Trigeminal neuralgia pathogenesis

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Trigeminal neuralgia pathogenesis

Neurovascular contact in trigeminal neuralgia

see Neurovascular contact in trigeminal neuralgia.

see Tumor associated trigeminal neuralgia.

Other anatomical abnormalities have been considered, including differences of trigeminal nerve (TN) volume.

No correlation between volumetry and clinical data was detected 1).

see Multiple sclerosis related trigeminal neuralgia.

The incidence rates of posterior fossa tumor-induced TN range from 2.1–11.6% percent; in the literature; these cases mainly comprise meningiomas (14–54% percnt;), epidermoid tumors (8–64% percent;), and vestibular schwannomas (7–31% percnt;) 2) 3) 4) 5).

It appears that aggressive bony edges may contribute-at least indirectly-to the neuralgia. This should be considered for surgical indication and conduct of surgery when patients undergo MVD 6).

Posterior fossa volume

Abarca et al. data support the theory that a small volume of the posterior fossa cisterns containing the trigeminal nerve may increase the incidence of ITN 7).

Horínek et al. did not find any association between the clinical neurovascular conflict (NVC) and the size of the posterior fossa and its substructures. MRI volumetry may show the atrophy of the affected trigeminal nerve in clinical neuromuscular conflict 8).

Park et al. did not find any volumetric differences (including the cisternal and parenchymal volumes) 9).

Chiari’s malformation and hydrocephalus are rare associates of TN. The pathophysiology of TN in these cases may be due to neurovascular conflict, related to raised intracranial pressure from the hydrocephalus and/or the small posterior fossa volume in these patients. Drainage of associated hydrocephalus may be an effective surgical treatment 10).

Pontomesencephalic cistern

High-resolution magnetic resonance imaging scans are able to demonstrate significant volumetric differences of the pontomesencephalic cistern in patients with unilateral TN. A smaller cistern may be correlated with the occurrence of a neurovascular compression, and these findings support the neurovascular compression theory in idiopathic TN 11).

Park et al. confirmed that small pontomesencephalic cistern volumes were more frequent in patients with TN 12).

Uric acid in trigeminal neuralgia

see Uric acid in trigeminal neuralgia.

References

1)

Urgosik D, Keller J, Svehlik V, Pingle M, Horinek D. Trigeminal nerve asymmetry in classic trigeminal neuralgia – pretreatment volumetry and clinical evaluation in patients irradiated by Leksell Gamma Knife. Neuro Endocrinol Lett. 2014 Jul 20;35(4). [Epub ahead of print] PubMed PMID: 25038607.
2)

Barker FG, 2nd, Jannetta PJ, Babu RP, Pomonis S, Bissonette DJ, Jho HD. Long-term outcome after operation for trigeminal neuralgia in patients with posterior fossa tumors. J Neurosurg. 1996;84:818–825.
3)

Jamjoom AB, Jamjoom ZA, al-Fehaily M, el-Watidy S, al-Moallem M, Nain Ur R. Trigeminal neuralgia related to cerebellopontine angle tumors. Neurosurg Rev. 1996;19:237–241.
4)

Nomura T, Ikezaki K, Matsushima T, Fukui M. Trigeminal neuralgia: differentiation between intracranial mass lesions and ordinary vascular compression as causative lesions. Neurosurg Rev. 1994;17:51–57.
5)

Shulev Y, Trashin A, Gordienko K. Secondary trigeminal neuralgia in cerebellopontine angle tumors. Skull Base. 2011;21:287–294
6)

Brinzeu A, Dumot C, Sindou M. Role of the petrous ridge and angulation of the trigeminal nerve in the pathogenesis of trigeminal neuralgia, with implications for microvascular decompression. Acta Neurochir (Wien). 2018 Jan 20. doi: 10.1007/s00701-018-3468-1. [Epub ahead of print] PubMed PMID: 29353407.
7)

Abarca-Olivas J, Feliu-Rey E, Sempere AP, Sanchez-Payá J, Baño-Ruiz E, Caminero-Canas MA, Nieto-Navarro J, Botella-Asunción C. [Volumetric measurement of the posterior fossa and its components using magnetic resonance imaging in idiopathic trigeminal neuralgia]. Rev Neurol. 2010 Nov 1;51(9):520-4. Spanish. PubMed PMID: 20979031.
8)

Horínek D, Brezová V, Nimsky C, Belsan T, Martinkovic L, Masopust V, Vrána J, Kozler P, Plas J, Krýsl D, Varjassyová A, Ghaly Y, Benes V. The MRI volumetry of the posterior fossa and its substructures in trigeminal neuralgia: a validated study. Acta Neurochir (Wien). 2009 Jun;151(6):669-75. doi: 10.1007/s00701-009-0283-8. Epub 2009 Apr 7. PubMed PMID: 19350204.
9) , 12)

Park YS, Ha SM. Does a small posterior fossa increase nerve vascular conflict in trigeminal neuralgia? Acta Radiol. 2014 Dec 8. pii: 0284185114561914. [Epub ahead of print] PubMed PMID: 25487716.
10)

Gnanalingham K, Joshi SM, Lopez B, Ellamushi H, Hamlyn P. Trigeminal neuralgia secondary to Chiari’s malformation–treatment with ventriculoperitoneal shunt. Surg Neurol. 2005 Jun;63(6):586-8; discussion 588-9. Review. PubMed PMID:
11)

Rasche D, Kress B, Stippich C, Nennig E, Sartor K, Tronnier VM. Volumetric measurement of the pontomesencephalic cistern in patients with trigeminal neuralgia and healthy controls. Neurosurgery. 2006 Sep;59(3):614-20; discussion 614-20. PubMed PMID: 16955043.

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