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General Considerations

Last Updated: March 16, 2020

Trigeminal neuralgia (TN) has been called one of the worst pains that can afflict a human being. John Fothergill was one of the first to describe this pain in his 1773 article: “On a Painful Affliction of the Face.” The pain of TN is relatively easy to diagnose—it is typically unilateral, episodic, severe, stabbing, shock-like or lancinating, and exacerbated by cutaneous stimuli such as tactile pressure, chewing, brushing, a breeze of air, or shaving. A crude annual incidence of TN is approximately 5.7 per 100,000 women and 2.5 per 100,000 men. Peak incidence lies between ages 50 and 60 years, and prevalence increases with age.

Initially a small dose of an antiepileptic drug (such as carbamazepine), rather than an analgesic drug, can provide excellent pain relief for TN. However, some patients do not respond to antiepileptic drugs or they suffer from adverse side effects, so they will qualify as candidates for one of the surgical procedures (microvascular decompression, stereotactic radiofrequency thermoablation, glycerol or balloon compression, and radiosurgery rhizotomy).

Regardless of the responsible etiology in the pathogenesis of this pain, MVD surgery, through mobilizing the offending vessel or by p...