Cause Of Trigeminal Neuralgia Research Articles

Virtual Reality Planning of Microvascular Decompression in Trigeminal Neuralgia: Technique and Clinical Outcome.

A neurovascular conflict (NVC) is considered the cause of trigeminal neuralgia (TN) in 75% of cases, and if so, a microvascular decompression (MVD) can lead to significant pain relief. A reliable preoperative detection of NVC is essential for clinical decision-making and surgical planning, making detailed neuroradiologic imaging an important component. We present our experiences and clinical outcomes with preoperative planning of the MVD procedure in a virtual reality (VR) environment, based on magnetic resonance imaging (MRI) including magnetic resonance angiography (MRA) and magnetic resonance venography (MRV) sequences. We analyzed the data of 30 consecutive MVDs in patients treated for TN, in a retrospective single-surgeon (R.A. Kockro) study. Out of the 30 cases, 26 were included. Preoperatively, MRA/MRV and MRI series were fused and three dimensionally reconstructed in a VR environment. All critical structures such as the trigeminal nerve as well as the arteries and veins of the cerebellopontine angle, the brainstem, the neighboring cranial nerves, and the transverse and sigmoid sinus were segmented. The NVC was visualized and a simulation of a retrosigmoid approach, with varying trajectories, to the NVC was performed. The intraoperative findings were then compared with the data of the simulation. The clinical outcome was assessed by a detailed review of medical reports, and follow-up-interviews were conducted in all available patients (20/26). The VR planning was well integrated into the clinical workflow, and imaging processing time was 30 to 40 minutes. There was a sole arterial conflict in 13 patients, a venous conflict in 4 patients, and a combined arteriovenous conflict in 9 patients. The preoperative simulations provided a precise visualization of the anatomical relationships of the offending vessels and the trigeminal nerves as well as the surrounding structures. For each case, the approach along the most suitable surgical corridor was simulated and the exact steps of the decompression were planned. The NVC and the anatomy of the cerebellopontine angle as seen intraoperatively matched with the preoperative simulations in all cases and the MVC could be performed as planned. At follow-up, 92.3% (24/26) of patients were pain free and all the patients who completed the questionnaire would undergo the surgery again (20/20). The surgical complication rate was zero. Current imaging technology allows detailed preoperative visualization of the pathoanatomical spatial relationships in cases of TN. 3D interactive VR technology allows establishing a clear dissection and decompression strategy, resulting in safe vascular microsurgery and excellent clinical results.

Microvascular decompression for trigeminal neuralgia: an experience of 84 operated cases

AimWe retrospectively analyse and review the results of microvascular decompression performed for trigeminal neuralgia. We also discuss the surgical nuances, complication avoidance and compare our results with other reported studies.Materials and methodsThis is a retrospective study in which the data of eighty-four patients who underwent microvascular decompression for trigeminal neuralgia in the last ten years from 2013 till May 2023 at our institute (Neuron hospital and SSG Hospital, Vadodara, India) was reviewed. The preoperative pain characteristics, radiology reports and the degree and duration of post-operative pain relief and neurologic outcome was assessed. MRI was done preoperatively in all the cases to rule out a secondary cause for trigeminal neuralgia. All the cases of secondary trigeminal neuralgia were excluded from the study. A favourable outcome was defined as a post-operative Barrow Neurological Institute pain intensity score of 1.ResultsEighty patients had excellent immediate postoperative pain relief without any need for medications. None of these patients have developed any recurrence of pain till date. Four operated patients did not experience any pain relief after surgery.ConclusionMicrovascular decompression for trigeminal neuralgia is a safe and effective procedure which treats the root cause of the disease and hence provides good long term pain relief.

