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Trigeminal Neuralgia

  • Peter Y. ChenEmail author
Chapter

Abstract

Trigeminal neuralgia (TN) is a pain syndrome typified by paroxysms of intense stabbing, electric shock-like unilateral facial pain provoked by light touch in the distribution of the fifth cranial or trigeminal nerve. Also known as tic douloureux to describe the involuntary facial movement or contortions of the facial features in reaction to the severity/intensity of the pain, the cause is usually idiopathic, but secondary causes such as vascular anomalies, tumors, or multiple sclerosis may be identified by neuroimaging. Antiepileptic drug therapy provides initial pain relief in the majority of patients. However, the TN pain may become refractory to pharmacological agents leading to referrals for evaluation of surgical or irradiation management ranging from operative craniotomy to radiation-based radiosurgical approaches. This chapter will highlight the key features of TN and elucidate state-of-the-art medicinal, surgical and radiotherapeutic regimens in the treatment of TN based on retrospective, observational clinical investigations along with systemic and comparative reviews.

Keywords

Trigeminal neuralgia (TN) Typical and atypical pain Vascular compression Demyelination Medicinal therapy Carbamazepine Barrow Neurological Institute (BNI) pain intensity score Microvascular decompression (MVD) Rhizotomy Stereotactic radiosurgery(SRS) Gamma Knife(GK) Dorsal root entry zone (DREZ) Meckel’s cave Maximal radiation dose Durable pain control 

Notes

Acknowledgments

The author extends sincere appreciation to the GK physicist Ann Maitz, MS, for the acquisition of GK treatment plan/dose-volume histogram data for the illustrative case presentation; 3D imaging expert Kenneth A. Richey, BSRT, R, CT, MR, for his design/formulation of the MR images for the figures; resident Leonid Zamdborg, MD, for his unending technical software support; and, last but not least, secretary Ann Karmo for her clerical skills in the details of manuscript style/publication guidelines.

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Authors and Affiliations

  1. 1.Department of Radiation OncologyBeaumont Health System, Oakland University-William Beaumont School of Medicine, William Beaumont HospitalRoyal OakUSA

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