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2017 ; 12
(4
): 585-597
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Trigeminal Neuralgia
#MMPMID29114270
Yadav YR
; Nishtha Y
; Sonjjay P
; Vijay P
; Shailendra R
; Yatin K
Asian J Neurosurg
2017[Oct]; 12
(4
): 585-597
PMID29114270
show ga
Trigeminal neuralgia (TN) is a sudden, severe, brief, stabbing, and recurrent
pain within one or more branches of the trigeminal nerve. Type 1 as intermittent
and Type 2 as constant pain represent distinct clinical, pathological, and
prognostic entities. Although multiple mechanism involving peripheral pathologies
at root (compression or traction), and dysfunctions of brain stem, basal
ganglion, and cortical pain modulatory mechanisms could have role, neurovascular
conflict is the most accepted theory. Diagnosis is essentially clinically;
magnetic resonance imaging is useful to rule out secondary causes, detect
pathological changes in affected root and neurovascular compression (NVC).
Carbamazepine is the drug of choice; oxcarbazepine, baclofen, lamotrigine,
phenytoin, and topiramate are also useful. Multidrug regimens and
multidisciplinary approaches are useful in selected patients. Microvascular
decompression is surgical treatment of choice in TN resistant to medical
management. Patients with significant medical comorbidities, without NVC and
multiple sclerosis are generally recommended to undergo gamma knife radiosurgery,
percutaneous balloon compression, glycerol rhizotomy, and radiofrequency
thermocoagulation procedures. Partial sensory root sectioning is indicated in
negative vessel explorations during surgery and large intraneural vein.
Endoscopic technique can be used alone for vascular decompression or as an
adjuvant to microscope. It allows better visualization of vascular conflict and
entire root from pons to ganglion including ventral aspect. The effectiveness and
completeness of decompression can be assessed and new vascular conflicts that may
be missed by microscope can be identified. It requires less brain retraction.
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