The Pathophysiology of Trigeminal Neuralgia

Abstract

Twenty years ago, it could be said with some veracity that, ‘With all reference to the opinions of distinguished men who have advanced theories concerning the etiology of trigeminal neuralgia (TN), so far as we are aware, no pathological lesion has been established as the causative factor’ [28]. This was so despite the work of Dandy concerning frequent abnormalities of the dorsal root of the trigeminal nerve, most commonly vascular but occasionally neoplastic or otherwise. Dandy’s ideas and observations on trigeminal neuralgia took some buffeting at the hands of Stookey and Ransohoff, the authors of the above quotation. He now appears to be vindicated. Dandy sectioned the nerve in treatment of TN. He did not and possibly could not treat it definitively except by removing the occasional tumor. He had few immediate heirs to continue his work. He had no magnification techniques to aid visualization. He had no photographs to share with others. No one outside his own circle verified his observations.