurgery for trigeminal neuralgia: a retrospective multi-institutional examination of treatment outcomes. Cureus 8:e554

    PubMed  PubMed Central  Google Scholar 

  41. Villavicencio AT, Lim M, Burneikiene S et al (2008) Cyberknife radiosurgery for trigeminal neuralgia treatment: a preliminary multicenter experience. Neurosurgery 62:647–655 discussion 647-655

    Article  PubMed  Google Scholar 

  42. Lim M, Villavicencio AT, Burneikiene S et al (2005) CyberKnife radiosurgery for idiopathic trigeminal neuralgia. Neurosurg Focus 18:E9

    Article  PubMed  Google Scholar 

  43. Lazzara BM, Ortiz O, Bordia R et al (2013) Cyberknife radiosurgery in treating trigeminal neuralgia. J Neurointerv Surg 5:81–85

    Article  PubMed  Google Scholar 

  44. Lloyd S, Chung DH, Colaco RJ, Goodrich I, Cardinale FS (2015) The effect of dose and other parameters on outcomes in CyberKnife stereotactic radiosurgery for trigeminal neuralgia. J Radiat Oncol 4:387

    Article  Google Scholar 

  45. Varela-Lema L, Lopez-Garcia M, Maceira-Rozas M, Munoz-Garzon V (2015) Linear accelerator stereotactic radiosurgery for trigeminal neuralgia. Pain Physician 18:15–27

    PubMed  Google Scholar 

  46. Karam SD, Tai A, Wooster M et al (2014) Trigeminal neuralgia treatment outcomes following gamma knife radiosurgery with a minimum 3-year follow-up. J Radiat Oncol 3:125–130

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical Scientist Training Program, University of Wisconsin-Madison, 6068 WIMR, 1111 Highland Avenue, Madison, WI, 53705, USA

    Ryan A. Denu

  2. Department of Human Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA

    Stephen A. Rosenberg & Steven P. Howard

  3. Carbone Cancer Center, University of Wisconsin, Madison, WI, USA

    Stephen A. Rosenberg & Steven P. Howard

  4. University of Wisconsin-Madison, K4/350, 600 Highland Avenue, Madison, WI, 53792, USA

    Steven P. Howard

Authors
  1. Ryan A. Denu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephen A. Rosenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Steven P. Howard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven P. Howard.

Ethics declarations

Funding

RAD is supported by training grants (T32GM008692, UL1TR000427 and TL1TR000429) and by F30CA203271. The content is the responsibility of the authors and does not necessarily represent the views of the NIH.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants included in the study.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Denu, R.A., Rosenberg, S.A. & Howard, S.P. Familial trigeminal neuralgia treated with stereotactic radiosurgery: a case report and literature review. J Radiat Oncol 6, 149–152 (2017). https://doi.org/10.1007/s13566-017-0300-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13566-017-0300-0

Keywords

Search

Navigation