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Trigeminal Neuralgia
Philip R. Chapman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Classical/classic TN, Tic douloureux, trigeminal nerve vascular loop syndrome
              • Definitions

                • Classic trigeminal neuralgia (TN): Typical clinical syndrome of paroxysmal pain in unilateral trigeminal nerve (CNV) distribution with radiologic evidence of vessel or vascular loop producing compression of proximal CNV

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Jain A et al: Absence of Meckel cave: a rare cause of trigeminal neuralgia. AJNR Am J Neuroradiol. ePub, 2021
                                    2. Jani RH et al: Trigeminal nerve compression without trigeminal neuralgia: intraoperative vs imaging evidence. Neurosurgery. 84(1):60-5, 2019
                                    3. Spina A et al: Gamma knife radiosurgery for trigeminal neuralgia: when? Neurosurg Rev. 42(2):599-601, 2019
                                    4. Brînzeu A et al: Reliability of MRI for predicting characteristics of neurovascular conflicts in trigeminal neuralgia: implications for surgical decision making. J Neurosurg. 1-11, 2018
                                    5. Majeed MH et al: Trigeminal neuralgia: a clinical review for the general physician. Cureus. 10(12):e3750, 2018
                                    6. Cruccu G et al: Trigeminal neuralgia: new classification and diagnostic grading for practice and research. Neurology. 87(2):220-8, 2016
                                    7. Mistry AM et al: Neurovascular compression at the root entry zone correlates with trigeminal neuralgia and early microvascular decompression outcome. World Neurosurg. 95:208-13, 2016
                                    8. Maarbjerg S et al: Significance of neurovascular contact in classical trigeminal neuralgia. Brain. 138(Pt 2):311-9, 2015
                                    9. Leal PR et al: Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes. J Neurosurg. 120(6):1484-95, 2014
                                    10. Anqi X et al: MR cisternography in the posterior fossa: the evaluation of trigeminal neurovascular compression. Turk Neurosurg. 23(2):218-25, 2013
                                    11. Lee JK et al: Long-term outcome of gamma knife surgery using a retrogasserian petrous bone target for classic trigeminal neuralgia. Acta Neurochir Suppl. 116:127-35, 2013
                                    12. Garcia M et al: High-resolution 3D-constructive interference in steady-state MR imaging and 3D time-of-flight MR angiography in neurovascular compression: a comparison between 3T and 1.5T. AJNR Am J Neuroradiol. 33(7):1251-6, 2012
                                    13. Leal PR et al: Visualization of vascular compression of the trigeminal nerve with high-resolution 3T MRI: a prospective study comparing preoperative imaging analysis to surgical findings in 40 consecutive patients who underwent microvascular decompression for trigeminal neuralgia. Neurosurgery. 69(1):15-25; discussion 26, 2011
                                    14. Lutz J et al: Trigeminal neuralgia due to neurovascular compression: high-spatial-resolution diffusion-tensor imaging reveals microstructural neural changes. Radiology. 258(2):524-30, 2011
                                    15. Leal PR et al: Preoperative demonstration of the neurovascular compression characteristics with special emphasis on the degree of compression, using high-resolution magnetic resonance imaging: a prospective study, with comparison to surgical findings, in 100 consecutive patients who underwent microvascular decompression for trigeminal neuralgia. Acta Neurochir (Wien). 152(5):817-25, 2010
                                    16. Fariselli L et al: CyberKnife radiosurgery as a first treatment for idiopathic trigeminal neuralgia. Neurosurgery. 64(2 Suppl):A96-101, 2009
                                    17. Kabatas S et al: Microvascular decompression as a surgical management for trigeminal neuralgia: long-term follow-up and review of the literature. Neurosurg Rev. 32(1):87-93; discussion 93-4, 2009
                                    18. Miller JP et al: Radiographic evaluation of trigeminal neurovascular compression in patients with and without trigeminal neuralgia. J Neurosurg. 110(4):627-32, 2009
                                    19. Satoh T et al: Severity analysis of neurovascular contact in patients with trigeminal neuralgia: assessment with the inner view of the 3D MR cisternogram and angiogram fusion imaging. AJNR Am J Neuroradiol. 30(3):603-7, 2009
                                    20. Sindou M et al: Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg. 107(6):1144-53, 2007
                                    21. Anderson VC et al: High-resolution three-dimensional magnetic resonance angiography and three-dimensional spoiled gradient-recalled imaging in the evaluation of neurovascular compression in patients with trigeminal neuralgia: a double-blind pilot study. Neurosurgery. 58(4):666-73; discussion 666-73, 2006
                                    22. Erbay SH et al: Nerve atrophy in severe trigeminal neuralgia: noninvasive confirmation at MR imaging--initial experience. Radiology. 238(2):689-92, 2006
                                    23. Yoshino N et al: Trigeminal neuralgia: evaluation of neuralgic manifestation and site of neurovascular compression with 3D CISS MR imaging and MR angiography. Radiology. 228(2):539-45, 2003
                                    24. Zakrzewska JM: Diagnosis and differential diagnosis of trigeminal neuralgia. Clin J Pain. 18(1):14-21, 2002
                                    25. Love S et al: Trigeminal neuralgia: pathology and pathogenesis. Brain. 124(Pt 12):2347-60, 2001
                                    26. Majoie CB et al: Trigeminal neuropathy: evaluation with MR imaging. Radiographics. 15(4):795-811, 1995
                                    27. Darlow LA et al: Magnetic resonance imaging in the diagnosis of trigeminal neuralgia. J Oral Maxillofac Surg. 50(6):621-6, 1992
                                    28. Hutchins LG et al: Trigeminal neuralgia (tic douloureux): MR imaging assessment. Radiology. 175(3):837-41, 1990
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Pathology

