Trigeminal Neuralgia
By
Dr. Ravindra Srivastava
Consultant Neurosurgeon
VIMHANS, New DELHI
 Paroxysms of severe, lancinating, electric
shock-like bouts of facial pain, lasting for
seconds to minutes and restricted to
distribution of the trigeminal nerve. No
neurologic deficit is present and is not
attributed to another disorder.
 Incidence : 4-5/ 1,00,000
 Female Predominance (Male: Female = 1:2
– 2:3
 usually unilateral (Right Side)
 mandibular (60%) (V3)
 maxillary (V2) (35%)
 ophthalmic VI branch (5%)
 Trigger zones - cheek, lip, nose or buccal
mucosa.
 Triggers - shaving, brushing teeth, drinking,
eating or even slight breeze
Etiology
 - Idiopathic (Vascular)
 - Tumour V (nerve) Schwannoma or Cerebello
pontine angle Tumors
 - Herpes Simplex virus infection
 - Multiple Sclerosis
 4% of Patients with Multiple sclerosis have
Trigeminal Neuralgia
 2% Patients with Trigeminal Neuralgia have
Multiple sclerosis
 Vascular- Aberrant loop of artery
-Superior cerebellar artery (75.5%),
- AICA (9.6%)
-PCA (0.7%) or
-vein (68.2%) found to be compressing the
root entry zone of the V nerve in 80-90% of
patients at surgery. Eliminating the
compression provides long term relief.
Investigations
 Whether there is an identifiable cause of
disease, particularly with a view to surgical
cure.
MRI SCAN- 3D CISS with MPR
sequences & MRA
 MRI scan should be obtained in
-Younger Patient
-Atypical clinical Features, including sensory
loss or a dull burning pain between paroxysms
-Patients who do not respond to initial
medical therapy.
Management
 Medical
 Surgical
 Gasserian ganglion level Procedures:-Micro vascular Decompression MVD
 Ablative treatments
-Radiofrequency thermocoagulation (RFT)
-Glycerol Rhizolysis (GR)
-Ballon Compression (BC)
-Stereotactic Radio surgery (SRS)
 Peripheral procedures
-Peripheral Neuroectomy
-Cryotheraphy
-Alcohol Block
MVD
 Concept of Dandy (1920)
 Popularized by Janetta.
 GOLD STANDARD as it deals the underlying
cause.
 Retromastoid Sub occipital craniotomy,
Retraction of superolateral margin of
cerebellum, arachnoid is dissected & vessel
freed, piece of shredded teflon placed
between the vessel & the nerve to separate
them.
 OF1185 pts treated by Barker at al with
mean follow up of 6.5Yrs, 70% had excellent
results at 10yrs.
 Our results in 10patients in whom MVD was
done 80% -85% had excellent results over of
period 5 Yrs.
Thank You