Therapeutic Outcome and Future Scopes in the Management of Trigeminal Neuralgia

  • W. Umamaheshwara Rao
  • Muralidhar Joshi


Trigeminal neuralgia (TGN) is an elusive medical condition with debilitating consequences. Treatment options for TGN have evolved and improved over the years; however, many existing drugs and percutaneous procedures have variable efficacy and recurrence is possible in many patients. Many new molecules acting on novel pain targets are being studied, which are in pre-clinical, or early clinical development phases. Various surgical therapies have been tried for the management of drug-resistant TGN. Among them, microvascular decompression (MVD) is performed to address the primary problem of aberrant vascular loops impinging on the trigeminal nerve. On the other hand, percutaneous destructive procedures aim at reducing the overall sensory input from the trigeminal ganglion.


  1. 1.
    Sindrup SH, Jensen TS. Pharmacotherapy of trigeminal neuralgia. Clin J Pain. 2002;18:22–7.CrossRefGoogle Scholar
  2. 2.
    Cruccu G, Sommer C, Anand P, Attal N, Baron R, Garcia-Larrea L, et al. EFNS guidelines on neuropathic pain assessment: revised 2009. Eur J Neurol. 2010;17:1010–8.CrossRefGoogle Scholar
  3. 3.
    Beydoun A. Clinical use of tricyclic anticonvulsants in painful neuropathies and bipolar disorders. Epilepsy Behav. 2002;3:S18–22.CrossRefGoogle Scholar
  4. 4.
    Beydoun A. Safety and efficacy of oxcarbazepine: results of randomized, double-blind trials. Pharmacotherapy. 2000;20:152S–8S.CrossRefGoogle Scholar
  5. 5.
    Liebel JT, Menger N, Langohr H. Oxcarbazepine in derBehandlung der Trigeminusneuralgie. Nervenheilkunde. 2001;20:461–5.Google Scholar
  6. 6.
    Montano N, Conforti G, Di Bonaventura R, Meglio M, Fernandez E, Papacci F. Advances in diagnosis and treatment of trigeminal neuralgia. Ther Clin Risk Manag. 2015;11:289–99.CrossRefGoogle Scholar
  7. 7.
    Zakrzewska JM, Chaudhry Z, Nurmikko TJ, Patton DW, Mullens EL. Lamotrigine (Lamictal) in refractory trigeminal neuralgia: results from a double-blind placebo-controlled crossover trial. Pain. 1997;73:223–30.CrossRefGoogle Scholar
  8. 8.
    Wiffen PJ, Derry S, Moore RA. Lamotrigine for acute and chronic pain. Cochrane Database Syst Rev. 2011;2:CD006044.Google Scholar
  9. 9.
    Fromm GH, Aumentado D, Terrence CF. A clinical and experimental investigation of the effects of tizanidine in trigeminal neuralgia. Pain. 1993;53:265–71.CrossRefGoogle Scholar
  10. 10.
    Nurmikko TJ, Eldridge PR. Trigeminal neuralgia–pathophysiology, diagnosis and current treatment. Br J Anaesth. 2001;87:117–32.CrossRefGoogle Scholar
  11. 11.
    Zakrzewska JM, Linskey ME. Trigeminal neuralgia. BMJ. 2014;348:g474.CrossRefGoogle Scholar
  12. 12.
    Hu Y, Guan X, Fan L, Li M, Liao Y, Nie Z, Jin L. Therapeutic efficacy and safety of botulinum toxin type A in trigeminal neuralgia: a systematic review. J Headache Pain. 2013;14:72.CrossRefGoogle Scholar
  13. 13.
    Cruccu G, Truini A. Refractory trigeminal neuralgia. Non-surgical treatment options. CNS Drugs. 2013;27:91–6.CrossRefGoogle Scholar
  14. 14.
    Zakrzewska JM, Palmer J, Morisset V, Giblin GM, Obermann M, Ettlin D, et al., Study Investigators. Safety and efficacy of a Nav1.7 selective sodium channel blocker in patients with trigeminal neuralgia: a double-blind, placebo-controlled, randomised withdrawal phase 2A trial. Lancet Neurol. 2017;16:291–300.CrossRefGoogle Scholar
  15. 15.
    Nurmikko TJ, Elderidge PR. Trigeminal neuralgia-pathophysiology, diagnosis and current treatment. Br J Anaesth. 2001;87:117–32.CrossRefGoogle Scholar
  16. 16.
    Oturai AB, Jensen K, Erikson J, Marsden F. Neurosurgery for trigeminal neuralgia: comparison of alcohol block, neurectomy and radiofrequency coagulation. Clin J Pain. 1996;12:311–5.CrossRefGoogle Scholar
  17. 17.
    Zakrzewska JM, Nally FF. The role of cryotherapy (cryoanalgesia) in the management of paroxysmal trigeminal neuralgia: a six-year experience. Br J Oral Maxillofac Surg. 1988;26:18–25.CrossRefGoogle Scholar
  18. 18.
    Stefanoff V. Treatment of trigeminal neuralgia (TN) with local laser irradiation and laser puncture. Int J Oral Maxillofac Surg. 1990;19:379–80.Google Scholar
  19. 19.
    Samosiuk IZ, Kozhanova AK, Samosiuk NI. Physiopuncture therapy of trigeminal neuralgia. Vopr Kurortol Fizioter Lech Fiz Kult. 2000:29–32.Google Scholar
  20. 20.
    Scrivani SJ, Keith DA, Mathews ES, Kaban LB. Percutaneous stereotactic differential radiofrequency thermal rhizotomy for the treatment of trigeminal neuralgia. J Oral Maxillofac Surg. 1999;57:104–11.CrossRefGoogle Scholar