                                            • Clinical Issues

                                              • Diagnostic Checklist

                                                TERMINOLOGY

                                                • Synonyms

                                                  • Classical/classic TN, Tic douloureux, trigeminal nerve vascular loop syndrome
                                                • Definitions

                                                  • Classic trigeminal neuralgia (TN): Typical clinical syndrome of paroxysmal pain in unilateral trigeminal nerve (CNV) distribution with radiologic evidence of vessel or vascular loop producing compression of proximal CNV

                                                IMAGING

                                                • General Features

                                                  • CT Findings

                                                    • MR Findings

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Jain A et al: Absence of Meckel cave: a rare cause of trigeminal neuralgia. AJNR Am J Neuroradiol. ePub, 2021
                                                                      2. Jani RH et al: Trigeminal nerve compression without trigeminal neuralgia: intraoperative vs imaging evidence. Neurosurgery. 84(1):60-5, 2019
                                                                      3. Spina A et al: Gamma knife radiosurgery for trigeminal neuralgia: when? Neurosurg Rev. 42(2):599-601, 2019
                                                                      4. Brînzeu A et al: Reliability of MRI for predicting characteristics of neurovascular conflicts in trigeminal neuralgia: implications for surgical decision making. J Neurosurg. 1-11, 2018
                                                                      5. Majeed MH et al: Trigeminal neuralgia: a clinical review for the general physician. Cureus. 10(12):e3750, 2018
                                                                      6. Cruccu G et al: Trigeminal neuralgia: new classification and diagnostic grading for practice and research. Neurology. 87(2):220-8, 2016
                                                                      7. Mistry AM et al: Neurovascular compression at the root entry zone correlates with trigeminal neuralgia and early microvascular decompression outcome. World Neurosurg. 95:208-13, 2016
                                                                      8. Maarbjerg S et al: Significance of neurovascular contact in classical trigeminal neuralgia. Brain. 138(Pt 2):311-9, 2015
                                                                      9. Leal PR et al: Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes. J Neurosurg. 120(6):1484-95, 2014
                                                                      10. Anqi X et al: MR cisternography in the posterior fossa: the evaluation of trigeminal neurovascular compression. Turk Neurosurg. 23(2):218-25, 2013
                                                                      11. Lee JK et al: Long-term outcome of gamma knife surgery using a retrogasserian petrous bone target for classic trigeminal neuralgia. Acta Neurochir Suppl. 116:127-35, 2013
                                                                      12. Garcia M et al: High-resolution 3D-constructive interference in steady-state MR imaging and 3D time-of-flight MR angiography in neurovascular compression: a comparison between 3T and 1.5T. AJNR Am J Neuroradiol. 33(7):1251-6, 2012
                                                                      13. Leal PR et al: Visualization of vascular compression of the trigeminal nerve with high-resolution 3T MRI: a prospective study comparing preoperative imaging analysis to surgical findings in 40 consecutive patients who underwent microvascular decompression for trigeminal neuralgia. Neurosurgery. 69(1):15-25; discussion 26, 2011
