27 - Neurosurgical treatment for pain: trigeminal neuralgia

Summary

Introduction

In this chapter we will focus on a chronic pain problem which is unique. Trigeminal neuralgia stands apart from other pain syndromes in two important areas. First, the diagnosis can be made quickly and relatively simply by interview, and second we have many excellent medical and surgical treatments for this disorder. Since this volume is intended for a general audience, we will not dwell on the technical aspects of the various surgical procedures. These are well covered in numerous other texts. Instead we will highlight the indications for treatment, the choice of medical and surgical options, the results and potential morbidity of treatment, with an overall discussion of each surgical procedure.

History

Facial pain has been noted and described since antiquity. Aretaeus described the condition as ‘Cephalaea’ in the first century A.D., and discussions of the disorder known as ‘trigeminal neuralgia’ have been described from thirteenth to seventeenth centuries in English literature (Burchiel 1987a). John Locke first described the condition in the medical literature in 1677. Although Nicholas Andre first apparently recognized trigeminal neuralgia as a definite clinical entity, John Fothergill's classical description in 1776 is often noted as the first clinical treatise on the subject (Burchiel 1987a). Although often the term trigeminal neuralgia is used loosely to describe facial pain in the distribution of the trigeminal nerve, it actually relates to a distinct clinical subpopulation of facial pain patients with very characteristic signs and symptoms. This distinction is of more than academic interest since idiopathic trigeminal neuralgia is a very treatable disease, while most of the other facial pain syndromes can be considerable treatment dilemmas.