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Trigeminal neuralgia and other neuropathic pain syndromes of the head and face

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Abstract

Trigeminal neuralgia is the most common craniofacial pain syndrome of neuropathic origin. Although the diagnosis remains based exclusively on history and symptomatology, modern diagnostic techniques, particularly high-resolution magnetic resonance imaging, provides valuable new insight into the pathophysiology of these cases with additional implications for therapeutic strategies. Other neuropathic syndromes affect the trigeminal nerve and warrant different treatments with varied rates of success. Rarely, neuralgias of other cranial nerves mimic trigeminal neuralgia. Finally, it is imperative to distinguish atypical facial pains from these neuropathic syndromes to avoid unsuccessful therapies.

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References and Recommended Reading

  1. Jannetta PJ: Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 1967, 26:159–162.

    PubMed  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  3. Pollack I, Jannetta PJ, Bissonette D: Bilateral trigeminal neuralgia: a 14 year experience with microvascular decompression. J Neurosurg 1988, 68:559–565.

    PubMed  CAS  Google Scholar 

  4. Burchiel KJ, Slavin KV: On the natural history of trigeminal neuralgia. Neurosurgery 2000, 46:152–155. Reflects the author’s experience and perspective regarding the natural history of TN; an issue that has never been studied scientifically.

    Article  PubMed  CAS  Google Scholar 

  5. Bullitt E, Tew JM, Boyd J: Intracranial tumors in patients with facial pain. J Neurosurg 1986, 64:865–871.

    PubMed  CAS  Google Scholar 

  6. Jensen TS, Rasmussen P, Riske-Nielson E: Association of trigeminal neuralgia with multiple sclerosis: clinical and pathologic features. Acta Neurol Scand 1982, 65:182–189.

    Article  PubMed  CAS  Google Scholar 

  7. Iragui VJ, Wiederholt WC, Romine JS: Evoked potentials in trigeminal neuralgia associated with multiple sclerosis. Arch Neurol 1986, 43:444–446.

    PubMed  CAS  Google Scholar 

  8. Golby AJ, Norbash A, Silverberg GD: Trigeminal neuralgia resulting from infarction of the root entry zone of the trigeminal nerve: case report. Neurosurgery 1998, 43:620–623.

    Article  PubMed  CAS  Google Scholar 

  9. Yonas H, Jannetta PJ: Neurinoma of the trigeminal nerve and atypical trigeminal neuralgia: their commonality. Neurosurgery 1980, 6:273–277.

    Article  PubMed  CAS  Google Scholar 

  10. Jannetta PJ: Neurovascular compression in cranial nerve and systemic disease. Ann Surg 1980, 192:518–525.

    Article  PubMed  CAS  Google Scholar 

  11. Hardy DG, Rhoton AL: Microsurgical relationships of the superior cerebellar artery and the trigeminal nerve. J Neurosurg 1978, 49:669–678.

    PubMed  CAS  Google Scholar 

  12. Jannetta PJ: Microvascular decompression of the trigeminal nerve for tic douloureux. In Neurological Surgery, edn 4. Edited by Youmans JR. Philadelphia: WB Saunders; 1996:3404–3415.

    Google Scholar 

  13. Lee SH, Levy EI, Scarrow AM, et al.: Recurrent trigeminal neuralgia attributable to veins after microvascular decompression. Neurosurgery 2000, 46:356–362.

    Article  PubMed  CAS  Google Scholar 

  14. Haines SJ, Jannetta PJ, Zorub DS: Microvascular relations of the trigeminal nerve: anatomical study with clinical correlation. J Neurosurg 1980, 52:381–386.

    PubMed  CAS  Google Scholar 

  15. Mehta L, Fatani J, Rao G: Superior cerebellar artery in the pontine zone. Saudi Med J 1981, 2:213–216.

    Google Scholar 

  16. Gardner WJ: Causation of trigeminal neuralgia. In Trigeminal Neuralgia: Pathogenesis and Pathophysiology. Edited by Hassler R, Walker AE. Philadelphia: WB Saunders; 1970:153–160.

