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Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component...
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Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins...
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Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this...
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Hydrocephalus-associated trigeminal neuralgia.

Jiangwei Ding1, Yangyang Wang2, Xiaoyan Hao3

  • 1Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.

Frontiers in Neurology
|February 11, 2026
PubMed
Summary

Hydrocephalus can cause trigeminal neuralgia (TGN). Cerebrospinal fluid (CSF) diversion procedures like ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV) are effective first-line treatments for TGN secondary to hydrocephalus.

Keywords:
Chiari malformationhydrocephaluspaintrigeminal neuralgiaventriculoperitoneal shunt

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Area of Science:

  • Neurosurgery
  • Neurology
  • Medical Research

Background:

  • Trigeminal neuralgia (TGN) secondary to hydrocephalus is an uncommon clinical presentation.
  • Hydrocephalus, a condition characterized by excess cerebrospinal fluid (CSF) in the brain, can lead to neurological symptoms including TGN.

Purpose of the Study:

  • To investigate the relationship between hydrocephalus and TGN.
  • To evaluate the effectiveness of surgical interventions for TGN caused by hydrocephalus.

Main Methods:

  • Retrospective analysis of three institutional cases.
  • Systematic literature review of concurrent hydrocephalus and TGN cases up to December 2024.
  • Analysis of demographic data, treatment strategies, and patient outcomes.

Main Results:

  • A total of 21 cases were analyzed, with a mean age of 38 years and a balanced gender distribution.
  • Common etiologies included isolated hydrocephalus (12 cases), Chiari I malformation (5 cases), Dandy-Walker syndrome (2 cases), and tumors (2 cases).
  • Ventriculoperitoneal shunt (VPS) achieved complete pain relief in 75% of hydrocephalus cases; endoscopic third ventriculostomy (ETV) was effective in two cases. Microvascular decompression (MVD) showed variable efficacy, particularly when combined with CSF diversion.

Conclusions:

  • Hydrocephalus is an underrecognized cause of secondary TGN.
  • CSF diversion procedures (VPS/ETV) are recommended as first-line treatments.
  • Microvascular decompression (MVD) is best reserved for refractory cases, supporting a multidisciplinary approach.