TRIGEMINAL NEURALGIA
ABSTRACT
Trigeminal neuralgia is a progressive, debilitating disease. It is characterized by an acute, stabbing and generally short-term hemifacial pain which is associated with a different extent of innervation by the trigeminal nerve. The facial nerves II and III are most commonly affected. In each case, an MRI scan with contrast should be performed to rule out any pathologies of the cerebellopontine angle. In the first place, an attempt should be made to control pain pharmacologically. If pharmacological treatment is ineffective, surgical methods should be considered. The methods used are classified as follows: percutaneous procedures (thermolysis), mechanical procedures (balloon compression), radiosurgery, and glycerol-based procedures (neurolysis of the trigeminal nerve branches). Microvascular compression, which in most cases is oriented towards superior cerebellar artery, is considered a method which helps to remove the underlying cause. The separation of the artery, rather than the vein, from the nerve using a Teflon felt at the central myelin-peripheral myelin transition zone is considered a gold-standard treatment for trigeminal neuralgia. Trigeminal pain in patients with multiple sclerosis is most difficult to treat using either pharmacological and/or surgical methods.
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