Surgical Management of Trigeminal Neuralgia Induced by Brainstem Infarct: A Systematic Review of the Literature

Abstract Background Although cases of trigeminal neuralgia (TN) induced by brainstem infarct have been reported, the neurosurgical literature lacks a comprehensive review for this subpopulation of patients. Here we present the first systematic review of the literature to discuss pathology, surgical management, and future directions for therapeutic innovation in this population. Methods Our systematic review was conducted according to PRISMA guidelines. Resulting articles were screened for those that presented cases of TN associated with brainstem infarct. Results A review of the literature identified 18 case reports of 21 patients with TN induced by brainstem infarct: 14 pontine infarcts and 7 medullary infarcts. While many cases of ischemic brainstem lesions are due to acute stroke, cerebral small vessel disease also plays a role in certain cases, and the relationship between these chronic lesions and TN is more likely to be overlooked. Furthermore, we found that reports of self-resolving TN pain following brainstem infarct is disproportionately biased, as most case reports published their data within the first few months following initial presentation. Reports with follow-up periods greater than 13 months reported eventual pain recurrence that necessitated surgical intervention. Notably, microvascular decompression was not sufficient to treat TN pain associated with concurrent neurovascular compression and brainstem infarct. Conclusion Brainstem infarcts affecting the trigeminal pathway represent an understudied pathologic cause of TN. While current neurosurgical literature lacks a clear picture of the most efficacious interventions in this population, we are optimistic this review will encourage further investigation into the best treatment for these patients.