Trigeminal Neuralgia as An Atypical Manifestation of Intracranial Hypertension. Case Report and Literature Review

Trigeminal neuralgia, a chronic neuropathic pain, is characterized by frequent episodes of stabbing facial pain, in the territory of the trigeminal nerve, which can severely impair patient’s quality of life. It is primarily caused by vascular compression of the trigeminal nerve root, but it is sometimes secondary to other identifiable neurological conditions, such as multiple sclerosis or a cerebellopontine angle tumor. Uncommonly, it may be caused by the presence of idiopathic intracranial hypertension, a condition most likely identified by headache, visual disturbances, and sixth nerve palsy, among other manifestations. Secondary causes of trigeminal neuralgia are usually detected after an atypical clinical manifestation, such as ophthalmic rather than maxillary or mandibular nerve involvement, more than one branch affected, or bilateral symptoms. We present a patient who presented with trigeminal neuralgia as a primary manifestation, and after thorough evaluation she was diagnosed with intracranial hypertension as the underlying mechanism responsible of the trigeminal neuralgia.

The potential role of a narrow foramen rotundum and foramen ovale in the development of concomitant continuous pain in trigeminal neuralgia

The most characteristic symptom of trigeminal neuralgia (TN) is paroxysmal and lancinating pain along the sensory distribution of the trigeminal nerve. Notably, a proportion of TN patients also experience persistent throbbing or burning in the same territory as their paroxysmal pain, termed concomitant continuous pain (CCP). The neurovascular compression (NVC) theory has been regarded as the primary cause of paroxysmal pain in TN. In contrast, the mechanisms underlying CCP can hardly be explained by NVC and have yet to be clearly elucidated. Both the foramen rotundum (FR) and foramen ovale (FO) are substantial bony apertures in the middle cranial fossa, through which the second (V2) and third divisions (V3) of the trigeminal nerve pass, respectively. Prior studies have proposed that a narrow FR and FO on the right side may result in a greater incidence of right-sided symptoms and be involved in the development of TN. However, given the nature of CCP and certain anatomical findings, we postulate that secondary compression of V2 and V3 by narrow foramina is more likely to be the primary cause of the persistent pain instead of the paroxysmal pain in cases of TN with CCP. TN with CCP may be the combination of trigeminal neuralgia induced by NVC and trigeminal neuropathic pain resulting from constant entrapment of V2 and V3. Therefore, considering that microvascular decompression cannot resolve all causes of TN with CCP, percutaneous ablative procedures and stereotactic radiosurgery may be more appropriate for patients with narrow foramina.

How I do it: Endoscopic microvascular decompression for a nerve penetrating trigeminocerebellar artery causing trigeminal neuralgia.

The trigeminocerebellar artery is a standard variant originating from the basilar artery and can be an infrequent cause of trigeminal neuralgia. Total endoscopic microvascular decompression (eMVD) was performed using a 0-degree endoscope through a retro sigmoid keyhole. Multiple points of neurovascular conflict enhanced by indocyanine green angiography were identified, and the root entry zone was decompressed. The patient had an improvement in facial pain with no complications. Complete eMVD for a nerve-penetrating artery is a practical, minimally invasive, uncomplicated technique that improves visualization and patient comfort.

Persistent Trigeminal Artery: A Little Known Cause of Trigeminal Neuralgia- MR Imaging

A persistent trigeminal artery (PTA) is a non-involuted embryonic vessel that connects the cavernous part of the internal carotid artery with the posterior circulation. In the adult, it is usually found incidentally but can be often associated with vascular malformation, cerebral aneurysm trigeminal neuralgia and even posterior circulation strokes. We report here a case of persistant trigeminal artery as a cause of trigeminal neuralgia and its aspects found in MR imaging.

Trigeminal Neuralgia: A Brief Review

Trigeminal neuralgia is a facial pain syndrome that occurs repeatedly and chronically on one side of the face following the distribution of the trigeminal nerve branches. Trigeminal neuralgia is estimated to be around 0.16%-0.3%, with an incidence rate of 4-29 people per 100,000 people/year, with a higher incidence in women than men (ratio 3:2). The incidence rate increases with age. The causes of trigeminal neuralgia are divided into two types, classic and symptomatic. The main mechanism of trigeminal neuralgia is compression by the intracranial blood vessels which causes damage to the protective covering of the nerves or is known as the process of demyelination. Treatment of trigeminal neuralgia is pharmacotherapy, non-pharmacotherapy, surgery should be considered if treatment is ineffective, and preventive education.

