Abstract
Trigeminal neuralgia is a disorder that is characterized by recurrent unilateral, brief, electric shock-like pain. It is limited to the distribution of one or more divisions of the nerve. The most common cause of TN is neurovascular compression of the trigeminal nerve. Medical treatment relieves pain in approximately 75–80% of patients. However, it often loses effectiveness over time. Ablative procedures are preferable in patients with multiple comorbidities that cannot undergo surgery. The main surgical treatment is microvascular decompression of the trigeminal nerve and has a 90% success rate initially. The general anesthetic goals and considerations generally are the same as for posterior fossa craniotomy. Brainstem auditory evoked potential and electromyographic monitoring of the trigeminal and the facial nerves are also used. Triggering of the trigeminocardiac reflex is not uncommon with this procedure. A 55-year-old female complains of severe, shooting, electric shock-like pain in her right cheek. The pain occurs spontaneously or when she touches her face, chews, or upon brushing her teeth. The symptoms started suddenly about 1 year ago. She saw a neurologist 6 months ago and was diagnosed with trigeminal neuralgia. The neurologist started her on medical treatment which initially provided some relief. However, few months later, her symptoms worsened again. The neurologist referred her to a pain management specialist, who recommended a nerve block. The block did not significantly help. She was then referred to a neurosurgeon, who recommended a trigeminal nerve decompression.
Published Version
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