A patient presents with recurrent episodes of unilateral facial pain described as electric shock-like, triggered by touching the corner of the mouth. MRI shows vascular compression of a nerve at the root entry zone. Which cranial nerve is involved, and what is the definitive surgical treatment?

• A Facial nerve (CN VII); microvascular decompression of CN VII
• B Glossopharyngeal nerve (CN IX); microvascular decompression of CN IX
• C Facial nerve (CN VII); transection of the nervus intermedius
• D Trigeminal nerve (CN V); microvascular decompression of CN V ✓

Explanation

The presentation is classic trigeminal neuralgia: unilateral electric shock-like facial pain triggered by innocuous stimuli. Vascular compression of the trigeminal nerve at the root entry zone is the most common cause. The definitive surgical treatment is microvascular decompression of the trigeminal nerve. Facial nerve microvascular decompression is performed for hemifacial spasm, which presents with involuntary twitching, not electric shock pain.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.