Treatment strategy for trigeminal neuralgia: a thirty years experience.

Trigeminal neuralgia is an invalidating disease when become drug-resistant. The only possible treatment is surgery with different modalities, percutaneous, open surgery or radiosurgery. The thirty years experience at the Fondazione Istituto Neurologico C. Besta, Milano, Italy suggests that these surgical strategies are successful in pain control in short and long term period in more than 90% of cases, with a low rate of side effects and high improvement of quality of life. The type of surgery should be tailored on the particular patient considering age, general physical condition, neuroradiological assessment in which MRI with dedicated sequences are mandatory, and also patient's attitude.