NEUROVASCULAR

COMPRESSION

 

 

TRIGEMINAL NEURALGIA

 

 

 

Trigeminal neuralgia is a facial pain with a very characteristic manifestation in the region of supply of  the fifth cranial nerve (trigeminal nerve). Pain related to trigeminal neuralgia is located in one or several branches of the nerve. The pain is classically described as sharp, lancinating and electrifying. Usually the pain is located only on one side, but in 5-6% the pain occurs on both sides. The pain attacks last from seconds to minutes. Some attacks persist for several days. Pain can be triggered by eating, laughing, brushing teeth, talking, shaving, or touching the face. Occasional slight numbness around the mouth can be present.


In rare cases trigeminal neuralgia is caused by to
tumors along the nerve or multiple sclerosis. For the majority of the cases, a vascular loop with a compressive effect on the nerve (so-called neurovascular compression) near the root entry zone can be assumed.
 
Medical treatment consists of tegretal (carbamazepine), phenytoin, gabapentine, pregabalin and lioresal. If a
tumor has been diagnosed, depending of the histology surgical removal, stereotactic radiation or chemotherapy can be taken into consideration. If the pain is resistant to medical therapy, progression of the pain or strong side effects due to medication occur, surgical procedures like microvascular decompression, radiofrequency, retroganglion glycerol injection, or stereotactic radiation are alternatives to be discussed. Radiofrequency and glycerol injection are destructive techniques which aim to block the pain pathways.

 

Microvascular decompression introduced by Jannetta is the causal therapy with the goal to remove surgically the neurovascular compression of the nerve. In contrast to the other destructive methods, excellent long-term results concerning freedom from pain, preservation of function and quality of life can be expected.

 

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