Clinical characteristics of pain in patients with trigeminal neuralgia: data from a neurosurgical clinic

Abstract

Among the pain syndromes caused by damage to cranial nerves, trigeminal nerve pathology occupies the main place. Trigeminal neuralgia is an exhausting condition characterized by acute shooting recurrent pain in the face. However, according to modern classification of facial pain types, there is also a distinction made for the second type of neuralgia, in which the mentioned pain alternates with dull, burning pain in the area of trigeminal nerve innervation. Numerous clinical and diagnostic criteria which can influence the results of surgical treatment of trigeminal neuralgia are being actively studied. However, the data varies both in terms of the number of criteria considered and the nature of the study, as well as the research outcomes.Objective ‒ to determine the demographic, clinical, and anatomical characteristics of patients with classical trigeminal neuralgia upon their admission in the neurosurgical ward for microvascular decompression of the trigeminal nerve.Materials and мethods. A retrospective analysis of medical data from 92 patients with trigeminal neuralgia, who were admitted to the Regional Clinical Center of Neurosurgery and Neurology from 2011 to 2023 was performed. The data included: patient's gender and age, type of neuralgia according to K. Burchiel and colleagues' classification (2009), involvement of trigeminal nerve branches, duration of pain prior to hospitalization, medication for conservative therapy and its dosage. Results. Trigeminal neuralgia most commonly affects elderly patients. This may be associated with systemic atherosclerotic vessel damage, leading to increased irritation by a denser vessel wall. Another cause of late disease manifestation may be gradual demyelination in the vicinity of the neurovascular conflict. Women are more likely to be affected than men. Right-sided trigeminal nerve involvement and the involvement of lower and upper jaw branches are more characteristic, with pain more frequently being paroxysmal in nature. In seven out of ten patients, the cause of neurovascular conflict is an artery, with the upper cerebellar artery being the most typical conflict.Conclusions. Demographic and clinical-diagnostic indicators vary among patients with trigeminal neuralgia. There are numerous variables that can influence the long-term effects of conservative and surgical treatment in patients with trigeminal neuralgia. A comprehensive assessment of these factors can identify a group of patients who are likely to have the most successful long-term treatment outcomes for trigeminal neuralgia.