Diagnosing trigeminal neuralgia is not difficult in most of the cases on the basis of an accurate reappraisal of history and symptoms and finely performed neurological examination of the patient. By so doing, the best therapeutical approach will be chosen from case to case. Whenever clinical procedure will be not satisfactory, instrumental diagnostic procedures (either neurophysiological or neuroimaging) should be sought in order to exclude any organic lesion or systemic disease possibly underlying trigeminal pain. Anticonvulsants, and mainly carbamazepine, presently are the most effective drugs in treating idiopathic trigeminal neuralgia, whereas local application of capsaicin seems to be promising in treating post-herpetic neuralgic pain, although results are not always excellent. Obviously, surgical procedures represent the first choice treatment in the presence of organic intracranial lesions, although clinical conditions of the patient and the risks of any single intervention should be taken into careful consideration. The demonstration of microvascular compression of trigeminal roots by means of neuroimages (but not the sole assumption of its existence), which has been proposed as a possible pathogenetic mechanism of the so-called idiopathic trigeminal neuralgia, may lead to surgical decompression in the posterior fossa. However, such an invasive procedure should be postponed and sought after medical treatment will prove uneffective. Also, any surgical intervention should be chosen according to clinical conditions of the patient and possible surgical risks.
|Translated title of the contribution||Trigeminal neuralgia: A critical review|
|Number of pages||11|
|Publication status||Published - 1994|
ASJC Scopus subject areas
- Clinical Neurology