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Trigeminusneuralgie

Moderne Diagnostik und Therapie

Trigeminal neuralgia

Modern diagnostic workup and treatment

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Zusammenfassung

Die Diagnostik und Therapie der Trigeminusneuralgie hat sich in den letzten Jahren weiterentwickelt. Der vorliegende Beitrag gibt eine Zusammenfassung der relevanten Aspekte aus neurologischer, neuroradiologischer und neurochirurgischer Sicht. Die Trigeminusneuralgie ist nach wie vor eine klinische Diagnose, eine qualitativ hochwertige Bildgebung ist aber obligat, um sekundäre Ursachen und einen Gefäß-Nerven-Kontakt zu identifizieren. Neue bildgebende Verfahren wie die Diffusions-Tensor-Bildgebung erlauben eine differenziertere Darstellung der Auswirkung des Kontakts auf den N. trigeminus. Carbamazepin und Oxcarbazepin sind weiterhin Mittel der ersten Wahl in der medikamentösen Behandlung. Diese wurden in den letzten Jahren um weitere Optionen ergänzt, beispielsweise Pregabalin, Lamotrigin und Onabotulinumtoxin A. Für therapierefraktäre Verläufe gibt es sehr gut wirksame neurochirurgische Verfahren. Die besten Langzeitergebnisse erbringt die mikrovaskuläre Dekompression, aber auch perkutane und radiochirurgische Verfahren haben ihren festen Platz in der Therapie, insbesondere bei erhöhtem Operationsrisiko, sekundären Formen oder Rezidiven.

Abstract

The present article gives an update of relevant aspects in the diagnosis and therapy of trigeminal neuralgia from the neurological, neuroradiological and neurosurgical point of view. The diagnosis of trigeminal neuralgia is clinical, but high-quality imaging is mandatory to identify secondary causes and a neurovascular contact. New methods such as DTI (diffusion tensor imaging) allow a more differentiated assessment of the consequences of a vascular contact on the trigeminal nerve. Carbamazepine and oxcarbazepine continue to be first choice for the medical treatment, but have been supplemented by additional options such as pregabaline, lamotrigine, and onabotulinumtoxin A. In patients insufficiently responding to medical treatment, there are neurosurgical treatment options giving very good results. The best long-term results have been described for microvascular decompression, but percutaneous and radiosurgical treatments also are good options, especially in patients with an increased surgical risk profile, in secondary trigeminal neuralgia, and in case of recurrence after microvascular decompression.

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Literatur

  1. Adamczyk M, Bulski T, Sowinska J, Furmanek A, Bekiesinska-Figatowska M (2007) Trigeminal nerve—artery contact in people without trigeminal neuralgia—MR study. Med Sci Monit 13(Suppl 1):38–43

    PubMed  Google Scholar 

  2. Barker FG, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD (1996) The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:1077–1083

    Article  Google Scholar 

  3. Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, Di SG, Donnet A, Eide PK, Leal PRL, Maarbjerg S, May A, Nurmikko T, Obermann M, Jensen TS, Cruccu G (2019) European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol 26:831–849

    Article  CAS  Google Scholar 

  4. Borges A, Casselman J (2010) Imaging the trigeminal nerve. Eur J Radiol 74:323–340

    Article  Google Scholar 

  5. Brisman R (2003) Repeat gamma knife radiosurgery for trigeminal neuralgia. Stereotact Funct Neurosurg 81:43–49

    Article  Google Scholar 

  6. Elawamy A, Abdalla EEM, Shehata GA (2017) Effects of pulsed versus conventional versus combined radiofrequency for the treatment of trigeminal neuralgia: a prospective study. Pain Phys 20:E873–E881

    Google Scholar 

  7. Elsner F, Radbruch L, Gaertner J, Straub U, Sabatowski R (2006) Efficacy of opioid analgesia at the superior cervical ganglion in neuropathic head and facial pain. Schmerz 20:268–266

    Article  CAS  Google Scholar 

  8. Förderreuther S, Engelter S, Evers S, Paulus W, Tronnier V, Mitrovic N (2012) Trigeminusneuralgie. Leitlinie der Deutschen Gesellschaft für Neurologie. https://www.dgn.org/leitlinien/2287-ll-58-2012-trigeminusneuralgie. Zugegriffen: 15.05.2020

  9. Headache Classification Subcommittee of the International Headache Society (IHS) (2018) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 38:1–211

    Google Scholar 

  10. Holland MT, Teferi N, Noeller J, Swenson A, Smith M, Buatti J, Hitchon PW (2017) Stereotactic radio surgery and radio frequency rhizotomy for trigeminal neuralgia in multiple sclerosis: a single institution experience. Clin Neurol Neurosurg 162:80–84

    Article  Google Scholar 

  11. Holste K, Chan AY, Rolston JD, Englot DJ (2020) Pain outcomes following microvascular decompression for drug-resistant trigeminal neuralgia: a systematic review and meta-analysis. Neurosurgery 86:182–190

    Article  Google Scholar 

  12. Jannetta PJ (1967) Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 26(1):Suppl:159–62

    CAS  Google Scholar 

  13. Love S, Coakham HB (2001) Trigeminal neuralgia: pathology and pathogenesis. Brain 124:2347–2360

    Article  CAS  Google Scholar 

  14. Lummel N, Mehrkens JH, Linn J, Buchholz G, Stahl R, Bochmann K, Brückmann H, Lutz J (2015) Diffusion tensor imaging of the trigeminal nerve in patients with trigeminal neuralgia due to multiple sclerosis. Neuroradiology 57:259–267

