Trigeminal Neuralgia Without Neurovascular Origin: systematic clinical, surgical and outcome review

Resumo

A neuralgia do trigêmeo (TN) é rara, com um elevado potencial de morbidade. É classificada em 3 categorias etiológicas. Não há consenso sobre o tratamento cirúrgico em que não tenha compressão microvascular como etiopatogênese. O objetivo é explorar os principais diagnósticos e tratamentos da TN com uma etiologia diferente da compressão vascular. Os artigos foram selecionados, sem limitação de período, em Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science e SciELO. Dos 93 artigos, 12 artigos foram selecionados para uma análise qualitativa da neuralgia do trigêmeo com causas secundárias. Esta patologia é geralmente vista na forma clássica, e em algumas condições com uma causa secundária. As principais etiologias do TN sem compressão neurovascular incluem esclerose múltipla, tumores e quistos. O TN secundário afeta mais mulheres e tem um início mais jovem. A TN é diagnosticada principalmente com base em evidências clínicas e na história do paciente, o que indica este tipo específico de neuralgia, normalmente confinada ao trajeto de um ou mais ramos do nervo trigêmeo. Uma abordagem inicial no tratamento do TN é orientada para conseguir o controle da dor e existem diferentes possibilidades para o fazer; no entanto, não existe um protocolo ou consenso que oriente a gestão do TN para completar o tratamento em todos os casos. O prognóstico varia de acordo com a gravidade do caso e o tratamento aplicado. O diagnóstico clínico e diferencial pode ser suficiente para o diagnóstico, sendo a imagem a mais preferida para estabelecer a etiologia e o tratamento. As opções terapêuticas são: farmacológicas, anestésicas, cirúrgicas com ou sem terapias alternativas.

Palavras-chave

Neuralgia do trigêmeo; Compressão neurovascular; Vascular, cancro; Tumor; Neoplasia

Abstract

Trigeminal neuralgia (TN) is rare, with a high potential for morbidity. It is classified into 3 etiological categories. There is no consensus on surgical treatment in which it does not have microvascular compression as etiopathogenesis. The aim of this study is to explore the main diagnoses and treatments of TN with an etiology other than vascular compression. Articles were selected, without period limitation, in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science and SciELO. Of the 93 articles, 12 articles were selected for a qualitative analysis of trigeminal neuralgia with secondary causes. This pathology is commonly seen in the classic form, and in some conditions with a secondary cause. The main etiologies of TN without neurovascular compression include multiple sclerosis, tumors, and cysts. Secondary TN affects more women and has a younger onset. TN is mainly diagnosed based on clinical evidence and patient history that indicates this specific type of neuralgia, usually confined to the path of one or more branches of the trigeminal nerve. An initial approach in the treatment of TN is guided to achieve pain control and there are different possibilities to do so; nevertheless, there isn’t a protocol or consensus that guides TN management to complete treatment in every case. The prognosis varies according to the severity of the case and the treatment applied. Clinical and differential diagnosis may be sufficient for diagnosis, with imaging being the most preferred to establish etiology and treatment. The therapeutic options are pharmacological, anesthetic, surgical with or without alternative therapies.

Keywords

Trigeminal neuralgia; Neurovascular compression; Vascular; Cancer; Tumor; Neoplasia

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Trigeminal Neuralgia Without Neurovascular Origin: systematic clinical, surgical and outcome review

Neuralgia Trigeminal Sem Origem Neurovascular: revisão sistemática clínica, cirúrgica e de resultados

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