Surgical Management for Trigeminal Neura[gia

Abstract

Trigeminal neuralgia is the most common facial neuralgia occurring in patients older than 50 years, with an annual incidence of 4 cases per 100,000 population. The pain is intermittent with attacks of sudden, lancinating, "electric-like shocks", often of devastating intensity but lasting for a few seconds. The pain is confined to one side of the face, usually the maxillary or mandibular branches are affected singly or in combination. Painful attacks may occur spontaneously but more often are triggered by• a particular movement or a stimulus in a specific area.

The precise etiology of trigeminal neuralgia has not been established completely. Substantial evidence suggests that compression and distortion of the root entry zone of the trigeminal nerve by vessels may be the primary etiologic entity. Other causes may be multiple sclerosis or • other pathology usually in the cerebellopontine angle or middle cranial fossa.

The diagnosis of trigeminal neuralgia should be based upon the patient's history and description of the painful attacks. Physical and neurological examinations usually are negative, unless an underlying condition exists. All patients should undergo imaging studies, either CT or MRI scans with special reference to the posterior fossa. The primary treatment of