Bilateral trigeminal neuralgia

A 56-year-old woman previously treated by a retrogasserian neurectomy for a right tic douloureux was rendered free of pain, but complete anaesthesia of the right half of her face remained. Seven years later, she developed a typical left trigeminal neuralgia. Contralateral rhizotomy was refused because of the patient's concern about having bilateral facial anaesthesia. Through a suboccipital craniectomy, the trigeminal nerve was decompressed from a thickened arachnoid membrane and a large bridging vein near the root entry zone. After eighteen months, the patient was free of pain with intact facial sensations on the left side. Therapeutic considerations in cases of bilateral trigeminal neuralgia are discussed.