                                                                      14. Lutz J et al: Trigeminal neuralgia due to neurovascular compression: high-spatial-resolution diffusion-tensor imaging reveals microstructural neural changes. Radiology. 258(2):524-30, 2011
                                                                      15. Leal PR et al: Preoperative demonstration of the neurovascular compression characteristics with special emphasis on the degree of compression, using high-resolution magnetic resonance imaging: a prospective study, with comparison to surgical findings, in 100 consecutive patients who underwent microvascular decompression for trigeminal neuralgia. Acta Neurochir (Wien). 152(5):817-25, 2010
                                                                      16. Fariselli L et al: CyberKnife radiosurgery as a first treatment for idiopathic trigeminal neuralgia. Neurosurgery. 64(2 Suppl):A96-101, 2009
                                                                      17. Kabatas S et al: Microvascular decompression as a surgical management for trigeminal neuralgia: long-term follow-up and review of the literature. Neurosurg Rev. 32(1):87-93; discussion 93-4, 2009
                                                                      18. Miller JP et al: Radiographic evaluation of trigeminal neurovascular compression in patients with and without trigeminal neuralgia. J Neurosurg. 110(4):627-32, 2009
                                                                      19. Satoh T et al: Severity analysis of neurovascular contact in patients with trigeminal neuralgia: assessment with the inner view of the 3D MR cisternogram and angiogram fusion imaging. AJNR Am J Neuroradiol. 30(3):603-7, 2009
                                                                      20. Sindou M et al: Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg. 107(6):1144-53, 2007
                                                                      21. Anderson VC et al: High-resolution three-dimensional magnetic resonance angiography and three-dimensional spoiled gradient-recalled imaging in the evaluation of neurovascular compression in patients with trigeminal neuralgia: a double-blind pilot study. Neurosurgery. 58(4):666-73; discussion 666-73, 2006
                                                                      22. Erbay SH et al: Nerve atrophy in severe trigeminal neuralgia: noninvasive confirmation at MR imaging--initial experience. Radiology. 238(2):689-92, 2006
                                                                      23. Yoshino N et al: Trigeminal neuralgia: evaluation of neuralgic manifestation and site of neurovascular compression with 3D CISS MR imaging and MR angiography. Radiology. 228(2):539-45, 2003
                                                                      24. Zakrzewska JM: Diagnosis and differential diagnosis of trigeminal neuralgia. Clin J Pain. 18(1):14-21, 2002
                                                                      25. Love S et al: Trigeminal neuralgia: pathology and pathogenesis. Brain. 124(Pt 12):2347-60, 2001
                                                                      26. Majoie CB et al: Trigeminal neuropathy: evaluation with MR imaging. Radiographics. 15(4):795-811, 1995
                                                                      27. Darlow LA et al: Magnetic resonance imaging in the diagnosis of trigeminal neuralgia. J Oral Maxillofac Surg. 50(6):621-6, 1992
                                                                      28. Hutchins LG et al: Trigeminal neuralgia (tic douloureux): MR imaging assessment. Radiology. 175(3):837-41, 1990