Kohei Hashida, Keisuke Onoda*, Takao Zama, Tomoyuki Hashimoto, Jumpei Kato, Tomihiro Wakamiya, Masahiro Indou, Tatsuya Tanaka, Takashi Agari, Takashi Sugawara, Kimihiro Nakahara, Hiroshi Itokawa and Akira Matsuno

Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, 852 Hatakegata, Narita, Chiba 286-0124, Japan

*Corresponding Author: Keisuke Onoda, Department of Neurosurgery, Interna- tional University of Health and Welfare, School of Medicine, Narita Hospital 852 Hatakegata, Narita, Chiba 286-0124, Japan.

Received: August 06, 2026; Published: August 28, 2026

Abstract

Background: Postherpetic trigeminal neuralgia (PHTN) typically presents with persistent neuropathic facial pain and sensory disturbances. Classical trigeminal neuralgia (TN)-like paroxysmal pain following herpes zoster is uncommon, and its underlying pathophysiology remains poorly understood. We report a rare case in which chronic inflammatory changes, trigeminal nerve tethering, and nerve deformity were associated with classical TN-like symptoms.

Case Description: A 65-year-old woman developed paroxysmal electric shock-like pain in the left V1–V2 distribution 18 months after herpes zoster infection. Magnetic resonance imaging demonstrated neurovascular contact with marked trigeminal nerve deformity. Intraoperatively, severe perineural adhesions and inflammatory granulation tissue were identified. Although vascular decompression was achieved, nerve deformity persisted, prompting meticulous perineural dissection and internal neurolysis. Histopathological examination demonstrated fibrosis with lymphocytic infiltration, consistent with chronic inflammation. After internal neurolysis, trigeminal nerve conduction showed unchanged latency and a 183% increase in amplitude. Nerve deformity improved substantially, and the patient experienced marked pain relief without neurological complications.

Conclusion: Chronic inflammatory changes following herpes zoster may promote trigeminal nerve tethering and deformation, potentially rendering otherwise asymptomatic neurovascular contact symptomatic. In selected patients with classical TN-like symptoms after herpes zoster, perineural dissection combined with microvascular decompression and internal neurolysis may address both vascular and nerve-related pathological components.

Keywords: Herpes Zoster; Internal Neurolysis; Microvascular Decompression; Trigeminal Nerve Tethering; Trigeminal Neuralgia

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Citation

Citation: Keisuke Onoda., et al. “Inflammation-Induced Trigeminal Nerve Tethering Following Herpes Zoster Mimicking Classical Trigeminal Neuralgia: A Case Report". Acta Scientific Neurology 9.9 (2026): 13-17.

Copyright

Copyright: ©2026 Keisuke Onoda., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.