Although we don't fully understand why people get trigeminal neuralgia, we do have some clues. There is a theory called the microvascular compression theory, which really had a lot of support - probably a little bit less support now - but at one time, that was the best theory that explained so much of this disorder. In a nutshell what it was was that there's a nerve and we know that there's some sort of short circuiting going on in the nerve that leads to these episodes of pain. One of the things that we found at the time of surgery is that there's a blood vessel that seems to be lying over the nerve. We found that by separating the blood vessel from the underlying nerve, that trigeminal neuralgia (in most cases) we could cure it. This theory came about called the microvascular compression theory of trigeminal neuralgia where we felt that a pulsating vessel up against the nerve led to loss of insulation on the nerve and then therefore the short circuiting and therefore then the pain syndrome. That was commonly held for years - if not decades. The problem we find in this theory is that there are some times when we will do surgery and we won't find any blood vessel at all. Yet we do the same maneuver where we stroke the nerve or we touch the nerve and people still get cured of their trigeminal neuralgia and so some elements of that theory are being put into question. My own personal opinion is that there's probably some genetic aberration or genetic abnormality in these patients where the insulation isn't being formed correctly and that's probably at the heart of it. But it's important to know this theory because that's the underpinning of the surgery that we do to treat this disorder.
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