CC BY-NC-ND 4.0 · Asian J Neurosurg 2017; 12(04): 585-597
DOI: 10.4103/ajns.AJNS_67_14
Review Article

Trigeminal neuralgia

Yad Yadav
Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh
,
Yadav Nishtha
1   Department of Radio Diagnosis and Imaging, All India Institute of Medical Science, New Delhi
,
Pande Sonjjay
2   Department of Radio Diagnosis and Imaging, NSCB Medical College, Jabalpur, Madhya Pradesh
,
Parihar Vijay
Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh
,
Ratre Shailendra
Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh
,
Khare Yatin
Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh
› Institutsangaben

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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Artikel online veröffentlicht:
20. September 2022

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