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Trigeminal Neuralgia

Trigeminal Neuralgia. By Dr . Ravindra Srivastava Consultant Neurosurgeon VIMHANS, New DELHI.

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Trigeminal Neuralgia

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  1. Trigeminal Neuralgia By Dr. RavindraSrivastava Consultant Neurosurgeon VIMHANS, New DELHI

  2. 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

  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

  4. Etiology • - Idiopathic (Vascular) • - Tumour V (nerve) Schwannoma or Cerebellopontineangle Tumors • - Herpes Simplex virus infection • - Multiple Sclerosis • 4% of Patients with Multiple sclerosis have Trigeminal Neuralgia • 2% Patients with Trigeminal Neuralgia have Multiple sclerosis

  5. 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.

  6. Investigations • Whether there is an identifiable cause of disease, particularly with a view to surgical cure.

  7. 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.

  8. Management • Medical • Surgical

  9. Gasserian ganglion level Procedures:- -Micro vascular Decompression MVD • Ablative treatments -Radiofrequency thermocoagulation(RFT) -Glycerol Rhizolysis (GR) -BallonCompression (BC) -Stereotactic Radio surgery (SRS)

  10. Peripheral procedures -Peripheral Neuroectomy -Cryotheraphy -Alcohol Block

  11. MVD • Concept of Dandy (1920) • Popularized by Janetta. • GOLD STANDARD as it deals the underlying cause. • RetromastoidSub 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.

  12. 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.

  13. Thank You

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