Arterial compression of nerve is the primary cause of trigeminal neuralgia

Abstract

Whether arterial or venous compression or arachnoid adhesions are primarily responsible for compression of the trigeminal nerve in patients with trigeminal neuralgia is unclear. The aim of this study was to determine the causes of trigeminal nerve compression in patients with trigeminal neuralgia. The surgical findings in patients with trigeminal neuralgia who were treated by micro vascular decompression were compared to those in patients with hemifacial spasm without any signs or symptoms of trigeminal neuralgia who were treated with microvascular decompression. The study included 99 patients with trigeminal neuralgia (median age, 57 years) and 101 patients with hemifacial spasm (median age, 47 years). There were significant differences between the groups in the relationship of artery to nerve (p < 0.001) and the presence of arachnoid adhesions (p < 0.001) but no significant difference in relationship of vein to nerve. After adjustment for age, gender, and other factors, patients with vein compression of nerve or with artery compression of nerve were more likely to have trigeminal neuralgia (OR = 5.21 and 42.54, p = 0.026 and p < 0.001, respectively). Patients with arachnoid adhesions were less likely to have trigeminal neuralgia (OR = 0.15, p = 0.038). Arterial compression of the trigeminal nerve is the primary cause of trigeminal neuralgia and therefore, decompression of veins need not be a priority when performing microvascular dissection in patients with trigeminal neuralgia.

Management of an Atypical Case of Recurrent Trigeminal Neuralgia, switching from V2 to V3 Division: A Case of Resistant Trigeminal Neuralgia

“…Neurovascular compression syndrome is defined as a direct contact with mechanical irritation of CNs by blood vessels the most is artery. 10,11 The most common cause of TN is NVCS and this is also matching with this patient. In our patient, only neurological compression by superior cerebellar artery was there.…”

Nerve Block for the Treatment of Headaches and Cranial Neuralgias – A Practical Approach

“…The most common causes of this condition are idiopathic and vascular compression of the fifth cranial nerve, and carbamazepine is the drug of choice for the pharmacological treatment of trigeminal neuralgias …”

“…The pain can be triggered by routine activities such as washing, shaving, or even talking. 30 The most common causes of this condition are idiopathic and vascular compression of the fifth cranial nerve, 55 and carbamazepine is the drug of choice for the pharmacological treatment of trigeminal neuralgias. 56 Neuralgia of the terminal branches of the trigeminal nerve is characterized by pain at the distribution of the trigeminal branch that worsens with local palpation and is abolished by infiltration of a local anesthetic.…”

Microstructural alterations in trigeminal neuralgia determined by diffusion tensor imaging are independent of symptom duration, severity, and type of neurovascular conflict

“…11,24,36 The relevance of venous contact as a cause for TN remains a matter of debate. 5,15,28 Currently, high-resolution MRI with steady-state sequences and MR angiography (MRA) are the gold standard for detecting neurovascular conflicts and help to exclude other causes of TN. 38 These sequences, however, do not allow for objective quantification and prognostication of structural changes that might have occurred in the respective nerve.…”