Trigeminal neuralgia (TGN) is among the most excruciating neuropathic craniofacial pain disorders. It is relatively rare in occurrence but at the same time presents significant challenges to management. Most cases of TGN fall under the category of Idiopathic TGN wherein the vast majority have evidence of a vascular malformation with an abnormal loop of artery in close proximity to the root entry zone of the trigeminal nerve root leading over time to increased compression and areas of demyelination of the nerve root. The pain is typically unilateral and has characteristic clinical features which are outlined later in the chapter. Carbamazepine is considered the drug of choice for treatment but other pharmacologic options such as Oxcarbazepine, baclofen, anti-convulsants are being increasingly used due to the potential for serious side effects with carbamazepine. For patients with Idiopathic TGN who have vascular compression, microvascular decompression is a very effective treatment modality.
KeywordsTrigeminal neuralgia (TGN) Root entry zone Microvascular decompression