    Google Scholar 

  17. Beaver DL: Electron microscopy of the gasserian ganglion in trigeminal neuralgia. J Neurosurg 1967, 26:138–150.

    PubMed  Google Scholar 

  18. Kerr FWL, Miller RH: The pathology of trigeminal neuralgia electron microscopic studies. Arch Neurol 1966, 15:308–319.

    PubMed  CAS  Google Scholar 

  19. Kerr FWL: Pathology of trigeminal neuralgia: light and electron microscopic observations. J Neurosurg 1967, 26:151–156.

    PubMed  Google Scholar 

  20. Kunc Z, Fuchsova M, Novak M: Excision of the spinal trigeminal tract. Acta Neurochir 1978, 41:233–241.

    Article  CAS  Google Scholar 

  21. Lazar ML, Kirkpatrick JB: Trigeminal neuralgia and multiple sclerosis: demonstration of the plaque in an operative case. Neurosurgery 1979, 5:711–717.

    Article  PubMed  CAS  Google Scholar 

  22. Garcin R, Godlewski S, Lapresle J: Névralgie du trijumeau et sclerose en plaques. Rev Neurol 1960, 102:441–451.

    PubMed  CAS  Google Scholar 

  23. Eide PK, Rabben T: Trigeminal neuropathic pain: pathophysiological mechanisms examined by quantitative assessment of abnormal pain and sensory perception. Neurosurgery 1998, 43:1103–1110.

    Article  PubMed  CAS  Google Scholar 

  24. Burchiel KJ: Abnormal impulse generation in focally demyelinated trigeminal roots. J Neurosurg 1980, 53:674–683.

    PubMed  CAS  Google Scholar 

  25. Loeser JD, Calvin WH, Howe JF: Pathophysiology of trigeminal neuralgia. Clin Neurosurg 1977, 24:527–537.

    PubMed  CAS  Google Scholar 

  26. Baumann TK, Burchiel KJ: Intraoperative microneurographic recordings in patients with trigeminal neuralgia. In Proceedings of the 8th World Congress on Pain, Progress in Pain Research and Management, vol 8. Edited by Jensen TS et al. Seattle, WA: IASP Press; 1977:459-467.

  27. Hutchins LG, Harnsbeger HR, Jacobs JM, et al.: Trigeminal neuralgia: magnetic resonance imaging assessment. Radiology 1990, 75:837–841.

    Google Scholar 

  28. Jawahar A, Kondziolka D, Kanal E, et al.: Imaging the trigeminal nerve and pons before and after surgical intervention for trigeminal neuralgia. Neurosurgery 2001, 48:101–107.

    Article  PubMed  CAS  Google Scholar 

  29. Majoie CBLM, Hulsmans FJH, Castelijns JA, et al.: Symptoms and signs related to the trigeminal nerve: diagnostic yield of magnetic resonance imaging. Radiology 1998, 209:557–562.

    PubMed  CAS  Google Scholar 

  30. Majoie CBLM, Hulsmans FJH, Verbeeten B, et al.: Trigeminal neuralgia: comparison of two magnetic resonance imaging techniques in the demonstration of neurovascular contact. Radiology 1997, 204:455–460.

    PubMed  CAS  Google Scholar 

  31. Meaney JFM, Eldridge PR, Dunn LT, et al.: Demonstration of neurovascular compression in trigeminal neuralgia with magnetic resonance imaging. J Neurosurg 1995, 83:799–805. Early description of diagnostic imaging of the trigeminal nerve and its vascular relationships in TN.

    PubMed  CAS  Google Scholar 

  32. Sist T, Filadora V, Miner M, et al.: Gabapentin for idiopathic trigeminal neuralgia: report of two cases. Neurology 1997, 48:14–67.