Vascular decompression in the treatment of trigeminal neuralgia in dolichoectated vertebrobasilar artery

Dolichoectasia of vertebrobasilar artery is an uncommon and rare cause of trigeminal neuralgia. The article presents a case of successful treatment of a patient with trigeminal neuralgia caused by vertebrobasilar dolichoectasia. The technical complexity of the operation is due to the rigidity and tortuosity of a large-caliber vessel with perforating branches leading to the brain stem and limited space in the cerebellopontine angle. The implantation of Teflon wool in areas of neurovascular conflict is an effective surgical aid for complete elimination of trigeminal neuralgia while maintaining the anatomical integrity of the nerve structures and minimizing the risk to the patient.

CSF neuron-specific enolase as a biomarker of neurovascular conflict severity in drug-resistant trigeminal neuralgia: a prospective study in patients submitted to microvascular decompression.

Although neurovascular conflict (NVC) is the most widely accepted cause of trigeminal neuralgia (TN), few articles have analyzed molecular and biochemical mechanisms underlying TN. In the present study, we dosed neuron-specific enolase (NSE) on serum and CSF samples of 20 patients submitted to microvascular decompression (MVD) and correlated these findings with the type of NVC. Blood samples were obtained preoperatively and 48 h after MVD. CSF from trigeminal cistern was intraoperatively obtained. NSE levels were measured using the Diasorin kit (LIAISON®NSE). NVC was classified as "contact" or "trigeminal nerve distortion/indentation" or "trigeminal root atrophy" based on MRI and intraoperative findings. Clinical outcome was measured by acute pain relief (APR) and Barrow Neurological Institute (BNI) scale at last available follow-up (FU; 6.40 ± 5.38 months). APR was obtained in all patients. A statistically significant BNI reduction was obtained at latest FU (p < 0.0001). Serum NSE levels significantly decreased following MVD (from 12.15 ± 3.02 ng/mL to 8.95 ± 2.83 ng/mL, p = 0.001). The mean CSF NSE value was 48.94 ng/mL, and the mean CSF/serum NSE rate was 4.18 with a strong correlation between these two variables (p = 0.0008). CSF NSE level in "trigeminal root atrophy" group was significantly higher compared to "contact" (p = 0.0045) and "distortion/indentation" (p = 0.010) groups. NSE levels seem to be related to the etiopathology and severity of NVC. A significant reduction of serum NSE levels could be related to the resolution of the NVC and clinical TN improvement.

A study on trigeminal nerve: Does superior cerebellar artery causes trigeminal neuralgia

Our brain is the most complex organ in our body which conducts various complex functions and this level of complexity is operated by different structures of the brain. The complexity of relaying information between brain and different parts of the body is conducted by 12 pairs of cranial nerves. Out of 12 pairs of cranial nerves, the most complex and largest nerve is know as trigeminal nerve which is responsible for sensation of face and motor functions such as biting and chewing. Sometimes due to offendation of this nerve typically by Superior Cerebellar Artery leads to most excruciating painful disorder humanity have ever witnessed.: A systemic self-study was planned to determine and review with proper enlightenment on the existing facts to find the root sources of trigeminal neuralgia.This article discussed and focused on the exact cause of trigeminal neuralgia it’s association with Superior Cerebellar Artery along with descriptive analysis on the available treatments for this disorder. We concluded with the fact that based on our thorough review and analysis Superior Cerebellar Artery is the main artery which typically causes world’s most excruciating painful Suicide Disease.

