Pathogenesis of trigeminal neuralgia

Pathogenesis of trigeminal neuralgia

To the editor,

I read with interest the article, “Differences in individual susceptibility affect the development of trigeminal neuralgia” by Duransoy et al. (2013). The authors have analyzed the possible pathogenesis of trigeminal neuralgia, with illustrative case examples. They have drawn very important conclusions, which may have implications in management of trigeminal neuralgia. The concept of microvascular compression at the root entry zone of trigeminal neuralgia as the pathogenetic mechanism of trigeminal neuralgia has been contested by various authors (Adams, 1989). This has been shown by the very high incidence of vascular compression at the root entry zone in asymptomatic population (Ramesh and Premkumar, 2009). Though the microvascular compression has been demonstrated in the majority of patients with trigeminal neuralgia and the microvascular decompression surgery results in pain relief, this alone does not explain the pathogenetic mechanism of trigeminal neuralgia. Focal demyelination has been observed in the area of vascular contact by some authors (Love and Coakham, 2001). But the demyelination does not occur in all individuals with the vascular contact. Hence, I also would agree with the authors’ view that there must be some individual susceptibility which predisposes to the development of focal demyelination at the root entry zone by vascular contact and causes trigeminal neuralgia and that mere vascular contact at the root entry zone need not result in trigeminal neuralgia. More studies and research are needed in this regard.

Vengalathur Ganesan Ramesh

Chettinad Hospital & Research Institute,

Chennai, India

Adams CB (1989) Microvascular compression: an alternative view and hypothesis. J Neurosurg 70:1-12.

Duransoy YK, Mete M, Akçay E, Selçuki M (2013) Differences in individual susceptibility affect the development of trigeminal neuralgia. Neural Regen Res 8:1337-1342.

Love S, Coakham HB (2001) Trigeminal neuralgia: pathology and pathogenesis. Brain 124:2347-2360.

Ramesh VG, Premkumar G (2009) An anatomical study of the neurovascular relationships at the trigeminal root entry zone. J Clin Neurosci 16:934-936.

Vengalathur Ganesan Ramesh, M.D. Department of Neurosurgery, Chettinad Hospital ＆ Research Institute, Chettinad Health City, Kelambakkam, Chennai - 603103, India. drvgramesh@ hotmail.com.

10.4103/1673-5374.131613

http://www.nrronline.org/

Accepted: 2014-04-14

Ramesh VG. Pathogenesis of trigeminal neuralgia. Neural Regen Res. 2014;9(8)：877.