    Google Scholar 

  33. Leandri M, Lundardi G, Inglese M, et al.: Lamotrigine in trigeminal neuralgia secondary to multiple sclerosis. J Neurol 2000, 247:556–558.

    Article  PubMed  CAS  Google Scholar 

  34. Zvartau-Hind M, Din MU, Gilani A, et al.: Topiramate relieves refractory trigeminal neuralgia in ms patients. Neurology 2000, 55:1585–1586.

    Google Scholar 

  35. Katusic S, Beard CM, Bergstralh E, et al.: Incidence and clinical features of trigeminal neuralgia. Ann Neurol 1990, 27:89–95.

    Article  PubMed  CAS  Google Scholar 

  36. Meglio M, Cioni B: Percutaneous procedures for trigeminal neuralgia: microcompression versus radiofrequency thermocoagulation. Pain 1989, 38:9–16.

    Article  PubMed  CAS  Google Scholar 

  37. Fraoli B, Esposito V, Guidetti B, et al.: Treatment of trigeminal neuralgia by thermocoagulation, glycerolization, and percutaneous compression of the gasserian ganglion and/or retrogasserian rootlets: long term results and therapeutic protocol. Neurosurgery 1989, 24:239–245.

    Article  Google Scholar 

  38. Skirving DJ, Dan NG: A 20-year review of percutaneous balloon compression of the trigeminal ganglion. J Neurosurg 2001, 94:913–917.

    PubMed  CAS  Google Scholar 

  39. Burchiel KJ: Surgical treatment of trigeminal neuralgia: major operative procedures. In Medical and Surgical Management of Trigeminal Neuralgia. Edited by Fromm G. Mt. Kisco, NY: Futura; 1987:101–119.

    Google Scholar 

  40. Moraci A, Buonaiuto C, Punzo A, et al.: Trigeminal neuralgia treated by percutaneous thermocoagulation: comparative analysis of percutaneous thermocoagulation and other surgical procedures. Neurochirurgica 1992, 35:48–53.

    CAS  Google Scholar 

  41. Sweet WH: Trigeminal neuralgia: problems as to cause and consequent conclusions regarding treatment. In Neurosurgery. Edited by Wilkins RH, Rengachary SS. New York: McGraw-Hill; 1985:366–372.

    Google Scholar 

  42. Piquer J, Joanes V, Roldan P, et al.: Long term results of percutaneous gasserian ganglion lesions. Acta Neurochir Suppl (Wien) 1987, 39:139–141.

    CAS  Google Scholar 

  43. Puca A, Meglio M, Cioni B, et al.: Intracerebral injury following thermocoagulation of the trigeminal ganglion. Surg Neurol 1992, 38:280–282.

    Article  PubMed  CAS  Google Scholar 

  44. Brisman R: Gamma knife radiosurgery for primary management of trigeminal neuralgia. J Neurosurg 2000, 93(suppl 3):159–161.

    PubMed  Google Scholar 

  45. Chang JW, Chang JH, Park YG, et al.: Gamma knife radiosurgery for idiopathic and secondary trigeminal neuralgia. J Neurosurg 2000, 93(suppl 3):147–151.

    PubMed  Google Scholar 

  46. Lunsford DL: Radiosurgery for trigeminal neuralgia. Surg Neurol 2000, 54:285–287.

    PubMed  CAS  Google Scholar 

  47. Maesawa S, Salame C, Flickinger JC, et al.: Clinical outcome after stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 2001, 94:14–20.

    PubMed  CAS  Google Scholar 

  48. Dandy WE: The treatment of trigeminal neuralgia by the cerebellar route. Am J Surg 1934, 24:447–455.

    Article  Google Scholar 

  49. Gardner WJ, Miklos MV: Response of trigeminal neuralgia to decompression of sensory root: discussion of cause of trigeminal neuralgia. JAMA 1959, 170:1773–1776.