Correlation study between multiplanar reconstruction trigeminal nerve angulation and trigeminal neuralgia

ObjectivesNeurovascular compression (NVC) produces morphological changes on the trigeminal nerve root is considered the cause of trigeminal neuralgia (TN), but there were some patients with TN found no NVC, and also NVC was found in asymptomatic individuals. Many studies found tight relationships of TN and morphological structures of trigeminal nerve. We designed this study to explore the correlation between multiplanar reconstruction (MPR) trigeminal nerve angulation (TNA) and TN.MethodsPatients with classical symptoms of TN were recruited as observation group (OG) in this study, 50 healthy controls were enrolled as control group (CG), the OG was further subtyped into young patients (YP), middle-aged patients (MP) and old patients (OP) based to the onset age of symptoms, and also divided into patients with or without trigger maneuvers (TM) based on the presence of TM or not. All the participants underwent magnetic resonance (MR) examinations in same device, bilateral TNA measurements were carried out in OG and CG, then TNA was compared between different groups or subgroups. All images were interpreted by two radiologists who were blinded to the study, diagnosis of TN was made by two senior neurosurgery professors.ResultUltimately, 95 patients with primary TN were recruited in OG, aged from 25 to 84 (61.15 ± 12.70) years with a course of 0.5 to 30 (5.03 ± 5.41) years, their onset age ranged from 24 to 82 (56.13 ± 11.98) years. There were 34 males and 61 females in OG, and 58 cases involved right side. The CG aged from 22 to 85 (61.86 ± 13.03) years. No statistical difference was found between the age of OG and CG(p = 0.76), and also the bilateral TNA of CG (154.92 ± 16.90° vs 155.55 ± 17.03°, p > 0.05), while TNA of OG was significantly smaller than CG (150.78 ± 11.29° vs 155.24 ± 16.88°, p = 0.019). In OG, TNA on the affected side was significantly smaller than the unaffected side (149.29 ± 12.44° vs 152.27 ± 9.85°, p = 0.014). TNA showed a positive correlation with onset age of patients with TN, as TNA on the affected side of YP was significantly smaller than MP and OP (139.00 ± 11.64° vs 148.86 ± 11.54°, 139.00 ± 11.64° vs 152.18 ± 12.61°, p = 0.004 and 0.026). Furthermore, patients with TM showed smaller TNA than those without TM (147.05 ± 11.30° vs 164.75 ± 8.39°, p < 0.001).ConclusionsThis study suggested that TNA might play a role in TN, small TNA could be a risk factor of TN. Furthermore, patients with small TNA are more likely to combine with TM, but more studies are needed to explore the exact role of TNA in TN.

Vertebrobasilar Dolichoectasia, An Unusual Cause of Trigeminal Neuralgia: A Case Report

Background: Trigeminal neuralgia is a facial pain syndrome that generally occur unilateral following the sensory distribution of the trigeminal nerve. It is classified into trigeminal neuralgia with no apparent cause, classic trigeminal neuralgia, which is caused by vascular compression of the trigeminal nerve root, and secondary trigeminal neuralgia caused by major neurological diseases such as cerebellopontine angle tumour or multiple sclerosis.Case: A 60 years old male, complained of pain in the right face since &gt;4 years ago, intermittent, radiating from around the upper right molars to the right face, like an electric shock, and appeared mainly when chewing. MRI and MRA examination of the patient revealed vertebrobasilar dolichoectasia causing displacement of the pons and right trigeminal nerve.Discussion: Vascular compression of the trigeminal nerve root is the most common cause of trigeminal neuralgia, which is commonly caused by small arteries such as the superior cerebellar artery. Vascular compression due to large arteries such as the basilar and vertebral arteries may occur in a minority of cases. MRI is an examination that plays an important role in cases of trigeminal neuralgia, because it can assess the pathology of cerebellopontine angle area, as well as assess the presence of neurovascular compression and morphological changes of the trigeminal nerve roots.

Percutaneous balloon compression for secondary trigeminal neuralgia caused by cerebellopontine angle tumors.

