[Surgical versus medical treatment of idiopathic trigeminal neuralgia]

The primary treatment of idiopathic trigeminal neuralgia is medical. Surgery is reserved for unresponsive patients or in case of long lasting, tedious or dangerous side effects of the medication. The surgeon has to inform the patient about risks and benefits of the different surgical methods and consider the patient's expectations and fears in order to choose the best surgical alternative. We describe the clinical picture of trigeminal neuralgia, the steps leading to the diagnosis. We also discuss the pathogenesis and the different treatment modalities with emphasis on surgical methods.