Clinical presentation of trigeminal neuralgia and the rationale of microvascular decompression

Neurol Sci (2008) 29:S191S195 DOI 10.1007/s10072-008-0923-4

CRANIAL NEURALGIAS

This contribution has been added in proofs, and belongs to the Session Cranial Neuralgias

Clinical presentation of trigeminal neuralgia and the rationale of microvascular decompression

Francesco Tomasello Concetta Alafaci Filippo Flavio Angileri

Amedeo Calisto Francesco Maria Salpietro

Springer-Verlag 2008

Abstract Among the facial pain syndromes, trigeminal neuralgia has a special position for many reasons. Already described in the Romans age, the specific features of its severe symptoms, the therapeutic debate and the recent curative possibilities, make this complex pain syndrome a unique entity. The clinical onset is predominantly unilateral and is described as an electric, lancinating, focal and sharp pain. It can last seconds to minutes initially, and sometimes can last as long as 1 hour. Usually the patient is symptom-free between attacks. Later in the course of the disease, patients report dull, aching, constant pain in the same distribution as the paroxysms. The pain can be triggered by non-noxious stimuli like chewing, talking, swallowing, wind on the face, cold and light touch. Thought to be attributable to fifth cranial nerve dysfunction, the first surgical attempts aimed to interrupt nerve continuity by means of a rizothomy, with disappearance of both pain and sensory disturbances. Further investigations claimed nerve compression by vascular structures as responsible of nervous dysfunction. Hence the attempt to perform a decompression in order to relieve the symptoms and maintain physiologic nerve function. From the successful attempts of first microvascular decompression descends the now standardised and widespread technique that is commonly used today to treat trigeminal neuralgia.

Keywords Trigeminal neuralgia Microvascular decompression Clinical presentation Pathogenesis Rationale

Introduction

Trigeminal neuralgia (TN), tic douloureux, or Fothergill disease, is a well-known condition that neurologists and neurosurgeons are familiar with. First descriptions of this clinical entity date back to the second century AD [1], but also Arabs had some knowledge of trigeminal neuralgia during the 11th century. The first report of medical treatment is attributed to John Locke, a British physician and philosopher, who prescribed laxatives to an affected patient in Paris, in 1677 [2]. One century later, Nicolas Andr and John Fothergill collected different series of patients. The first, who named the disease tic douloureux, grouped the disease with convulsions, tetanus and spasm, conceptualising them as a unique...