Summary

1. Correct diagnosis, based on a careful analysis of the clinical history and examination, is critical to therapeutic success.
2.  MRI must be done to rule out the presence of:

MS

Mass lesion (tumor or cyst)

Vascular compression

3. All trigeminal neuralgia patients should undergo a trial of medical therapy.

4. Surgery is to be considered when medical therapy fails, or the patient experiences significant side-effects.

5. Approximately 50% of patients will eventually require surgery due to failed medical therapy.

6. TN patients should be aware of all – ablative vs. non-ablative – surgical options.

7.   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)

4-cm incision,

<2-cm bone opening (“suboccipital craniectomy”)

45-minute surgery

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