    CAS  Google Scholar 

  50. Hamlyn P, King T: Neurovascular compression in trigeminal neuralgia. J Neurosurg 1992, 76:948–954.

    PubMed  CAS  Google Scholar 

  51. Tashiro H, Kondo A, Aoyama I, et al.: Trigeminal neuralgia caused by compression from arteries transfixing the nerve. J Neurosurg 1991, 75:783–786.

    PubMed  CAS  Google Scholar 

  52. Tsubaki S, Fukishima T, Tamagawa T, et al.: Parapontine trigeminal cryptic angiomas presenting as trigeminal neuralgia. J Neurosurg 1989, 71:368–374.

    Article  PubMed  CAS  Google Scholar 

  53. Barker FG, Jannetta PJ, Bissonette DJ, et al.: The long term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 1996, 334:1077–1083. The largest series reported of MVD for TN.

    Article  PubMed  Google Scholar 

  54. McLaughlin MR, Jannetta PJ, Clyde BL, et al.: Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg 1999, 90:1–8.

    PubMed  CAS  Google Scholar 

  55. Sheldon CH, Pudenz RH, Freshwater DB: Compression rather than decompression for trigeminal neuralgia. J Neurosurg 1955, 12:123–126.

    Google Scholar 

  56. Sindou M, Fobe J, Ciriano D, et al.: Hearing prognosis and intraoperative guidance of brainstem auditory evoked potential in microvascular decompression. Laryngoscope 1992, 102:678–682.

    Article  PubMed  CAS  Google Scholar 

  57. Szapiro J, Sindou M, Szapiro J: Prognostic factors in microvascular decompression for trigeminal neuralgia. J Neurosurg 1985, 17:920–929.

    Article  Google Scholar 

  58. Adams CBT: Microvascular compression: an alternative view and hypothesis. J Neurosurg 1989, 70:1–12.

    PubMed  CAS  Google Scholar 

  59. Morley TP: Case against microvascular decompression in the treatment of trigeminal neuralgia. Arch Neurol 1985, 42:801–802.

    PubMed  CAS  Google Scholar 

  60. Sweet WH, Wepsic JG: Controlled thermocoagulation of the trigeminal ganglion and rootlets for differential destruction of pain fibers, I: trigeminal neuralgia. J Neurosurg 1974, 40:143–156.

    PubMed  CAS  Google Scholar 

  61. Bederson J, Wilson CB: Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. J Neurosurg 1989, 71:359–367.

    PubMed  CAS  Google Scholar 

  62. Klun B: Microvascular decompression and partial sensory rhizotomy in the treatment of trigeminal neuralgia. Neurosurgery 1992, 30:49–52.

    Article  PubMed  CAS  Google Scholar 

  63. Matsushima T, Fukui M, Sazuki S, et al.: The microsurgical anatomy of the infratentorial lateral supracerebellar approach to the trigeminal nerve for tic douloureux. Neurosurgery 1989, 24:890–895.

    Article  PubMed  CAS  Google Scholar 

  64. Burchiel KJ, Clarke H, Haglund M, et al.: Long term efficacy of microvascular decompression in trigeminal neuralgia. J Neurosurg 1988, 69:35–38.

    PubMed  CAS  Google Scholar 

  65. Hussein M, Wilson L, Illingworth R: Patterns of sensory loss following fractional posterior fossa Vth nerve section for trigeminal neuralgia. J Neurol Neurosurg Psychiatry 1982, 45:786–790.

    PubMed  CAS  Google Scholar 

  66. Bullard DE, Nashold BS: The caudalis DREZ for facial pain. Stereotact Funct Neurosurg 1997, 68:168–174.

    Article  PubMed  CAS  Google Scholar 

  67. Burchiel KJ: Trigeminal neuropathic pain. Acta Neurochir Suppl 1993, 58:145–149.

    CAS  Google Scholar 

  68. Burchiel KJ, Steege T, Howe J, et al.: Comparison of percutaneous radiofrequency gangliolysis and microvascular decompression for the surgical management of tic douloureux. Neurosurgery 1981, 9:111–119.

