The Changing Face of Trigeminal Neuralgia

A Narrative Review

Stine Maarbjerg MD, PhD; Rafael Benoliel BDS (Hons)

Disclosures

Headache. 2021;61(6):817-837. 

In This Article

Trigeminal Neuralgia Attributed to Space-occupying Lesions

Trigeminal nerve dysfunction has been observed in 33% of patients with middle and posterior cranial fossa tumors but in only 13% was this the presenting symptom.[78] About 10% of cases with intracranial tumors experienced TN-like symptomatology. Pain may mimic TN, persistent idiopathic facial pain, and temporomandibular disorders.[79] Posterior fossa tumors and meningiomas are most likely to cause TN-like symptoms.[78,80] Cerebellopontine angle tumors (e.g., acoustic neuromas) may also cause TN, and this diagnosis is more likely when the patient is young and suffers pain in more than one trigeminal branch. In patients with TN under the age of 29 years, the possibility of underlying pathology is significantly increased.[81] Specifically, 10%–13.4% of patients with TN may have intracranial tumors, and MRI is the most sensitive diagnostic technique.[82] Most of these patients are usually younger than expected for TN and develop subtle or frank neurologic deficit.[83] A reduced corneal reflex and hypesthesia were typical of cranial masses. Gamma knife stereotactic (GKS) radiosurgery has recently been used to treat benign intracranial tumors.[84,85] However, although tumor control may be successful, the facial pain does not always resolve.

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