Trigeminal neuralgia: Diagnosis and medical and surgical management

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Description: In most cases, the demyelinization is secondary to chronic compression of the trigeminal root at or near its exit from the pons.2,5,8 In some cases, the compression can be caused by pathology including vascular abnormalities such as an aneurysm or arteriovenous malformation or benign tumors such as epidermoids, neurofi broma, or meningioma within the cerebellopontine angle.9 Demyelinization due to multiple sclerosis may also cause typical symptoms of trigeminal neuralgia.2 These structural pathologies and demyelinating diseases must be considered when fi rst evaluating a patient with trigeminal neuralgia. Current theories regarding the cause of the demyelination center on vascular compression of the nerve root at its exit zone from the pons.1,5,7 The most common vessel causing vascular compression of the trigeminal root in this region is the superior cerebellar artery, but an ectatic basilar artery and constricting petrosal veins have also been implicated on inspection at operation.9,10 HISTORY AND PHYSICAL EXAMINATION Inasmuch as the diagnosis of trigeminal neuralgia depends on the nature of the pain and the lack of neurologic physical fi ndings, health care providers must be aware of the spectrum of typical symptoms and be able to perform a detailed neurologic inventory and examination.
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