Online ISSN: 2515-8260

Keywords : Trigeminal neuralgia

Clinical and Radiological Spectrum of Trigeminal Neuralgia

Praveen Chowdary Meduri, Annam Jayamadhavi, Susmitha Yella

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 770-776

Background: Trigeminal neuralgia is one of the most painful neurological disorders.In this study we aimed to describe the clinical and radiological spectrum of trigeminal neuralgia.
Martial and Methods: This is a single center prospective study conducted at a tertiary hospital in Southern India. A total of 50 patients  with clinical diagnosis of trigeminal neuralgia according to ICHD-3 criteria were included in the study. Demographic characteristics, detailed case history that included side of face involved – left/right, area of face involved (V1/V2/V3/V1+V2/V2+V3/  V1+V2+V3), pain characteristics, triggering factors, sensory abnormalities was  taken. MRI brain was performed in all patients. Classical,secondary,idiopathic trigeminal neuralgia was diagnosed based on ICHD-3 criteria.
Results: Fifty patients were included in our study, whose age group ranged from 32 to 77 years.The highest incidence was found in 51-60 years age group accounting for 36 % of cases. 30 (60%) were females and 20 (40%) were males. In 32 patients (64%) right side of face was affected and in 18 (36%) patients left side was affected. The most commonly described character of pain was lancinating type (32%) followed by mixed features (26%). V3 was involved in 24 patients accounting for 48% of cases. V2 was involved in 20 (40%) patients, V1+V2 in 1 (2%) patient, V2+V3 in 4(8%) patients, V1+V2+V3 in 1 (2%) patient. V1 involvement alone was not seen in our study.
Conclusion: Our study determined the clinical and radiological spectrum of trigeminal neuralgia patients. We conclude that the highest incidence is in 51-60 years age group with female preponderance, predominant involvement of right side of face and predominant maxillary division involvement. Lancinating type of pain was the most common type with touch being the most common trigger factor. Classical trigeminal neuralgia was the most common subtype.

Factors affecting the surgical outcome of microvascular decompression in trigeminal neuralgia

Dr. Vivek Kumar, Dr. Kanishk Goyal, Dr. Vinay, Dr Anita Jagetia

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 465-474

Background: Microvascular decompression is an established surgical modality for treatment of trigeminal neuralgia with variable long-term success rates depending on numerous patient and disease related factors. 
Methods: A prospective study was done including 31 patients, aged between 18 to 74 years who underwent microvascular decompression for primary trigeminal neuralgia at our institution. Barrows neurological institute pain intensity scale and facial numbness score were used to assess outcome till 1 year follow up period. 
Results: 71% patients were suffering from typical trigeminal neuralgia with involvement of both V2 and V3 divisions being the most common presentation. All patients achieved favorable outcome based on BNI pain and numbness score in the immediate post-operative period however at one year 3 patients had un-favourable pain score. Younger age, longer duration of neuralgia before surgery, involvement of all three trigeminal nerve divisions, pure venous compression and presence of focal arachnoiditis were factors associated with poor outcome. 
Conclusions: MVD is a safe and effective procedure in all age groups including elderly patients with both typical and atypical symptomatology. It is seen to be effective in relieving both arterial and mixed venous neurovascular conflict especially in patients with NVC grade III severity. However, the distribution of pain in all three divisions of trigeminal nerve, pure venous compression and presence of focal arachnoiditis seem to be associated with poorer outcome.