    Article  CAS  Google Scholar 

  15. Lutz J, Linn J, Mehrkens JH, Thon N, Stahl R, Seelos K, Brückmann H, Holtmannspötter M (2011) Trigeminal neuralgia due to neurovascular compression: high-spatial-resolution diffusion-tensor imaging reveals microstructural neural changes. Radiology 258:524–530

    Article  Google Scholar 

  16. Maarbjerg S, Di SG, Bendtsen L, Cruccu G (2017) Trigeminal neuralgia—diagnosis and treatment. Cephalalgia 37:648–657

    Article  Google Scholar 

  17. Matsushima T, Huynh-Le P, Miyazono M (2004) Trigeminal neuralgia caused by venous compression. Neurosurgery 55:334–337

    Article  Google Scholar 

  18. McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK (1999) Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg 90:1–8

    Article  CAS  Google Scholar 

  19. Moore D, Chong MS, Shetty A, Zakrzewska JM (2019) A systematic review of rescue analgesic strategies in acute exacerbations of primary trigeminal neuralgia. Br J Anaesth 123:e385–e396

    Article  CAS  Google Scholar 

  20. Noorani I, Lodge A, Vajramani G, Sparrow O (2019) The effectiveness of percutaneous balloon compression, thermocoagulation, and glycerol rhizolysis for trigeminal neuralgia in multiple sclerosis. Neurosurgery 85:E684–E692

    Article  Google Scholar 

  21. Peker S, Dincer A, Necmettin PM (2009) Vascular compression of the trigeminal nerve is a frequent finding in asymptomatic individuals: 3‑T MR imaging of 200 trigeminal nerves using 3D CISS sequences. Acta Neurochir 151:1081–1088

    Article  Google Scholar 

  22. Romanelli P, Conti A, Redaelli I, Martinotti AS, Bergantin A, Bianchi LC, Beltramo G (2019) Cyberknife radiosurgery for trigeminal neuralgia. Cureus 11:e6014

    PubMed  PubMed Central  Google Scholar 

  23. Staudt MD, Joswig H, Pickett GE, MacDougall KW, Parrent AG (2019) Percutaneous glycerol rhizotomy for trigeminal neuralgia in patients with multiple sclerosis: a long-term retrospective cohort study. J Neurosurg 12:1–9. https://doi.org/10.3171/2019.1.JNS183093

    Article  Google Scholar 

  24. Steiger H, Horstmann G, Freynhagen R (2007) Therapiemöglichkeiten der Trigeminusneuralgie – Chirurgische Verfahren im Fokus. Current treatments for trigeminal neuralgia – a surgical approach. Dtsch Arztebl 104:A-2655 (B-2345 / C‑2277)

    Google Scholar 

  25. Tatli M, Satici O, Kanpolat Y, Sindou M (2008) Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes. Acta Neurochir 150:243–255

    Article  CAS  Google Scholar 

  26. Tomasello F, Germano A, Lavano A, Romano A, Cafarella D, Gorgoglione N, La TD (2020) A novel technical refinement of microvascular decompression: pain relief and complication rate in a consecutive series of patients with trigeminal neuralgia. Oper Neurosurg 19(3):226–233. https://doi.org/10.1093/ons/opaa044

  27. Truini A, Prosperini L, Calistri V, Fiorelli M, Pozzilli C, Millefiorini E, Frontoni M, Cortese A, Caramia F, Cruccu G (2016) A dual concurrent mechanism explains trigeminal neuralgia in patients with multiple sclerosis. Neurology 86:2094–2099

    Article  Google Scholar 

  28. Vergani F, Panaretos P, Penalosa A, English P, Nicholson C, Jenkins A (2011) Preoperative MRI/MRA for microvascular decompression in trigeminal neuralgia: consecutive series of 67 patients. Acta Neurochir 153:2377–2381

    Article  Google Scholar 

  29. Wei J, Zhu X, Yang G, Shen J, Xie P, Zuo X, Xia L, Han Q, Zhao Y (2019) The efficacy and safety of botulinum toxin type A in treatment of trigeminal neuralgia and peripheral neuropathic pain: a meta-analysis of randomized controlled trials. Brain Behav 9:e1409

    PubMed  PubMed Central  Google Scholar 

  30. Zakrzewska JM, Palmer J, Morisset V, Giblin GM, Obermann M, Ettlin DA, Cruccu G, Bendtsen L, Estacion M, Derjean D, Waxman SG, Layton G, Gunn K, Tate S (2017) Safety and efficacy of a Nav1.7 selective sodium channel blocker in patients with trigeminal neuralgia: a double-blind, placebo-controlled, randomised withdrawal phase 2a trial. Lancet Neurol 16:291–300

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Neurologische Klinik, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland

    Ruth Ruscheweyh

  2. Radiologisches Zentrum München (RZM), Pippingerstr. 25, 81245, München, Deutschland

    Jürgen Lutz

  3. Neurochirurgische Klinik, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland

    Jan-Hinnerk Mehrkens

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  1. Ruth Ruscheweyh
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  2. Jürgen Lutz
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  3. Jan-Hinnerk Mehrkens
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Correspondence to Ruth Ruscheweyh.

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Interessenkonflikt

R. Ruscheweyh erhielt Honorare für Vorträge oder Advisory Boards sowie Unterstützung für Kongressreisen von Hormosan, Novartis, Lilly, Pharm-Allergan und Teva. J. Lutz und J.-H. Mehrkens geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Ruscheweyh, R., Lutz, J. & Mehrkens, JH. Trigeminusneuralgie. Schmerz 34, 486–494 (2020). https://doi.org/10.1007/s00482-020-00496-4

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  • DOI: https://doi.org/10.1007/s00482-020-00496-4

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