Effectiveness of Differentiated Treatment Strategies and Quality-of-Life Assessment in Patients with Trigeminal Neuralgia
Keywords:
trigeminal neuralgia, microvascular decompression, differentiated approach, disease severity, quality of life, facial painAbstract
Background and objective. Trigeminal neuralgia (TN) is a severe paroxysmal facial pain disorder for which treatment must be individualized. This study aimed to improve treatment outcomes in patients with TN through a differentiated approach that accounts for disease severity, somatic status and quality of life (QoL).
Methods. A 【retrospective / prospective — specify】 observational study of 171 patients with TN treated in the inpatient neurosurgery department of the multidisciplinary clinic of the Tashkent Medical Academy (2019–2023). Patients were allocated to three groups by treatment modality, disease severity and somatic status: conservative treatment plus peripheral trigeminal branch blocks (Group 1, n = 55); Gasserian ganglion blocks plus trigeminal branch exeresis (Group 2, n = 57); and microvascular decompression (MVD; Group 3, n = 59). Diagnosis was based on clinical criteria, high-resolution magnetic resonance imaging (MRI) and electroneuromyography (ENMG). Pain and QoL were assessed before and after treatment using institutional questionnaires.
Results. Positive outcomes were achieved in 163 of 171 patients (95.0%). The best results were obtained in Group 3 (MVD), where 87% of patients achieved significant improvement and none showed no change. Pain and QoL scores improved significantly in all groups after treatment (P < 0.001), most markedly after MVD.
Conclusion. A differentiated, severity- and comorbidity-based treatment strategy yields high rates of pain relief and QoL improvement in TN. MVD provides the most durable outcomes in surgically fit patients, while destructive and conservative approaches remain valuable for patients with contraindications to MVD.
References
Cruccu G, Di Stefano G, Truini A. Trigeminal neuralgia. N Engl J Med. 2020;383(8):754–762. doi:10.1056/NEJMra1914484.
Ashina S, Robertson CE, Srikiatkhachorn A, Di Stefano G, Donnet A, Hodaie M, et al. Trigeminal neuralgia. Nat Rev Dis Primers. 2024;10(1):39. doi:10.1038/s41572-024-00523-z.
Manvelov LS, Tyurnikov VM, Kadykov AV. Trigeminal neuralgia: epidemiology, etiology, pathomorphology, pathogenesis, clinical features, diagnosis. Vrach. 2013;4:6–8.
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211. doi:10.1177/0333102417738202.
Cruccu G, Finnerup NB, Jensen TS, Scholz J, Sindou M, Svensson P, et al. Trigeminal neuralgia: new classification and diagnostic grading for practice and research. Neurology. 2016;87(2):220–228. doi:10.1212/WNL.0000000000002840.
Bendtsen L, Zakrzewska JM, Heinskou TB, Hodaie M, Leal PRL, Nurmikko T, et al. Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. Lancet Neurol. 2020;19(9):784–796. doi:10.1016/S1474-4422(20)30233-7.
Antonaci F, Arceri S, Rakusa M, et al. Pitfalls in recognition and management of trigeminal neuralgia. J Headache Pain. 2020;21(1):82. doi:10.1186/s10194-020-01149-8.
Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, Di Stefano G, Donnet A, et al. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol. 2019;26(6):831–849. doi:10.1111/ene.13950.
Koreshkina MI. Differential diagnosis and treatment of trigeminal neuralgia. Remedium Privolzhye. 2016;2(142):24–27.
Erika IA, Rafaela FC, Elcio JP, Juliana GC. Trigeminal neuralgia: basic and clinical aspects. Curr Neuropharmacol. 2020;18(2):109–119. doi:10.2174/1570159X17666191010094350.
Barker FG 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996;334(17):1077–1083. doi:10.1056/NEJM199604253341701.
Holste K, Chan AY, Rolston JD, Englot DJ. Pain outcomes following microvascular decompression for drug-resistant trigeminal neuralgia: a systematic review and meta-analysis. Neurosurgery. 2020;86(2):182–190. doi:10.1093/neuros/nyz075.
Evsina OV. Quality of life in medicine — an important indicator of patient health status (literature review). Personality in a Changing World: Health, Adaptation, Development. 2013;1:119–133.
Novik AA, Ionova TI. Guide to Quality of Life Research in Medicine. 3rd ed. Shevchenko YuL, editor. Moscow: Russian Academy of Natural Sciences; 2012. 527 p. ISBN 978-5-94515-117-8.
Waldman LE, Ashina S, et al. Suicidal ideation and self-injury in trigeminal neuralgia. J Pain Res. 2024;17. doi:10.2147/JPR.S493649.
