Trigeminal neuropathic pain in tumors of anterior and middle cranial base

Abstract

With cranial base neoplasms, the trigeminal nerve's function can often be disrupted, which is accompanied by both symptoms of insufficiency and irritation phenomena, including chronic neuropathic facial pain. In this situation, the problems of diagnosis and treatment are due to the complexity of the topographic structure of the mentioned anatomical region and various pathogenetic mechanisms for the development of pain syndrome. Thus, this issue is an interdisciplinary problem. A single approach to the treatment of such patients has not been developed yet. Material and methods. A selection of publications was made in the PubMed, Сochrane library and eLibrary systems using the following keywords: neuropathic facial pain, skull base tumors, trigeminal and cancer pain, facial pain and cancer/tumor, pain and depression, neuropathic facial pain, trigeminal neuropathy. Publications with a high degree of evidence were not found. 42 out of the 112 papers were selected as the most relevant. Results and discussion. Trigeminal neuropathic pain syndrome develops in about 5 % of patients with skull base tumors.Remaining after treatment (surgical or radiological), it dictates the need for the prescription of symptomatic therapy, taking into account the pathogenesis of the pathological process. The efficacy of drugs widely used for neuropathic pain in this category of patients has not been studied extensively. Conclusion. In the analyzed literature, it was not possible to find a unified approach to the management of such patients. As a rule, the authors offer well-established methods of conservative therapy used in the treatment of neuropathic facial pain as such, regardless of the mechanism of its occurrence. The question of the tactics of treating such pain caused by tumor lesions of the skull base remains unresolved.