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Trigeminal neuralgia: definition and classification

Jorge L. Eller, Ahmed M. Raslan, and Kim J. Burchiel

Based on specific, objective, and reproducible criteria, a classification scheme for trigeminal neuralgia (TN) and related facial pain syndromes is proposed. Such a classification scheme is based on information provided in the patient's history and incorporates seven diagnostic criteria, as follows. 1) and 2) Trigeminal neuralgia Types 1 and 2 (TN1 and TN2) refer to idiopathic, spontaneous facial pain that is either predominantly episodic (as in TN1) or constant (as in TN2) in nature. 3) Trigeminal neuropathic pain results from unintentional injury to the trigeminal nerve from trauma or surgery. 4) Trigeminal deafferentation pain results from intentional injury to the nerve by peripheral nerve ablation, gangliolysis, or rhizotomy in an attempt to treat either TN or other related facial pain. 5) Symptomatic TN results from multiple sclerosis. 6) Postherpetic TN follows a cutaneous herpes zoster outbreak in the trigeminal distribution. 7) The category of atypical facial pain is reserved for facial pain secondary to a somatoform pain disorder and requires psychological testing for diagnostic confirmation. The purpose of a classification scheme like this is to advocate a more rigorous, standardized natural history and outcome studies for TN and related facial pain syndromes.

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Proposal for evaluating the quality of reports of surgical interventions in the treatment of trigeminal neuralgia: the Surgical Trigeminal Neuralgia Score

Harith Akram, Bilal Mirza, Neil Kitchen, and Joanna M. Zakrzewska

following. Conception and design: Akram, Zakrzewska. Acquisition of data: Akram, Mirza, Zakrzewska. Analysis and interpretation of data: Akram, Mirza, Zakrzewska. Drafting the article: all authors. Critically revising the article: Kitchen, Zakrzewska. Reviewed submitted version of manuscript: Kitchen, Zakrzewska. Statistical analysis: Akram, Mirza. Administrative/technical/material support: Akram. References 1 Azar M , Yahyavi ST , Bitaraf MA , Gazik FK , Allahverdi M , Shahbazi S , : Gamma knife radiosurgery in patients with trigeminal neuralgia

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Bridging veins and veins of the brainstem in microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm

Hiroki Toda, Koichi Iwasaki, Naoya Yoshimoto, Yoshihito Miki, Hirokuni Hashikata, Masanori Goto, and Namiko Nishida

T wo types of posterior fossa veins are involved in microvascular decompression surgery, namely, the bridging veins and veins of the brainstem. 20 Bridging veins often traverse the surgical corridors to the trigeminal and facial nerves. 19 Veins of the brainstem may sometimes compress the trigeminal and facial nerve roots and cause trigeminal neuralgias 4 , 8 , 10 , 11 , 15 , 17 and hemifacial spasms, 2 , 6 , 7 respectively. Therefore, venous dissection is essential in microvascular decompression surgery, but the dissection of these veins may cause severe

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Gamma Knife stereotactic radiosurgical treatment of idiopathic trigeminal neuralgia: long-term outcome and complications

Kostas N. Fountas, Joseph R. Smith, Gregory P. Lee, Patrick D. Jenkins, Rebecca R. Cantrell, and W. Chris Sheils

ideal dose and the ideal location of the anatomic target remain to be defined. A better understanding of the radiobiology of the trigeminal nerve root entry zone may help to maximize the efficacy and minimize the complication rates of GKS. Finally, the development of a universally accepted outcome classification system seems imperative for the meaningful and accurate clinical interpretation of the results reported by different centers worldwide. References 1 Brisman R : Gamma knife radiosurgery for primary management for trigeminal neuralgia . J Neurosurg

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Microvascular decompression in patients with isolated maxillary division trigeminal neuralgia, with particular attention to venous pathology

Raymond F. Sekula Jr., Andrew M. Frederickson, Peter J. Jannetta, Sanjay Bhatia, Matthew R. Quigley, and Khaled M. Abdel Aziz

of the trigeminal nerve in 14% of his cases of TN. Since Dandy's report, authors of several studies have noted an increased rate of venous contact or compression in patients with TN as compared with rates in cadavers without a history of TN. 4 , 5 Trigeminal neuralgia, which is most often unilateral, can occur in any one or combination of the 3 branches of the trigeminal nerve. In order of frequency in the general population, TN occurs in the V2 and V3 distributions (30–36%), V2 distribution (10–22%), V1 and V2 distributions (17–22%), V3 distribution (15%), V1 and

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CyberKnife radiosurgery for trigeminal neuralgia: a retrospective review of 168 cases

Albert Guillemette, Sami Heymann, David Roberge, Cynthia Ménard, and Marie-Pierre Fournier-Gosselin

