TY - JOUR
T1 - The spectrum of trigeminal neuralgia without neurovascular compression
AU - Magown, Philippe
AU - Ko, Andrew L.
AU - Burchiel, Kim J.
N1 - Publisher Copyright:
© Copyright 2019 by the Congress of Neurological Surgeons.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - BACKGROUND: In trigeminal neuralgia type 1 (TN1), neurovascular compression (NVC) is often assumed to be the pain initiating mechanism. NVC can be surgically addressed by microvascular decompression (MVD). However, some patients with TN1 present without NVC (WONVC). OBJECTIVE: To characterize and analyze the clinical spectrum of a TN1 patient population WONVC. METHODS: A retrospective chart review of patients presenting with TN1 between 2007 and 2017 was performed. Patients who were potential candidates for MVD surgery underwent high-resolution imaging with 3-dimensional (3D) reconstruction to address the presence, or absence, of NVC. Demographic data about the populations with NVC (WNVC) and WONVC were collected. RESULTS: Of 242 patients with TN1, 32% did not have NVC. Patients WONVC were on average 10.6 yr younger than those WNVC. TN1 onset in patients WONVC was more frequent below 48.7 yr, and the opposite was found in patients WNVC. Compared to patients WNVC, those WONVC were predominantly female (odds ratio 4.8), on average were 4 yr younger at symptom onset (34.7 yr) and 7.8 yr younger at first clinic visit, and had a 3.7 yr shorter symptom duration. CONCLUSION: Patients presenting with TN1 WONVC were predominantly females in their mid-30s with short symptom duration. In the absence of NVC, this subgroup of TN1 patients has limited surgical options, and potentially a longer condition duration that must be managed medically or surgically. This population WONVC might provide insights into the true pathophysiology of TN1.
AB - BACKGROUND: In trigeminal neuralgia type 1 (TN1), neurovascular compression (NVC) is often assumed to be the pain initiating mechanism. NVC can be surgically addressed by microvascular decompression (MVD). However, some patients with TN1 present without NVC (WONVC). OBJECTIVE: To characterize and analyze the clinical spectrum of a TN1 patient population WONVC. METHODS: A retrospective chart review of patients presenting with TN1 between 2007 and 2017 was performed. Patients who were potential candidates for MVD surgery underwent high-resolution imaging with 3-dimensional (3D) reconstruction to address the presence, or absence, of NVC. Demographic data about the populations with NVC (WNVC) and WONVC were collected. RESULTS: Of 242 patients with TN1, 32% did not have NVC. Patients WONVC were on average 10.6 yr younger than those WNVC. TN1 onset in patients WONVC was more frequent below 48.7 yr, and the opposite was found in patients WNVC. Compared to patients WNVC, those WONVC were predominantly female (odds ratio 4.8), on average were 4 yr younger at symptom onset (34.7 yr) and 7.8 yr younger at first clinic visit, and had a 3.7 yr shorter symptom duration. CONCLUSION: Patients presenting with TN1 WONVC were predominantly females in their mid-30s with short symptom duration. In the absence of NVC, this subgroup of TN1 patients has limited surgical options, and potentially a longer condition duration that must be managed medically or surgically. This population WONVC might provide insights into the true pathophysiology of TN1.
KW - Cranial nerve neuralgia
KW - Neuralgia\pathophysiology
KW - Neurovascular compression
KW - Pain
KW - Trigeminal
KW - Trigeminal neuralgia
KW - Trigeminal neurovascular compression
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U2 - 10.1093/neuros/nyz048
DO - 10.1093/neuros/nyz048
M3 - Article
C2 - 31329945
AN - SCOPUS:85071350294
SN - 0148-396X
VL - 85
SP - E553-E559
JO - Clinical neurosurgery
JF - Clinical neurosurgery
IS - 3
M1 - nyz048
ER -