  21. 21.
    Hakansson S. Trigeminal neuralgia treated by the injection into the trigeminal cistern. Neurosurgery. 1981;9:638–46.CrossRefGoogle Scholar
  22. 22.
    Kouzounias K, Schechtmann G, Lind G, Winter J, Linderoth B. Factors that influence outcome of percutaneous balloon compression in the treatment of trigeminal neuralgia. Neurosurgery. 2010;67:925–34.CrossRefGoogle Scholar
  23. 23.
    Abdennebi B, Mahfouf L, Nedjahi T. Long-term results of percutaneous compression of the gasserian ganglion in trigeminal neuralgia. Stereotact Funct Neurosurg. 1997;68:190–5.CrossRefGoogle Scholar
  24. 24.
    Lichtor T, Mullan JF. A 10-year follow-up review of percutaneous micro-compression of the trigeminal ganglion. J Neurosurg. 1990;72:49–54.CrossRefGoogle Scholar
  25. 25.
    Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol. 2008;15:1013–28.CrossRefGoogle Scholar
  26. 26.
    Gu W, Zhao W. Microvascular decompression for recurrent trigeminal neuralgia. J Clin Neurosci. 2014;21:1549–53.CrossRefGoogle Scholar
  27. 27.
    Broggi G, Ferroli P, Franzini A, Servello D, Dones I. Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis. J Neurol Neurosurg Psychiatry. 2000;68:59–64.CrossRefGoogle Scholar
  28. 28.
    Oesman C, Mooij JJ. Long-term follow-up of microvascular decompression for trigeminal neuralgia. Skull Base. 2011;21:313–22.CrossRefGoogle Scholar
  29. 29.
    Kondo A. Follow-up results of microvascular decompression in trigeminal neuralgia and hemifacial spasm. Neurosurgery. 1997;40:46–52.PubMedGoogle Scholar
  30. 30.
    Jafree DJ, Williams AC, Zakrzewska JM. Impact of pain and postoperative complications on patient-reported outcome measures 5 years after microvascular decompression or partial sensory rhizotomy for trigeminal neuralgia. Acta Neurochir. 2018;160:125–34.CrossRefGoogle Scholar
  31. 31.
    Han JH, Kim DG, Chung HT, Paek SH, Kim YH, Kim CY, et al. Long-term outcome of gamma knife radiosurgery for treatment of typical trigeminal neuralgia. Int J Radiat Oncol Biol Phys. 2009;75:822–7.CrossRefGoogle Scholar
  32. 32.
    Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008;71:1183–90.CrossRefGoogle Scholar
  33. 33.
    Zakrzewska JM, Lopez BC, Kim SE, Coakham HB. Patient reports of satisfaction after microvascular decompression and partial sensory rhizotomy for trigeminal neuralgia. Neurosurgery. 2005;56:1304–11.CrossRefGoogle Scholar
  34. 34.
    Tatli M, Satici O, Kanpolat Y, Sindou M. Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes. Acta Neurochir. 2008;150:243–55.CrossRefGoogle Scholar
  35. 35.
    Akram H, Mirza B, Kitchen N, Zakrzewska JM. Proposal for evaluating the quality of reports of surgical interventions in the treatment of trigeminal neuralgia: the surgical trigeminal neuralgia score. Neurosurg Focus. 2013;35:E3.CrossRefGoogle Scholar
  36. 36.
    Jie H, Xuanchen Z, Deheng L, Kun G, Fengyang X, Xiang C, et al. The long-term outcome of nerve combing for trigeminal neuralgia. Acta Neurochir. 2013;155:1703–8.CrossRefGoogle Scholar
  37. 37.
    Sessirisombat S. Carbon-dioxide laser in the treatment of trigeminal neuralgia: a preliminary study. J Interdiscipl Med Dent Sci. 2017;5:1–4.CrossRefGoogle Scholar
  38. 38.
    Fontaine D, Hamani C, Lozano A. Efficacy and safety of motor cortex stimulation for chronic neuropathic pain: critical review of the literature. J Neurosurg. 2009;110:251–6.CrossRefGoogle Scholar
  39. 39.
    Buchanan RJ, Darrow D, Monsivais D, Nadasdy Z, Gjini K. Motor cortex stimulation for neuropathic pain syndromes: a case series experience. Neuroreport. 2014;25:715–7.CrossRefGoogle Scholar
  40. 40.
    Lefaucheur JP, Drouot X, Menard-Lefaucheur I, Zerah F, Bendib B, Cesaro P, et al. Neurogenic pain relief by repetitive transcranial magnetic cortical stimulation depends on the origin and the site of pain. J Neurol Neurosurg Psychiatry. 2004;75:612–6.CrossRefGoogle Scholar
  41. 41.
    Khedr EM, Kotb H, Kamel NF, Ahmed MA, Sadek R, Rothwell JC. Long lasting antalgic effects of daily sessions of repetitive transcranial magnetic stimulation in central and peripheral neuropathic pain. J Neurol Neurosurg Psychiatry. 2005;76:833–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • W. Umamaheshwara Rao
    • 1
  • Muralidhar Joshi
    • 2
  1. 1.Anaesthesiologist and Interventional Pain SpecialistVirinchi HospitalsHyderabadIndia
  2. 2.Pain Management CentreVirinchi HospitalsHyderabadIndia

Personalised recommendations