Classification of trigeminal neuralgia: clinical, therapeutic, and prognostic implications in a series of 144 patients undergoing microvascular decompression

Clinical article

View More View Less
  • Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Object

Trigeminal neuralgia (TN) presents a diagnostic challenge because of the variety of symptoms, findings during microvascular decompression (MVD), and postsurgical outcomes observed among patients who suffer from this disorder. Recently, a new paradigm for classification of TN was proposed, based on the quality of pain. This study represents the first clinical analysis of this paradigm.

Methods

The authors analyzed 144 consecutive cases involving patients who underwent MVD for TN. Preoperative symptoms were classified into 1 of 2 categories based on the preponderance of shocklike (Type 1 TN) or constant (Type 2 TN) pain. Analysis of clinical characteristics, neurovascular pathology, and postoperative outcome was performed.

Results

Compared with Type 2 TN, Type 1 TN patients were older, were more likely to have right-sided symptoms, and reported a shorter duration of symptoms prior to evaluation. Previous treatment by percutaneous or radiosurgical procedures was not a predictor of symptoms, surgical findings, or outcome (p = 0.48). Type 1 TN was significantly more likely to be associated with arterial compression. Venous or no compression was more common among Type 2 TN patients (p < 0.01). Type 1 TN patients were also more likely to be pain-free immediately after surgery, and less likely to have a recurrence of pain within 2 years (p < 0.05). Although a subset of patients progressed from Type 1 to Type 2 TN over time, their pathological and prognostic profiles nevertheless resembled those of Type 1 TN.

Conclusions

Type 1 and Type 2 TN represent distinct clinical, pathological, and prognostic entities. Classification of patients according to this paradigm should be helpful to determine how best to treat patients with this disorder.

Abbreviations used in this paper:

GKS = Gamma Knife surgery; MVD = microvascular decompression; TN = trigeminal neuralgia.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Barker FG II, , Jannetta PJ, , Bissonette DJ, , Larkins MV, & Jho HD: The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:10771083, 1996

    • Search Google Scholar
    • Export Citation
  • 2

    Bullitt E, , Tew JM, & Boyd J: Intracranial tumors in patients with facial pain. J Neurosurg 64:865871, 1986

  • 3

    Burchiel KJ: Abnormal impulse generation in focally demyelinated trigeminal roots. J Neurosurg 53:674683, 1980

  • 4

    Burchiel KJ: A new classification for facial pain. Neurosurgery 53:11641167, 2003

  • 5

    Burchiel KJ, & Slavin KV: On the natural history of trigeminal neuralgia. Neurosurgery 46:152155, 2000

  • 6

    Devor M, , Govrin-Lippmann R, & Rappaport ZH: Mechanism of trigeminal neuralgia: an ultrastructural analysis of trigeminal root specimens obtained during microvascular decompression surgery. J Neurosurg 96:532543, 2002

    • Search Google Scholar
    • Export Citation
  • 7

    Eller JL, , Raslan AM, & Burchiel KJ: Trigeminal neuralgia: definition and classification. Neurosurg Focus 18:5 E3, 2005

  • 8

    Fromm G, & Sessle BJ: Trigeminal Neuralgia: Current Concepts Regarding Pathogenesis and Treatment Boston, Butterworth-Heinemann, 1991

  • 9

    Golby AJ, , Norbash A, & Silverberg GD: Trigeminal neuralgia resulting from infarction of the root entry zone of the trigeminal nerve: case report. Neurosurgery 43:620623, 1998

    • Search Google Scholar
    • Export Citation
  • 10

    Haines SJ, , Jannetta PJ, & Zorub DS: Microvascular relations of the trigeminal nerve. An anatomical study with clinical correlation. J Neurosurg 52:381386, 1980

    • Search Google Scholar
    • Export Citation
  • 11

    Hamlyn PJ, & King TT: Neurovascular compression in trigeminal neuralgia: a clinical and anatomical study. J Neurosurg 76:948954, 1992

  • 12

    Hilton DA, , Love S, , Gradidge T, & Coakham HB: Pathological findings associated with trigeminal neuralgia caused by vascular compression. Neurosurgery 35:299303, 1994

    • Search Google Scholar
    • Export Citation
  • 13

    Jannetta PJ: Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 26:Suppl 159162, 1967

    • Search Google Scholar
    • Export Citation
  • 14

    Leandri M, , Eldridge P, & Miles J: Recovery of nerve conduction following microvascular decompression for trigeminal neuralgia. Neurology 51:16411646, 1998

    • Search Google Scholar
    • Export Citation
  • 15

    Li ST, , Pan Q, , Liu N, , Shen F, , Liu Z, & Guan Y: Trigeminal neuralgia: what are the important factors for good operative outcomes with microvascular decompression. Surg Neurol 62:400405, 2004

    • Search Google Scholar
    • Export Citation
  • 16

    Nurmikko TJ, & Eldridge PR: Trigeminal neuralgia–pathophysiology, diagnosis and current treatment. Br J Anaesth 87:117132, 2001

  • 17

    Tyler-Kabara EC, , Kassam AB, , Horowitz MH, , Urgo L, , Hadjipanayis C, & Levy EI, et al.: Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression. J Neurosurg 96:527531, 2002

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1068 235 32
Full Text Views 257 39 2
PDF Downloads 275 41 4
EPUB Downloads 0 0 0