The most common cause for trigeminal neuralgia (TN) is vascular compression at the nerve root, and microvascular decompression (MVD) has been proven to be an effective surgical approach for this disease. For some patients, TN is secondary to the intracranial space-occupying lesion, and tumor resection is usually recommended. However, it is not easy to determine proper treatments when craniotomy is infeasible. In this study, we aim to explore the clinical outcomes of percutaneous balloon compression (PBC) for secondary TN caused by cerebellopontine angle (CPA) tumors. From June 2016 to December 2019, 15 patients with TN caused by CPA tumors underwent PBC in Nanjing Drum Tower Hospital. The clinical features, surgical outcomes, and complications of these patients were analyzed retrospectively. Fourteen out of the 15 patients had immediate pain relief after successful PBC, while one showed occasional pain, without needing any medication. No patients had a relapse of facial pain within a mean follow-up of 32.5months. As for surgical complications, 14 patients experienced facial numbness, and six had masseter muscle weakness. No patients experienced serious surgical morbidities. For the patients with TN caused by CPA tumors, PBC could be considered a useful technique, especially when craniotomy is infeasible.

Surgical Treatment for Trigeminal Neuralgia.

Various treatments for trigeminal neuralgia (TN) are known to yield initial satisfactory results; however, the surgical treatment has excellent long-term outcomes and a low recurrence rate. Surgical treatment addresses the challenge of vascular compression, which accounts for 85% of the causes of TN. As for surgical treatment for TN, microvascular decompression (MVD) has become the surgical treatment of choice after Peter J. Jannetta reported the results of MVD surgery in 1996. Since then, many studies have reported a success rate of over 90% for the initial surgical treatment. Most MVDs aim to separate (decompress) the culprit vessel from the trigeminal nerve. To increase the success rate of surgery, accurate indications for MVD and management of the offender vessels without complications are critical. In addition, if there is no vascular compression, partial sensory rhizotomy or internal neurolysis can be performed to improve surgical outcomes.

Clinicoradiological Evaluation of Trigeminal Neurovascular Loops: A Retrospective Cohort Study from Eastern India

Introduction: Several lesions may affect trigeminal nerve from the nucleus to peripheral branches causing facial pain, called trigeminal Neuralgia (TN). Neurovascular compression (NVC) of the trigeminal nerve is the primary cause of TN, usually occurring at the root entry zone but is known to occur in both symptomatic and asymptomatic nerves. Aim: To evaluate trigeminal neurovascular loops (NVLs) clinico- radiologically and to know the association between the shortest distance of loop as well as the severity of compression with clinical symptoms. Materials and Methods: This is a Retrospective cohort study conducted in March 2020 after collecting data from January 2017 to January 2020 in a tertiary care center of Eastern India. All the patients, detected with trigeminal NVLs by Magnetic Resonance (MR) imaging were evaluated clinically (from records) &amp; radiologically and an association is drawn between the distance of the loop, the severity of compression with symptoms. Data were analyzed using Statistical Package for Social Sciences (SPSS) statistical software version 24.0. Result: Among 103 cases studied, the symptomatic and asymptomatic loops were 76 &amp; 27. In symptomatic group, males and females were 48 (63%) and 28 (36.8%) respectively with mean age of 56 years with male:female ratio in symptomatic group of 76 cases was 1.7:1. Left-sided presentation and pain in the maxillary area were found in 39 (51.3%) and 33 (43.4%) cases. Sharp/electric current like/ lancinating pain was present in 72 (94.7%) case. Triggering factors and spontaneous onset pain were presentations in 70 (92%) and 76 (100%) cases. Magnetic Resonance Imaging (MRI) showed NVLs with a just contact to the nerve in all asymptomatic (27/27,100%) and most symptomatic cases (57/76, 75%). The superior cerebellar artery was found to be the most common vessel involved (59/76, 77.6%). Proximal and bilateral NVLs were found in 62 (82.89%) and 27 (35.9%) cases of symptomatic nerves. Severe NVC was only present in symptomatic nerves in 19 (25%) cases. Conclusion: Typical clinical features of trigeminal neuralgia include male preponderance, lancinating pain on maxillary area of left face. Compression by NVLs are most common cause of TN, among which Superior cerebellar artery is most common culprit vessel. Severe neurovascular compressions are more symptomatic. All neurovascular compressions are not always symptomatic.

