Mixed trigeminal neuralgia [Neurosurgery Wiki]

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====== Mixed trigeminal neuralgia ======

[[Classical trigeminal neuralgia]] (TN) involves sharp, shooting pain in any [[trigeminal nerve]] distribution, whereas [[atypical trigeminal neuralgia]] presents with constant aching, numbness or burning that can appear with classic features, leading to a mixed presentation or [[mixed trigeminal neuralgia]].

Wu et al., retrospectively studied 73 adult patients with mixed TN and 386 classic TN patients, who all underwent [[MVD]] between December 2007 and October 2016. Recorded variables included demographics, graded radiologic and intraoperative findings, and graded pain outcomes in the immediate postoperative period (up to 3 months after MVD) and long-term follow-up.

Mean age of mixed TN patients was 53.2 years. Immediate postoperative outcomes were as follows: 67 (91.8%) had pain relief including improvement of atypical pain, while six patients (8.2%) had no pain relief. Having pre-existing pain syndromes (p=0.001) or distortion of trigeminal nerve intraoperatively (p=0.001) were associated with poor surgical outcome for mixed TN. Mean length of follow-up was 20.6 months. Forty-four patients (60.3%) developed recurrence of any TN pain. In comparison, 93% of classic TN patients had pain relief in the immediate postoperative period, and recurrence rate was 19.9%.
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Patients with mixed TN suffer from both classic and atypical TN symptoms. 91.8% of the cohort reported partial or complete pain relief including improvement of atypical pain following MVD in the immediate post-operative stage, compared to 93% of the classic TN cohort. 60.3% of mixed TN patients eventually developed TN recurrence
((Wu A, Doshi T, Hung A, Garzon-Muvdi T, Bender MT, Bettegowda C, Lim M.
Immediate and Long-term Outcomes of Microvascular Decompression for Mixed
Trigeminal Neuralgia. World Neurosurg. 2018 Jun 12. pii: S1878-8750(18)31230-0.
doi: 10.1016/j.wneu.2018.06.016. [Epub ahead of print] PubMed PMID: 29906578.
)).