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Trigeminal Neuralgia

Classical Trigeminal Neuralgia (TN) is a painful condition of the face, characterized by a paroxysmal, lancinating, shock-like pain, lasting a few seconds and it is often triggered by sensory stimuli. It is confined to the somatosensory distribution of one or more branches of the trigeminal nerve, on one side of the face and appears with a prevalence of three to five per 100,000 people in the general population.


Treatment

Conservative treatment is the first choice; many patients, suffering from TN (classical or due to MS) experience adequate relief with drugs such as carbamazepine, phenytoin, gabapentin or baclofen. However, for the control of medically refractory pain, several neurosurgical procedures have been developed, ranging from open surgical procedures (vascular decompression of the trigeminal root in the brainstem) to percutaneous procedures (radiofrequency trigeminal rhizotomy, glycerol rhizolysis, balloon compression (BC), and stereotactic radiosurgery) which are more routinely used today. The plethora of current treatments suggests that none is ideal, and improvements seen in short term studies are confounded by spontaneous remissions occured in TN. Although all these treatment options appear to have a good success rate with low risks, the ideal treatment algorithm is still under debate.(see articles)

In our Department we use for more than 150 cases, all the percutaneous methods (balloon compression, RF rhizolysis, glycerol injection) and microvscular decompression procedures.



Fig 1. Pain distribution in trigeminal neuralgia.


Fig 2. Balloon compression technique for trigeminal neuralgia. The balloon has been inflated into the gasserian ganglion.