# Hydrocephalus-associated trigeminal neuralgia

## TL;DR

This study explores how hydrocephalus can cause trigeminal neuralgia and finds that CSF diversion surgeries often relieve the pain.

## Contribution

The study identifies hydrocephalus as an underrecognized cause of trigeminal neuralgia and evaluates treatment efficacy.

## Key findings

- CSF diversion procedures like VPS and ETV provided pain relief in most hydrocephalus-related TGN cases.
- MVD showed variable results and worked best when combined with CSF diversion.
- Hydrocephalus may be a secondary cause of TGN that is often overlooked.

## Abstract

Trigeminal neuralgia (TGN) secondary to hydrocephalus is relatively uncommon in clinical practice. This study aimed to investigate the correlation between hydrocephalus and TGN and evaluate the efficacy of surgical intervention in alleviating TGN.

We conducted a retrospective analysis of three cases from our institution and performed a systematic literature review (PubMed search up to December 2024). The inclusion criteria were patients with concurrent hydrocephalus and TGN. Data were analyzed for demographic characteristics, treatment modalities, and outcomes.

Among the 21 analyzed cases (including the 3 patients reported in our study), the mean age was 38 years (range: 22–64), with a balanced gender distribution (male-to-female ratio: 11:10). The etiologies included isolated hydrocephalus (n = 12 cases), Chiari I malformation (CIM) (n = 5), Dandy–Walker syndrome (DWS) (n = 2), and tumor-related cases (n = 2). Ventriculoperitoneal shunt (VPS) resulted in complete pain relief in 75% (n = 9/12) of hydrocephalus cases, while endoscopic third ventriculostomy (ETV) was effective in two cases. Microvascular decompression (MVD) showed variable efficacy, with better outcomes when combined with cerebrospinal fluid (CSF) diversion procedures.

Hydrocephalus may represent an underrecognized secondary cause of TGN. CSF diversion procedures (VPS/ETV) should be considered as first-line interventions, with MVD reserved for refractory cases. These findings support a multidisciplinary approach to diagnosis and management.