    Article  PubMed  CAS  Google Scholar 

  69. Goldstein NP, Gibilisco JA, Rushton JG: Trigeminal neuropathy and neuritis; a study of etiology with emphasis on dental causes. JAMA 1963, 184:458–462.

    PubMed  CAS  Google Scholar 

  70. Thrush DC, Small M: How benign a symptom is face numbness? Lancet 1970, 2:851–853.

    Article  PubMed  CAS  Google Scholar 

  71. Sampson JH, Nashold BS: Facial pain due to vascular lesions of the brainstem relieved by dorsal root entry zone lesions in the nucleus caudalis. J Neurosurg 1992, 77:473–475.

    PubMed  CAS  Google Scholar 

  72. Young RF: Geniculate neuralgia [letter]. J Neurosurg 1992, 76:888.

    PubMed  CAS  Google Scholar 

  73. Laha RK, Jannetta PJ: Glossopharyngeal neuralgia. J Neurosurg 1977, 47:316–320.

    PubMed  CAS  Google Scholar 

  74. Ekbom KA, Westerberg CE: Carbamazepine in glossopharyngeal neuralgia. Arch Neurol 1966, 14:595–596.

    PubMed  CAS  Google Scholar 

  75. Star MJ, Curd JG, Thorne RP: Atlantoaxial lateral mass osteoarthritis: a frequently overlooked cause of severe occipitocervical pain. Spine 1992, 17:71–76.

    Article  Google Scholar 

  76. Poletti CE, Sweet WH: Entrapment of the C2 root and ganglion by the atlanto-epistrophic ligament: clinical syndrome and surgical anatomy. Neurosurgery 1990, 27:288–291.

    Article  PubMed  CAS  Google Scholar 

  77. Poletti CE: Proposed operation for occipital neuralgia: C2 and C3 root decompression. Neurosurgery 1983, 12:221–224.

    Article  PubMed  CAS  Google Scholar 

  78. Onofrio BM, Campa HK: Evaluation of rhizotomy: review of 12 years’ experience. J Neurosurg 1972, 36:751–755.

    PubMed  CAS  Google Scholar 

  79. White JC, Sweet WH: Pain and the Neurosurgeon. Springfield, IL: Charles C. Thomas; 1969:264–265.

    Google Scholar 

  80. Blume HG: Radiofrequency denaturation in occipital pain: a new approach in 114 cases. Adv Pain Res Ther 1976, 1:691–698.

    Google Scholar 

  81. Uematsu S: Percutaneous electrothermocoagulation of spinal nerve trunk, ganglion, and rootlets. In Operative Neurosurgical Techniques. Edited by Schmidek HH, Sweet WH. New York: Grune and Stratton; 1982:1177–1198.

    Google Scholar 

  82. Aubry M, Pialoux P: Sluder’s syndrome. In Handbook of Clinical Neurology, vol 5. Edited by Vinken PJ, Bruyn GW. Amsterdam: Elsevier North Holland; 1968:350–361.

    Google Scholar 

  83. Toussaint D: Raeder’s syndrome. In Handbook of Clinical Neurology, vol 5. Edited by Vinken PJ, Bruyn GW. Amsterdam: Elsevier North Holland; 1968:333–336.

    Google Scholar 

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  1. Department of Neurosurgery, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road,L472, 97201-3098, Portland, OR, USA

    W. Jeffrey Elias MD & Kim J. Burchiel MD

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Elias, W.J., Burchiel, K.J. Trigeminal neuralgia and other neuropathic pain syndromes of the head and face. Current Science Inc 6, 115–124 (2002). https://doi.org/10.1007/s11916-002-0007-8

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