Treatment of trigeminal neuralgia.

When medical treatment for trigeminal neuralgia fails or is limited by significant side effects, neurosurgeons need to inform their patients of all the available treatment options. The best treatment for the patient depends on the age of the patient, medical comorbidities, and the risks the patient is willing to assume. We recommend microvascular decompression for younger healthy patients with a longer life expectancy. Percutaneous trigeminal neurolysis remains a useful minimally invasive approach for the older patient and for the patient with medical comorbidities and a shorter life expectancy. The role of stereotactic radiosurgery in the treatment of trigeminal neuralgia will be better defined in the future. Partial sectioning of the trigeminal nerve may be considered in patients who have negative explorations during a microvascular decompression or when other less invasive procedures have failed to provide adequate relief.