Artyushkevich AS, Ruman GM, Adashchik NF, Bayda AG. Clinical features, diagnosis and treatment of facial nerve neuropathies. Modern Dentistry. 2015;2(61):23–28.
Kupfer M, et al. Magnetic resonance imaging in the diagnosis of trigeminal neuralgia: a systematic review of the imaging protocol and diagnostic accuracy. Eur Radiol. 2025. doi:10.1007/s00330-025-12141-8.
Yang D, Shen J, Xia X, Lin Y, Yang T, Lin H, et al. Preoperative evaluation of neurovascular relationship in trigeminal neuralgia by 3D-FLASH and 3D-CISS MRI sequences. Br J Radiol. 2018;91(1088):20170557. doi:10.1259/bjr.20170557.
Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol. 2008;15(10):1013–1028. doi:10.1111/j.1468-1331.2008.02185.x.
Venda Nova C, Zakrzewska JM, Baker SR, Ní Ríordáin R. Patient-reported outcome measures in trigeminal neuralgia: treatment outcome domains, dimensions and measures — a systematic review. World Neurosurg X. 2020;6:100070. doi:10.1016/j.wnsx.2020.100070.
Venda Nova C, Zakrzewska JM, Baker SR, Ní Ríordáin R. Patient-reported outcome measures in trigeminal neuralgia — a systematic review of psychometric performance. Eur J Pain. 2021;25(5):1449–1461. doi:10.1002/ejp.1779.
Symonds T, Randall JA, Hoffman DL, Zakrzewska JM, Gehringer W, Lee JYK. Measuring the impact of trigeminal neuralgia pain: the Penn Facial Pain Scale-Revised. J Pain Res. 2018;11:1067–1073. doi:10.2147/JPR.S152958.
Di Carlo DT, Benedetto N, Perrini P. Clinical outcome after microvascular decompression for trigeminal neuralgia: a systematic review and meta-analysis. Neurosurg Rev. 2023;46(1):8. doi:10.1007/s10143-022-01922-0.
Chen F, Niu Y, Meng F, Xu P, Zhang C, Xue Y, et al. Recurrence rates after microvascular decompression in patients with primary trigeminal neuralgia and its influencing factors: a systematic review and meta-analysis based on 8,172 surgery patients. Front Neurol. 2021;12:738032. doi:10.3389/fneur.2021.738032.
Texakalidis P, Xenos D, Tora MS, Wetzel JS, Boulis NM. Comparative safety and efficacy of percutaneous approaches for the treatment of trigeminal neuralgia: a systematic review and meta-analysis. Clin Neurol Neurosurg. 2019;182:112–122. doi:10.1016/j.clineuro.2019.05.011.
Tuleasca C, Régis J, Sahgal A, De Salles A, Hayashi M, Ma L, et al. Stereotactic radiosurgery for trigeminal neuralgia: a systematic review. J Neurosurg. 2018;130(3):733–757. doi:10.3171/2017.9.JNS17545.
Greve T, Tonn JC, Mehrkens JH. An age-dependent outcome analysis of microvascular decompression and percutaneous thermocoagulation in trigeminal neuralgia. BMC Neurol. 2021;21(1):206. doi:10.1186/s12883-021-02197-6.
Di Stefano G, La Cesa S, Truini A, Cruccu G. Natural history and outcome of 200 outpatients with classical trigeminal neuralgia treated with carbamazepine or oxcarbazepine in a tertiary centre for neuropathic pain. J Headache Pain. 2014;15(1):34. doi:10.1186/1129-2377-15-34.
Qin Z, Xie S, Mao Z, et al. Comparative efficacy and acceptability of antiepileptic drugs for classical trigeminal neuralgia: a Bayesian network meta-analysis protocol. BMJ Open. 2018;8(1):e017392. doi:10.1136/bmjopen-2017-017392.
Yoshizaki W, Fujikawa Y, Torikoshi S, Katayama T, Iwasaki K, Toda H. Effects of microvascular decompression on quality-of-life in trigeminal neuralgia patients aged 70 years and older. Surg Neurol Int. 2023;14:41. doi:10.25259/SNI_1099_2022.
Biniyam AA, Abenet TM, Yared ZZ, et al. Clinical characteristics and associated factors of trigeminal neuralgia: experience from Addis Ababa, Ethiopia. BMC Oral Health. 2020;20(1):244. doi:10.1186/s12903-020-01227-y.
Haldor S. Is this really trigeminal neuralgia? Diagnostic re-evaluation of patients referred for neurosurgery. Scand J Pain. 2021;21(4):788–793. doi:10.1515/sjpain-2021-0045.
Sanjeet S, Nana T, Jianhua W, et al. Long-term evaluation of a multidisciplinary trigeminal neuralgia service. J Headache Pain. 2022;23(1):114. doi:10.1186/s10194-022-01489-7.
