gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Quantitative sensory testing in patients with trigeminal neuralgia

Quantitativ-sensorische Testung bei Patienten mit Trigeminus-Neuralgie

Meeting Abstract

  • corresponding author Dirk Rasche - Neurochirurgische Klinik, Med. Fakultät Heidelberg, Universität Heidelberg, Heidelberg
  • M. Ruppolt - Neurochirurgische Klinik, Med. Fakultät Heidelberg, Universität Heidelberg, Heidelberg
  • C. Rolko - Zentralinstitut für Seelische Gesundheit, Mannheim
  • J. K. Krauss - Neurochirurgische Klinik, Med. Fakultät Mannheim, Universität Heidelberg, Mannheim
  • V. Tronnier - Neurochirurgische Klinik, Med. Fakultät Heidelberg, Universität Heidelberg, Heidelberg

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMO.05.03

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Veröffentlicht: 23. April 2004

© 2004 Rasche et al.
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Trigeminal neuralgia is one of the facial pain syndromes with characteristic pain and mainly without neurological deficits. In other facial pain syndromes hypaesthesia, hyperalgesia or allodynia can be present. The aim of this study was to develop a clinical test to objectively assess a neurological deficit in the face. Follow-up examinations concerning different treatments, e.g. pharmacological treatment, thermocoagulation in the gasserian ganglion or microvascular decompression in the parapontine angle should help to differentiate between different types of pain transmission, receptors and involved nerve branches.


A standard protocol for examination of the face testing thermal, mechanical, vibratory and pain sensory was developed for a multicenter study concerning neuropathic pain. Therefore an electrical thermodetector, special sets of pinpricks and von-Frey-Filaments were used. A total of 30 patients with trigeminal neuralgia be examined was 3-6 months postoperatively, a follow-up examination was performed. Of these, 20 patients - had received microvascular decompression, and 10 cases - unilateral thermocoagulation of the gasserian ganglion.


In all patients with trigeminal neuralgia, significant differences could be found concerning the warm and cold sensory detection threshold, which was elevated in the involved nerve branches in comparison with the contralateral side (p= 0.027; p=0.008). Also the tactile sensory threshold was significantly elevated in the involved branches (p=0.04). This effect was also seen in the non-involved nerve branches on the affected side in comparison to the healthy side. After thermocoagulation in the gasserian ganglion, in 8/10 patients a light hypaesthesia, and in 2 patients no sensory deficit was clinically detectable. In these cases this could be evaluated by sensory testing. An elevation of the sensory tjresholds for mechanical and tactile, cold and warm detection could be observed in the involved nerve branches. Hyperalgesia or allodynia could not be detected. At the follow-up examination 9/10 patients were pain-free, three patients still were on carbamazepine in reduced dosage. In 3/20 patients, slight unilateral hypaesthesia was clinically found after microvascular decompression of the trigeminal nerve root entry zone. This was interpreted as a result of intraoperative neurovascular manipulation. This hypaesthesia could also be detected in the quantitative sensory testing. In the other 17 patients no side differences were observed. In total, 16 of these 20 patients were pain-free and without medication, three patients continued receiving specific analgesics. In one patient with persisting pain a thermocoagulation was performed.


Quantitative sensory testing according to the standard protocol is a safe and reliable method to objective neurological differences in the trigeminal area. It is appropriate to quantify sensory disturbances and can help to differentiate between involved nerve branches. Follow-up examinations can demonstrate the influence and effects of different treatments. In our cases patients with trigeminal neuralgia showed subclinical sensory deficits and significant side differences in the pre-operative examination. A post-operative sensory deficit could be detected with quantitative sensory testing.