Abstract
Most cases of trigeminal neuralgias (TNs) are idiopathic, caused by neurovascular compression. However, up to 10% of TNs are symptomatic, caused by structural lesions such as brain tumors. Differential diagnosis of causative intracranial lesions, including neurovascular compression or brain tumors, is very important for TN management. We retrospectively reviewed 41 patients with TNs who underwent magnetic resonance imaging (MRI) and were treated in the Department of Oral and Maxillofacial Surgery, Okazaki City Hospital from January 2006 through January 2012. TNs caused by intracranial lesions developed in 17 of 41 patients (41.5%). All of these patients presented with typical TN symptoms, of which the underlying cause was neurovascular compression in 10 patients and brain tumors in 7 patients. Symptomatic TNs tended to occur in male and young patients, poorly respond to carbamazepine, and to be accompanied by another neurological symptom as compared with idiopathic TNs. The absence of significant clinical differences between the two TN types makes it difficult to distinguish them on the basis of clinical presentations alone. Even in patients presenting with typical TN symptoms, MRI was considered an essential examination for distinguishing TNs caused by neurovascular compression from those caused by structural lesions.
