Trigeminal neuralgia in children – differential therapy and neurosurgical indication

Idiopathic trigeminal neuralgia is very seldom in childhood. Symptomatic facial pain in infectious or oncological diseases is more common. In these cases an etiological treatment is possible. In idiopathic trigeminal neuralgia without any diagnostic background high definition MRT could show cerebral vessels in contact with the trigeminal nerve. In case of therapeutic resistance to pharmacological therapy with substances like oxcarbazepine, gabapentine, pregabaline, amitriptyline or baclofen there will be an neurosurgical option of microvascular decompression by means of a teflon patch. The case of a seven years old boy is showing the advantage of such a neurosurgical intervention after years of frustrating pharmacological treatment. Directly after the operation the boy was cured from more than 30 painful tics per day before. The operation technique after Jannetta has been done even in more than 20 children in between starting from 13 months. Postoperative prognosis seems to be less optimistic as known from adults: the benefit after 10 years of catamnesis is limited to approximately 60%. The actual case gives the possibility to develop the differential considerations and implications before a neurosurgical intervention.