Trigeminal Neuralgia Current Concepts Regarding Etiology and Pathogenesis

Sphenocavernous and Infratemporal Trigeminal Neurinomas: Surgical Series of 15 Cases

“…The facial pain is most often described as diffuse nonparoxysmal, burning pain without a trigger point. 14,15 The degree of sensory loss is quite variable;15 40% of our cases, including several large infratemporal neurinomas, had no objective sensory loss on preoperative examination. This paradoxical find- ing is classically explained by the fact that neurinomas are mainly schwannomas and nerve fibers are more likely to be pushed aside rather than destroyed.…”

“…A transient aphasia was observed in two cases when the subtemporal approach was used on the dominant side. Two patients developed bacterial meningitis; one with CSF leak (case 14). In this case a huge infratemporal fossa cavity filled with CSF developed because of an unrecognized opening in the prepontine cistern.…”

New insight into trigeminal neuralgia

“…Several works supporting this hypothesis have been reported [12]. The perioral location of the trigger point would in this case be explained by the large representation of the perioral region in the spinal trigeminal nucleus, which makes it the most likely source of paroxysmal activity [12]. In summary, the primary cause of TN must necessarily affect the peripheral afferents, but the pathophysiological mechanism may or may not secondarily involve the brainstem neurons.…”

“…But paroxysmal bursts of ectopic activity arising from largediameter, non-nociceptive afferents may induce a secondary central dysfunction: a repeated, abnormally high-frequency activity in tactile afferents projecting to WDR neurons in the spinal trigeminal nucleus may change their excitability and induce a persistent derangement that provokes high-frequency signals from WDR neurons and thus pain [11]. Several works supporting this hypothesis have been reported [12]. The perioral location of the trigger point would in this case be explained by the large representation of the perioral region in the spinal trigeminal nucleus, which makes it the most likely source of paroxysmal activity [12].…”

Painful Neuropathy with Trigeminal Nerve Involvement in Type 2 Diabetes

“…Pain distribution is usually unilateral and follows the sensory distribution of the trigeminal nerve, typically radiating out to the maxillary or mandibular areas. 2 In the very few existing reports of the relationship between diabetes and trigeminal neuralgia, neuralgia usually involves the ophthalmic and mandibular divisions of the trigeminal nerve. 3,4 Acute painful neuropathy is a relatively rare, but very distinctive, syndrome which is usually related to poor glycaemic control.…”