Secondary trigeminal neuralgia

Abstract

Abstract Secondary trigeminal neuralgia (TN), caused by a tumour or multiple sclerosis (MS), is symptomatically indistinguishable from classical or idiopathic TN, although patients tend to be younger and show more sensory deficits. Bilateral TN is more frequent in MS. Most tumours and arteriovenous malformations are located in posterior fossa and directly or indirectly cause compression of the trigeminal root. Magnetic resonance imaging is the investigation of choice. Complete resection of a tumour or arteriovenous malformation yields excellent short- and long-term results. Partial resections are accompanied by microvascular decompression, stereotactic radiosurgery, or endovascular embolization as required. Pharmacological management follows the same principles as for classical and idiopathic TN. Because of poor tolerance of centrally acting drugs, MS patients should be considered early for a neuroablative procedure. The role of magnetic resonance imaging-confirmed neurovascular compression as a concause of TN in a patient with MS remains unclear and routine microvascular decompression is not recommended.