Trigeminal Neuralgia - Recent Advances

The treatment of TN is a challenge both for neurologists and neurosurgeons. Progress has been made in the recent years both for surgical treatment due to neuroradiological techniques. Trigeminal neuralgia is a severe, unilateral, episodic pain of the face that is provoked by light touch; it should be differentiated from dental causes of pain. The first line drug for treatment is either carbamazepine or oxcarbazepine. Botulinum toxin A (Botox) injections may reduce pain from trigeminal neuralgia in people who are not helped by medications and to patients before surgery. Ultrasound-guided intervention allows precise targeting of the affected nerves without collateral damage to the nearby vessels and prevents accidental nerve injury, vascular thrombosis, and postinjection hematoma. Bony landmarks of the cranium serve as important guides for palpation-guided injections and can be delineated using ultrasound. Ultrasound also provides real-time images of the adjacent muscles and accompanying arteries and can be used to guide the needle to the target region. Most importantly, ultrasound guidance significantly reduces the risk of collateral injury to vital neurovascular structures.