Trigeminal Neuralgia

Trigeminal NeuralgiaAbdullatif Sami Al RashedENT Block 5.6College of Medicine, KFUAl-Ahsa, Saudi Arabia

Anatomy of Trigeminal Nerve

Introduction Idiopathic trigeminal neuralgia is

marked by paroxysms of intense, stabbing pain on one side of the face (tic douloureux).

Clinical Features recurrent episodes of sudden onset,

excruciating unilateral paroxysmal shooting “electric” pain in trigeminal root territory (V3>V2>>V1)

may have normal sensory exam pain lasts seconds/minutes over days/weeks;

may remit for weeks/months triggers:

touching face, eating, talking, cold wind, shaving, applying make-up

Etiology classic TN: idiopathic secondary TN: compression by tortuous

blood vessel (superior cerebellar artery), cerebellopontine angle tumor (5%), MS (5%)

Epidemiology

F>M; usually middle-aged and elderly

Diagnosis clinical diagnosis investigate for secondary causes, which

are more likely if bilateral TN or associated sensory loss: MRI to rule out structural lesion, MS, or

vascular lesion

Treatment first line: carbamazepine or oxcarbazepine second line: baclofen or lamotrigine narcotics not generally recommended if medical treatment fails:

Gasserian ganglion percutaneous technique, gamma knife, invasive percutaneous denervation

(radiofrequency/glycerol), percutaneous balloon microcompression, microvascular decompression

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