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Letter: Neurovascular Compression in Patients With Trigeminal Neuralgia May be Associated With Worse Outcomes After Primary Percutaneous Rhizotomy.

Neurosurgery·2025
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Controversies in Trigeminal Neuralgia: A Review.

Vengalathur Ganesan Ramesh1

  • 1Department of Neurosurgery, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chennai, Tamil Nadu, India.

Asian Journal of Neurosurgery
|May 11, 2026
PubMed
Summary

Trigeminal neuralgia (TN) presents many controversies regarding its classification, pathogenesis, and treatment. Further research is needed for a definitive understanding and minimally invasive, recurrence-free procedures for intractable TN.

Keywords:
controversies in trigeminal neuralgiapathogenesis of trigeminal neuralgiatreatment of trigeminal neuralgiatrigeminal neuralgiatrigeminal neuralgia classification

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Area of Science:

  • Neurology
  • Neurosurgery
  • Pain Medicine

Background:

  • Trigeminal neuralgia (TN) is a complex neurological condition characterized by severe facial pain.
  • Several aspects of TN, including its classification, pathogenesis, and treatment, remain areas of significant debate and ongoing research.

Purpose of the Study:

  • To review and discuss the controversial aspects of trigeminal neuralgia (TN).
  • To explore historical and current concepts regarding TN pathogenesis and treatment modalities.
  • To highlight the need for further research into the exact pathogenesis and optimal treatment of intractable TN.

Main Methods:

  • Literature review and synthesis of existing theories and concepts related to trigeminal neuralgia.
  • Discussion of historical contributions (Dandy, Jannetta) and modern treatment approaches.
  • Analysis of the merits, demerits, complications, and recurrence rates of various interventions.

Main Results:

  • Historical concepts like accessory fascicles and microvascular compression have influenced surgical approaches.
  • A variety of treatments exist for intractable TN, including microvascular decompression, percutaneous procedures, and radiosurgery.
  • Despite advancements, the exact pathogenesis of TN remains unclear, and all current procedures have associated complications and recurrence rates.

Conclusions:

  • Understanding the anatomical distribution, classification, clinical features, and pathogenesis of TN is crucial for addressing current controversies.
  • While surgical and percutaneous interventions offer options for intractable TN, they are associated with risks and recurrence.
  • Further investigation is essential to elucidate the precise pathogenesis of TN and develop minimally invasive treatments with no pain recurrence.