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%. : 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 ¹⁾.