Trigeminal neuralgia (TN) is a chronic pain disorder that influences the trigeminal or 5th cranial nerve, which is considered to be one of the largest nerves in the head. TN originates presumably from a blood vessel pressing on the trigeminal nerve as it departures the brainstream and this compression initiates the wearing away of the protective coating around the nerve (the myelin sheath). The condition causes extreme, sporadic, sudden burning or lightning-like face pain lasting for a few seconds to less than 2 minutes. Attacks happen in quick concession and were considered stereotyped in the individual patient. Furthermore, it was found that in symptomatic cases, a persistence of aching can arise among paroxysms and signs of sensory impairment in the trigeminal division. A strict measure for TN was described by the International Headache Society as classic trigeminal neuralgia and symptomatic trigeminal neuralgia. TN was found to be predominant among females (1.6/1) with majority of cases developing in subjects aged 50 and above with infrequent pediatric cases revealing a large range of age of onset.
Al-Awadi and Karagiozov (2004) described the clinical features of two sisters (65 and 70 years old) suffering from trigeminal neuralgia and the association of their features with characteristics of the familial neuralgia group. The sensory zones V2 and V3 were found to be affected in both the patients. Slight stimuli on the affected regions with chewing, swallowing and dental care developed into unbearable pain. Both sisters underwent a lateral suboccipital craniectomy, which showed a loop of the superior cerebellar artery compressing teh trigeminal nerve. Dissection and displacement of the loop away from the nerve roots was performed and its position was sustained using loose Teflon felt looping strips and balls. The subject did not experience any complication post surgery and the pain was well controlled.
[Al-Awadi Y, Karagiozov KL. Familial trigeminal neuralgia - report of two cases. Kuwait Med J. 2004; 36(2): 128-30.]
Salama et al. (2009) assessed the outcome of microvascular decompression (MVD) in patients with more than 3 years' history of intractable idiopathic trigeminal neuralgia and poor response to drugs. In this study, 21 patients (8 females and 13 males) with intractable idiopathic TN (group 1) underwent MVD and were followed up for 2 years. Compared to a group of patients that recieved pharmacotherapy, the MVD group had lesser recurrences and better response.