MRI Findings in Trigeminal Neuralgia without Neurovascular Compression: Implications of Petrous Ridge and Trigeminal Nerve Angles.

ObjectiveTo determine the anatomical characteristics of the petrous ridge and trigeminal nerve in trigeminal neuralgia (TN) without neurovascular compression (NVC).Materials and MethodsFrom May 2017 to March 2021, 66 patients (49 female and 17 male; mean age ± standard deviation [SD], 56.8 ± 13.3 years) with TN without NVC and 57 controls (46 female and 11 male; 52.0 ± 15.6 years) were enrolled. The angle of the petrous ridge (APR) and angle of the trigeminal nerve (ATN) were measured using magnetic resonance imaging with a high-resolution three-dimensional T2 sequence. Data on the symptomatic side were compared with those on the asymptomatic side in patients and with the mean measurements of the bilateral sides in controls. Receiver operating characteristic (ROC) analysis was conducted to evaluate the performance of APR and ATN in distinguishing TN patients from controls.ResultsIn TN patients without NVC, the mean ± standard deviation (SD) of APR on the symptomatic side (98.40° ± 19.75°) was significantly smaller than that of the asymptomatic side (105.59° ± 22.45°, p = 0.019) and controls (108.44° ± 15.98°, p = 0.003). The mean ATN ± SD on the symptomatic side (144.41° ± 8.92°) was significantly smaller than that of the asymptomatic side (149.67° ± 8.09°, p = 0.003) and controls (150.45° ± 8.48°, p = 0.001). The area under the ROC curve for distinguishing TN patients from controls was 0.673 (95% confidence interval [CI]: 0.579–0.758) for APR and 0.700 (CI: 0.607–0.782) for ATN. The sensitivity and specificity using the diagnostic cutoff yielding the highest Youden index were 81.8% (54/66) and 49.1% (28/57), respectively, for APR (with a cutoff score of 94.30°) and 65.2% (43/66) and 66.7% (38/57), respectively, for ATN (cutoff score, 148.25°).ConclusionIn patients with TN without NVC, APR and ATN were smaller than those in controls, which may explain the potential cause of TN and provide additional information for diagnosis.

Radiologic and Neurosurgical Diagnosis of Arterial Neurovascular Conflict on Magnetic Resonance Imaging for Trigeminal Neuralgia in Routine Clinical Practice

The most common cause of trigeminal neuralgia is neurovascular conflict, particularly arterial compression of the trigeminal nerve (ACTN). It is possible to show this condition preoperatively on fine-cut constructive interference in steady state magnetic resonance imaging (MRI), supplemented by time-of-flight magnetic resonance angiography. We have noticed significant variability in the interpretation of these studies between radiologists and the treating neurosurgeon. We have assessed the sensitivity and specificity of these 2 styles of interpretation compared with the intraoperative observations. We studied 68 patients who underwent de novo microvascular decompression from 2011 to 2018 under the care of a single neurosurgeon in Melbourne, Australia. Data was recorded prospectively in the radiology reports, operation reports, hospital admission records and neurosurgeon correspondence from the perioperative clinic reviews. In particular, the surgical interpretation of the MRI was clearly described prospectively and preoperatively in the correspondence. The presence or absence of ACTN was recorded prospectively in the operation report. These data were collated retrospectively by the first author. Of patients, 83.8% (57/68) had clear ACTN confirmed at surgery. Radiologists detected this abnormality in 50.9% (29/57) of these patients, with a sensitivity of 50.9% and specificity of 81.8%. The operating neurosurgeon detected ACTN in 87.7% (50/57) of the positive cases with a sensitivity of 87.7% and a specificity of 72.7%. Statistical analysis showed a significant disagreement between both styles of interpretation, with a radiologic accuracy of 55.9% compared with 85.3% neurosurgically (P < 0.0001). Follow-up review of the patient's response to surgery further supported the neurosurgical diagnosis of ACTN. There was a strong tendency for radiologists to underreport ACTN on the preoperative MRI compared with the intraoperative findings. In this series, the neurosurgeon was able to accurately detect ACTN in 88% of patients preoperatively. However, the diagnosis of absent ACTN was still associated with a false-negative rate of 46.7% when the neurosurgeon performed the interpretation. At the current standard of fine-cut constructive interference in steady state MRI in Melbourne, underdetection of ACTN remains common. Clinicians using this test need to be acutely aware of its limitations in deciding whether to proceed to microvascular decompression.

