COMPREHENSIVE STUDY OF DIAGNOSIS AND TREATMENT OF TRIGEMINAL NEURALGIA SECONDARY TO TUMORS

Among 5,058 patients seen at the Mayo Clinic from 1976 through 1990 fo r face pain, we diagnosed trigeminal neuralgia in 2,972. Tumors were c ausing the face pain in 296 patients. Sex and pain distributions paral leled those in idiopathic trigeminal neuralgia; however, patients with tumors causing trigeminal neuralgia were younger than those with idio pathic pain. Meningiomas and posterior fossa tumors were the most comm on. Neurologic deficits developed on follow-up evaluation in 47% of th e patients, often precipitating further study and eventual diagnosis o f the tumor. Delay in tumor diagnosis averaged 6.3 years. CT with cont rast was the most frequently used initial diagnostic radiographic tech nique, detecting a tumor in 40 of 43 examinations. MRI was subsequentl y used to confirm and better delineate the tumor in five of five cases . Carbamazepine was the most effective drug for relieving trigeminal n euralgia, but relief was usually temporary. Of the surgical treatment options, total removal of the tumor was the most effective in complete ly relieving tic pain. In patients at high surgical risk, however, tem porarily or permanently blocking afferent impulses with radiofrequency ablation, glycerol rhizotomy, or alcohol blocks was a good alternativ e to craniotomy.