The primary etiology of trigeminal neuralgia is vascular pulsatile compression of the junctional area of central trigeminal myelin (consisting of oligodendroglia) and peripheral myelin (consisting of Schwann's cells). The cause is located, therefore, in the cerebellopontile angle adjacent to the brain stem.1,2 A rather specific clinical correlation exists relating the location of the vessel with the location of the facial pain. The most common etiologic vessel (80%) is the superior cerebellar artery which, in elongating as part of the aging process, compresses the nerve on the rostral-anterior aspect and causes lower facial (V2-3or V2) trigeminal neuralgia. Veins that do pulsate in the intact head, as Portnoy et al have demonstrated,3 are causal of trigeminal neuralgia in about 8% of patients. Benign extraaxial cerebellopontile angle tumors occasionally cause trigeminal neuralgia (5%), almost universally by causing secondary vascular compression of the nerve.
With the application of microsurgical
Jannetta PJ. Microsurgical Management of Trigeminal Neuralgia. Arch Neurol. 1985;42(8):800. doi:10.1001/archneur.1985.04210090068018
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