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.
Key-words:
Cranial nerve - microvascular decompression - neurosurgical procedures/methods - route
entry zone - trigeminal nerve diseases - trigeminal neuralgia - trigeminal neuralgia/surgery
