History of Trigeminal Neuralgia

Although early descriptions of TN can be inferred from the writings of Galen, Aretaeus of Cappadocia, and Avicenna, the first accurate descriptions of TN were not officially documented until the 1700s.

In 1756, Nicholas André conceptualized TN in terms of convulsive behavior. He believed that the grimaces of pain his patients expressed suggested that TN belonged to the same spectrum of diseases as tetanus or spasms. He coined the term tic douloureux to reflect both the pain his patients described as well as the facial spasms he documented.  The name persisted, even though not all patients demonstrated facial tics in conjunction with their pain.

In 1773, John Fothergill presented his impression of TN to the Medical Society of London. He described the condition as "a painful affection of the face” in which excruciating episodes come on suddenly but last a short time, returning at irregular intervals. He also mentioned how certain actions, such as eating, talking or tactile contact, might elicit these painful episodes. Fothergill discounted the notion that TN was part of the spectrum of convulsive disorders and suggested, instead, that it might be the manifestation of some type of cancer.

In 1891, Sir Victor Horsley proposed the first open surgical procedure for TN, which involved sectioning the preganglionic rootlets of the nerve. In 1925, Walter Dandy advocated the partial sectioning of the nerve in the posterior cranial fossa. During that procedure, he observed that the nerve was being compressed by vascular loops. In 1932, Dandy theorized that trigeminal neuralgia was caused by a blood vessel compressing the nerve. With the advent of the operative microscope, Peter Jannetta was finally able to further confirm this theory in 1967.

Jannetta pioneered a procedure in which he moved the offending blood vessel and placed a sponge to prevent the vessel from returning to its native position. Jannetta’s procedure, now known as microvascular decompression, was considered controversial for many years until other surgeons began to experiment with the technique and refine it with different tools and approaches. Microvascular decompression is now regarded by many as one of the most important modern breakthroughs in the treatment of neurological disease.