Trigeminal neuralgia in young adults.
OBJECTIVE
Trigeminal neuralgia (TN) is a form of facial pain that can be debilitating if left untreated. It typically affects elderly adults and is thought to be related to neurovascular compression. It is uncommon in people younger than 30 years of age, with only 1% of cases reportedly occurring in those younger than 20 years of age. The most common cause of compression in young adults is thought to be venous nerve compression either alone or in association with arterial nerve compression. The objective of this study was to review data in cases of TN in which patients were 25 years of age or younger and to identify TN disease characteristics, demographics, clinical features, operative findings, and outcome.


METHODS
The authors retrospectively reviewed the clinical records, surgical treatment, and long-term outcome in patients 25 years of age or younger with TN who underwent surgery performed by the senior author (K.J.B.) at Oregon Health & Science University between 1995 and 2008.


RESULTS
Seven patients (2 males and 5 females) met the inclusion criteria. The average age at symptom onset was 19.6 ± 3.4 years (± SD) and the average age at surgery was 22.9 ± 1.7 years. Six patients had right-sided symptoms and 1 had left-sided symptoms. Pain distribution was the V2 in 3 cases, V2-3 in 3 cases, and V3 in 1 case, with no cases of V1 affliction. A total of 11 procedures were performed in 7 patients, and 4 patients underwent a second procedure. Surgery and imaging revealed venous compression in all cases. The average follow-up period was 35.5 ± 39.9 months (median 12 months). Three patients reported a good outcome (no pain with or without medications) and 4 reported a poor outcome (either no pain relief or mild pain relief after surgery).


CONCLUSIONS
Trigeminal neuralgia is uncommon in young adults. Patients tend to present with symptoms similar to those in adults: long periods of pain and venous compression, but outcome unfortunately is not as good as that reported in the older population.
Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA.
Diaa
D
Bahgat
Dibyendu K
DK
Ray
Ahmed M
AM
Raslan
Shirley
S
McCartney
Kim J
KJ
Burchiel
D000328:Adult; D000367:Age Factors; D000700:Analgesics / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D015994:Incidence; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D009408:Nerve Compression Syndromes / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D009460:Neurologic Examination; D009922:Oregon; D010147:Pain Measurement; D016634:Radiosurgery; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D014680:Veins / Q000601:surgery; D055815:Young Adult
D000700:Analgesics