What is the role of trigeminal neuralgia in the etiology of facial pain and headache?

Updated: Jan 29, 2020
  • Author: Tejas Raval, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

This is the most common cranial neuralgia, with an incidence of 5 per 100,000. [29] It is a brief, paroxysmal, unilateral, stabbing pain in the distribution of one or more of the branches of the fifth cranial nerve. The mandibular branch is most commonly affected. Pain is often triggered by minimal stimulation of the affected area, oftentimes in the location of a “trigger zone.” Most cases are idiopathic, but secondary trigeminal neuralgia (TN) can be caused by vascular or neoplastic compression of the gasserian ganglion or infiltrating lesions. [25] Treatment initially consists of carbamazepine or other antiepileptic drugs. [29] Surgical microvascular decompression and also the use of gamma knife radiation have been shown to treat cases caused by compression of the trigeminal nerve from pontine vessels. [31]

A study by Nanda et al suggested that microvascular decompression has a higher rate of success in producing total long-term pain relief than does gamma knife radiosurgery. The study, which included 49 patients treated with gamma knife radiosurgery and 20 patients treated with microvascular decompression, found that at last follow-up (median 5.3 years), 85% of the microvascular decompression patients were experiencing total pain relief, compared with 45% of the gamma knife patients. [32]

A literature review by Zagzoog et al indicated that outcomes for endoscopic microvascular decompression in cases of trigeminal neuralgia are at least equal to those for open microvascular decompression, with 88% and 81% of patients, respectively, obtaining good pain relief. Moreover, the average reported complication rates, including for facial paresis and hearing loss, were statistically lower in patients who underwent the endoscopic procedure. [33]


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