June 26, 2022, in the form of a poster presentation. References 1 van Hecke O , Austin SK , Khan RA , Smith BH , Torrance N . Neuropathic pain in the general population: a systematic review of epidemiological studies . Pain . 2014 ; 155 ( 4 ): 654 – 662 . 10.1016/j.pain.2013.11.013 31815078 2 Silva M , Ouanounou A . Trigeminal neuralgia: etiology, diagnosis, and treatment . SN Compr Clin Med . 2020 ; 2 ( 9 ): 1585 – 1592 . 10.1007/s42399-020-00415-9 31815078 3 Eller JL , Raslan AM , Burchiel KJ . Trigeminal neuralgia

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Fully endoscopic microvascular decompression for trigeminal neuralgia: technique review and early outcomes

Leif-Erik Bohman, John Pierce, James H. Stephen, Sukhmeet Sandhu, and John Y. K. Lee

true bimanual, panoramic CPA surgery can be performed. The senior surgeon (J.Y.K.L.) has thus developed a technique for safe, efficient, and fully endoscopic microvascular decompression (E-MVD) of the trigeminal nerve. 7 , 13 We present the results for the first 47 consecutive patients treated with E-MVD of the trigeminal nerve for trigeminal neuralgia (TN). We review our surgical technique as well as short-term results including surgical complications and medium-term outcomes in facial pain measured with a validated facial pain instrument. 15 Methods Data

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CyberKnife radiosurgery for idiopathic trigeminal neuralgia

Michael Lim, Alan T. Villavicencio, Sigita Burneikiene, Steven D. Chang, Pantaleo Romanelli, Lee McNeely, Melinda McIntyre, Jeffrey J. Thramann, and John R. Adler


Gamma knife surgery is an accepted treatment option for trigeminal neuralgia (TN). The safety and efficacy of CyberKnife radiosurgery as a treatment option for TN, however, has not been established.


Forty-one patients were treated between May 2002 and September 2004 for idiopathic TN at Stanford University and the Rocky Mountain CyberKnife Center. Patients with atypical pain, multiple sclerosis, or previous radiosurgical treatment or a follow-up duration of less than 6 months were excluded. Patients were evaluated for the level of pain control, response rate, time to pain relief, occurrence of hypesthesia, and time to pain recurrence with respect to the length of the nerve treated and the maximum and the minimum dose to the nerve margin.

Thirty-eight patients (92.7%) experienced initial pain relief at a median of 7 days after treatment (range < 24 hours–4 months). Pain control was ranked as excellent in 36 patients (87.8%), moderate in two (4.9%), and three (7.3%) reported no change. Six (15.8%) of the 38 patients with initial relief experienced a recurrence of pain at a median of 6 months (range 2–8 months). Long-term response after a mean follow-up time of 11 months was found in 32 (78%) of 41. Twenty-one patients (51.2%) experienced numbness after treatment.


CyberKnife radiosurgery for TN has high rates of initial pain control and short latency to pain relief compared with those reported for other radiosurgery systems. The doses used for treatment were safe and effective. Higher prescribed doses were not associated with improvement in pain relief or recurrence rate. The hypesthesia rate was related to the length of the trigeminal nerve treated.

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Historical perspectives on the diagnosis and treatment of trigeminal neuralgia

Chad D. Cole, James K. Liu, and Ronald I. Apfelbaum

Since the earliest recorded history of medicine, physicians have been challenged by the difficulty in relieving the great pain experienced by individuals suffering from trigeminal neuralgia (TN). The nature of the pain and the events that incite it have been well described, but effective treatments with acceptable levels of side effects remained elusive until the latter part of the 20th century. As a result, many theories about the origins of TN have been proposed, along with numerous treatment modalities. The pathophysiological causes of TN remain incompletely understood, but the medical and surgical treatment techniques currently used offer effective ways to relieve this extremely painful condition. In this historical review the authors discuss the initial descriptions of tic douloureux, Fothergill disease, and TN, along with various therapeutic interventions and their refinements.

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Radiofrequency trigeminal rhizolysis for the treatment of trigeminal neuralgia secondary to brainstem infarction

Report of two cases

Mina Foroohar, Martin Herman, Scott Heller, and Robert M. Levy

Although percutaneous radiofrequency trigeminal rhizolysis (RFL) has been used to treat idiopathic trigeminal neuralgia thought secondary to multiple sclerosis, the use of RFL for trigeminal neuralgia caused by brainstem infarction has not been advocated. The authors report two patients with trigeminal neuralgia following pontine infarction in whom aggressive medical management failed, but who were successfully treated with RFL. Pain relief has persisted for the 3- and 6-year duration of follow-up examinations. Descending trigeminal reticular fibers may be affected by brainstem infarction and result in trigeminal neuralgia; thus, treatment by rhizotomy may be effective in decreasing the peripheral afferent input into the spinal trigeminal nucleus thus decreasing the pain. These two cases demonstrate the utility of RFL in the relief of ischemia-induced trigeminal neuralgia and lead the authors to suggest that its use be broadened to include this indication.