This chapter addresses the diagnostic and therapeutic problems of trigeminal neuralgia (TN). While classical TN has no apparent cause other than vascular compressions, symptomatic TN is caused by a demonstrable structural lesion such as cerebellopontine angle tumors or multiple sclerosis. Categorization of TN into typical and atypical forms is based on symptom constellation, and not etiology. Some clinical criteria that were used to distinguish between classic and symptomatic TN, such as age at onset, involvement of the ophthalmic division, and unresponsiveness to treatment, are no longer considered reliable. Bilateral pain and clinically manifest sensory deficits are rare occurrences even in symptomatic TN. Hence, MRI or trigeminal reflex testing is recommended in all patients. Carbamazepine (CBZ) and oxcarbazepine (OXC) are the first-choice medical treatment. Patients that reach adequate dosage of CBZ/OXC without getting sufficient pain relief should be made aware of the available surgical interventions. Some surgical procedures, that is, Gasserian ganglion percutaneous techniques, gamma knife, and microvascular decompression, are extremely efficacious with relatively few complications.
KeywordsTrigeminal Nerve Trigeminal Neuralgia Microvascular Decompression Vascular Compression Gasserian Ganglion
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