Abstract

ROBAINA PADRON, Francisco Javier. Trigeminal neuralgia: A Review of the medical a surgical management. Rev. Soc. Esp. Dolor [online]. 2008, vol.15, n.4, pp.248-256. ISSN 1134-8046.

Trigetninal neuralgia is defined by the International Association for the Study of Pain (IASP) as a paroxistic, unilateral, severe, penetrant pain of short duration and localized in the distribution of one or several trigeminal nerve branches. It can be idiopathic or sintomatic, secundary to múltiple sclerosis or due to tumoral lesions in the cerebelo pontine angle in the posterior fossa. Is a neuropathic pain due in its idiopathic form to vascular compression of the trigeminal root. Its prevalence is rather high and posible is increasing due to the improvement of live expectancy of the polulation. The medical treatment is the first step for pain control Carbamacepine is the most used and usefull drug to treat this pain condition, although it can induce side effects. Doses of 300-1200 mgr/day can be very effective. Other drugs as tizanidine are not better than carmacepine. Tocainide offers similar results and pimozide better results, but showing higher side effects. Lamotrigine is also effective but there are few series to confirm the results. Adverse skin reactions are frecuent using this drug. Lamotrigine dayly doses ranged between 200-400 mgr. Baclofeno is also a complementary drug in refractary cases. Other medication as clonacepam, gabapentine, oxcarbamacepin, phenitoin and sodic valproate, have not shown better results. The surgical treatment can be done at different levéis. 1-peripheric; 2- ganglion; 3- trigeminal root in the posterior fossa. Decompressive surgery in the posterior fossa is the only thechnic that don't give rise to hipoesthesia or anaesthesia in the some or all trigeminal branches after the procedure becuse is not destructive. To take the decission for a particular interventional or surgical thecnique, its necessary to look first at patient's phisical state, describe to them pros and cons of every technique, bearing in mid the experience of the physisian who is going to perform the procedure. Radiofrecuency thermocoagulation of Gasserian ganglion its have advantages and disadvantages but has no mortality, obtaining persistent pain relief in 75% of patients. Glicerol rhyzotomy achive paain relief in 55% of cases. Percutaneous microcompression of trigeminal ganglion with Fogarty's balloom needs general anaesthesis achieven persisting pain relief in 76% of cases. Microvascualr decompression obtain long term results in 77% of patients with a mortality rate of 1% in very expert hands. Stereotactic radiosurgery of Gasserian ganglion obtain long term good results in 70% of cases. Management of trigeminal neuralgia is very difficult with a low percentage of good results achieved with medication only. Percutaneous interventional techniques including stereotactic radiosurgery are a valid alternative for pain relief. Only in young patients or in case of personal decission, microvascular decompression, should be offer as the last choice.

Keywords : Trigeminal neuralgia; Pharmacological treatment; Percutaneous techiniques; Surgical Treatment.

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