Comparison of Microvascular Decompression and Two Isocenters Gamma Knife for the Treatment of Trigeminal Neuralgia Caused by Vertebrobasilar Dolichoectasia.

Background: Vertebrobasilar dolichoectasia (VBD) is one of the rare causes of trigeminal neuralgia (TN). The common surgical treatments for patients with TN caused by VBD (VBD-TN) are microvascular decompression (MVD) and Gamma Knife radiosurgery (GKRS). However, the therapeutic effects of the two methods have not been clinically compared, so this study was performed to evaluate the treatment outcomes of MVD and GKRS for patients with VBD-TN.Methods: The retrospective study was performed from March 2011 to March 2019 in Wuhan Union Hospital. A total of 80 patients diagnosed with VBD-TN were included in this study, and they were divided into the MVD group (n = 46) and GKRS group (n = 34) according to the surgical methods. The imaging data, intraoperative findings, treatment outcomes, and complications of the two groups were analyzed and compared. Meanwhile, the influencing factors of the treatment effect are also explored on the two groups.Results: Patients who underwent MVD were younger than patients who underwent GKRS (median ages were 61.1 and 65.4 years old, respectively, p = 0.03). The median follow-up was 61.1 months for the MVD group and 56.8 months for the GKRS group. The favorable outcomes [Barrow Neurological Institute (BNI) pain score, BNI scores I–II] occurred in 97.8% of patients treated with MVD and in 78.9% of patients treated with GKRS (p = 0.009). The favorable outcomes in the percentage of patients after MVD 1, 3, 5, and 7 years were 95.7, 85.1, 74.2, and 74.2%, respectively, whereas the corresponding percentages after GKRS were 76.5, 66.2, 56.6, and 47.2%, respectively (p = 0.031). The postoperative complications (except facial numbness) in the MVD group were higher than those in the GKRS group (p = 0.036), but the incidence of new and worsening facial numbness was lower in the GKRS group (p < 0.001).Conclusions: MVD is superior to GKRS in obtaining and maintaining favorable outcomes for patients with VBD-TN, but it also comes with more complications other than facial numbness. Thus, the treatment program can be tailored to a patient's unique condition and wishes.

A Pilot With Electrical Pain in the Face

An intracranial epidermoid cyst is an unusual but treatable cause of trigeminal neuralgia.

Absence of Meckel Cave: A Rare Cause of Trigeminal Neuralgia

Trigeminal neuralgia is a debilitating condition with numerous etiologies. In this retrospective case series, we report a cohort of patients with a rarely described entity, absence of Meckel cave, and propose this as a rare cause of trigeminal neuralgia. A search of the electronic medical record was performed between 2000 and 2020 to identify MR imaging reports with terms including "Meckel's cave" and "hypoplasia," "atresia," "collapse," or "asymmetry." Images were reviewed by 2 blinded, board-certified neuroradiologists. Seven cases of the absence of Meckel cave were identified. Seven patients (100%) had ipsilateral trigeminal neuralgia and ipsilateral trigeminal nerve atrophy, suggesting an association between absence of Meckel cave and trigeminal neuralgia. Absence of Meckel cave is a rare entity of unknown etiology, with few existing reports that suggest the possibility of an association with trigeminal neuralgia. Its recognition may have important implications in patient management. Future studies and longitudinal data are needed to assess treatment outcomes and added risks from surgical intervention in these patients.