Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a pain syndrome typified by paroxysms of intense stabbing, electric shock-like unilateral facial pain provoked by light touch in the distribution of the fifth cranial or trigeminal nerve. Also known as tic douloureux to describe the involuntary facial movement or contortions of the facial features in reaction to the severity/intensity of the pain, the cause is usually idiopathic, but secondary causes such as vascular anomalies, tumors, or multiple sclerosis may be identified by neuroimaging. Antiepileptic drug therapy provides initial pain relief in the majority of patients. However, the TN pain may become refractory to pharmacological agents leading to referrals for evaluation of surgical or irradiation management ranging from operative craniotomy to radiation-based radiosurgical approaches. This chapter will highlight the key features of TN and elucidate state-of-the-art medicinal, surgical, and radiotherapeutic regimens in the treatment of TN based on retrospective, observational clinical investigations along with systemic and comparative reviews.