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Trigeminal Neuralgia

Trigeminal neuralgia is one of the most disabling neurological conditions due to the severity of the painful episodes. Various causes include neurovascular conflict (compression / proximity of the vascular loop to the trigeminal nerve), tumors in CP angle as epidermoid, meningioma and rarely schwanomma. Rarely, vascular lesions in the brain stem as cavernomas, AVMs or aneurysms can also cause this presentation.
Surgery is considered in those with failure of the medical management to separate the trigeminal nerve and the conflicting blood vessel. Surgery is considered primarily in those with tumors.
Various images highlight the different morphologies managed surgically. The microscopic surgical procedure involves separating the trigeminal nerve and the blood vessel by interposition of an inert material like Teflon. The procedure provides immediate relief to majority of the patients.

Figure 1: Vessel flow void adjacent to the fifth nerve.

Figure 2: Ectatic Basilar Artery with compression over nerve root.

Figure 3: Tumor (epidermoid) in the left cerebellopontine angle with distortion and compression of the fifth cranial nerve.