- Correct diagnosis, based on a careful analysis of the clinical history and examination, is critical to therapeutic success.
- MRI must be done to rule out the presence of:
Mass lesion (tumor or cyst)
- All trigeminal neuralgia patients should undergo a trial of medical therapy.
- Surgery is to be considered when medical therapy fails, or the patient experiences significant side-effects.
- Approximately 50% of patients will eventually require surgery due to failed medical therapy.
- TN patients should be aware of all – ablative vs. non-ablative – surgical options.
- For non-MS patients with evidence of vascular compression on the MRI scan, MVD is the treatment of choice:
Surgery is simplified (minimally invasive surgery)
<2-cm bone opening (“suboccipital craniectomy”)
Foley catheter not needed (for bladder drainage during surgery)
Minimal blood loss, avoiding blood transfusion
1-2 days of hospital stay
Negligible permanent facial numbness as compared to 80% following ablative surgery