1. Trigeminal Neuralgia
Rory Eschete
Biology 472
Neuroanatomy

2. Brief History
 Aretaeus of Cappadocia, 1st Century AD
 described undistinguished symptoms of both migraines and TN
 Nicolas André, 1787
 “tic douloureux” or “painful twitch” in French (1787)
 treats with caustic solution of mercury water
 John Fothergill, 1773
 accurate description
 Charles Bell, 1820
 distinguishes functions of the cranial nerves

3. Symptoms
 Sudden burning or shock-like facial pain
 Episodes can be five seconds to two minutes
 Multiple occurrences per day are possible
 Attacks can occur in quick succession or volleys lasting as long as
two hours
 No pain between attacks
 Flurries of episodes can occur from weeks to months then stop
abruptly for a month or year at a time
 initiated by physical stimulation of a trigger point on the same side
of the face as the pain. Trigger points can be anywhere on the
face or in the mouth or nose. They are generally not in the same
place as the pain.
 Talking, eating, brushing the teeth, or even cool air on the face
 There is no loss of taste or hearing in someone suffering
from tic douloureux

4. The Trigeminal Nerve CNV
 Trigeminal Neuralgia most
commonly affects the maxillary
and mandibular nerves
 Maxillary Sensory V2:
 lower eyelid, upper lip, gums
and teeth; cheek; nose, palate,
and pharynx
 Mandibular Sensory V3:
 lower gums, teeth and lips;
palate and anterior portion of
tongue
 Sensation originates in these
areas
 Impulses travel to the
semilunar sensory ganglion
and ultimately the sensory
nuclei of the pons in the
brainstem

5. Causes
 Blood vessel pressing on the Trigeminal Nerve as it exits the
brainstem
 (Superior Cerebellar Artery)
 Demyelination and Indentation of the nerve results in
hyperactivity of the nerve
 also hinders nerves ability to shut off signal
 Multiple Sclerosis, a disease that can cause deterioration of
the trigeminal nerve’s myelin sheath.
 Leukocytes are driven to white matter causing inflammation and
pressure to myelin
 Nerve compression from a tumor (Rare)
 Arteriovenous malformation - tangle of arteries and
veins. (Rare)
 Injury to the trigeminal nerve (result of sinus surgery, oral
surgery, stroke, or facial trauma)

6. Vasculature and Innervation

7. Demyelination
 Myelin - the protective
coating of the neuron
 Functions to increase the
speed at which action
potentials propagate along
the axon of the neuron
 “Rubber Insulation of Wire”
 Demyelination - deterioration
of the myelin
 Without myelin, neurons
fire and the action potential
slows, dissipates, or jumps
to another demyelinated
nerve.
 Results in uncontrollable
signaling

8. Neuronal Dysfunction
 The Semilunar Ganglion
 pressure applied by the
superior cerebellar artery
causes indentation and
demyelination of nerves
 Somatic Sensory Nerve
 sensation of face
 Neuronal Crosstalk
 messages or action potentials
jumping laterally from axon to
axon
 Trigger Area
 Sensation Area
Trigger Neuron Sensation Neuron
cross-talk

9. Medicinal Treatment
 Tegretol
 an anticonvulsant and specific analgesic for trigeminal neuralgia,
available for oral administration as chewable tablets
 decreases nerve impulses that cause seizures and pain.
 side effects of this drug may include drowsiness and alterations
to the blood count
 Dilantin
 anticonvulsant used to slow imupulses
 side effects include severe depression
 Baclofen
 muscle relaxer and antispastic agent normally used to treat
symptoms of multiple sclerosis

10. Surgical Procedures Old and New
 Sawyer and Mackey, 1874
 treated patients with Gelsemium soaked in spirits
 resulted in loss of sight, double vision, headaches, or paralysis
 Schloesser, 1904
 Alcohol Chemoneurolysis Injection into the Trigeminal Ganglion
 resulted in paralysis of facial muscles and unilateral loss of facial
sensation
 Kirschner, 1931
 Radiofrequency Lesioning
 fine electrode in a needle is placed through the cheek into the root
of the trigeminal nerve in the skull
 has advanced and is used in a modern form today

11. Microvascular Decompression
 most common solution to
Trigeminal Neuralgia
 relatively minimal (if any) loss
of facial sensation or
numbness.
 opening is made in the skull
and a Teflon pillow is placed
between the nerve and the
artery to relieve pressure.
 95% immediate relief success
rate
 https://www.youtube.com/wat
ch?v=qTFZ3ERzbZ0

12. References
Cole CD, Liu JK, Apfelbaum RI 2005. Historical Perspectives on
the Diagnosis and Treatment of Trigeminal Neuralgia.
Neurosurg Focus. 18(5)
Dixon J, Chan L, Olmedo R, Talavera F, Ungar J, 2005. Tic
Douloureux. emedicinehealth.1-13.
Janetta P, 2011. Trigeminal Neuralgia. Oxford University Press.
2-10
Office of Communications and Public Liaison, 2014. Trigeminal
Neuralgia. National Institute of Neurological Disorders and
Stroke
Towne EB, 1927. Neurosurgery: Tic Douloureux. Cal West Med.
v27(6): 814.
Zakrzewska JM, Linskey ME, 2014. Trigeminal Neuralgia. Clin
Evid. pII: 1207
Love S, Coakham HB, 2001. Trigeminal Neuralgia: Pathology
and Pathogenesis. Brain. v124(12): 2347-2360.