Current concepts concerning the etiology and treatment of trigeminal neuralgia

Trigeminal neuralgia (tic douloureux) was first identified over three hundred years ago. Only recently have the causes of the disorder begun to be recognized and understood. The first attempts at treatment involved the neurotomy of peripheral branches of the trigeminal nerve. This procedure, along with neurectomy, ganglionectomy, rhizotomy, tractotomy, and injections of toxic substances into the ganglion and nerve branches were the main treatment modalities in years past. Although they exhibited marked success, they are fraught with complications, such as relapse, loss of facial sensation and motor control, infection, deafferentation pain, and a fairly high rate of mortality from the procedure. The current treatment modalities that result in a predictable success with minimal risk are microvascular decompression, percutaneous retrogasserian thermal rhizotomy, and percutaneous retrogasserian glycerol rhizotomy. Other procedures, such as balloon compression of the gasserian ganglion, cryotherapy, acupuncture, and drug therapy, are also being used with marked promise.