Trigeminal neuralgia is one of the entities that most affect the quality of life of people who suffer. Medical treatment of choice continues to be managed to improve most patients and a normal life are incorporated. Furthermore monotherapy or combination therapy can rational decrease the incidence of adverse effects, which were previously a limitation. There are currently several open clinical trials to demonstrate the efficacy of new drug treatments orally or intranasally. It will also evaluate the application of botulinum toxin in the ganglion of Gasser.
In cases refractory to pharmacotherapy have to resort to surgical techniques divided into ablative (one related to the trigeminal structure is injured) or non-ablative. Ablative techniques are simpler and less surgical risk but are associated with increased incidence of sequelae such as facial numbness; while nonablative (Janetta technique consisting separates the glass which contacts the trigeminal Teflon or other element) has more surgical risk but better end results. Within ablative we include percutaneous acting on the trigeminal ganglion injuring radiofrequency, glycerol or mechanically and that the protuberance injured Knife as gamma or HIFU.
In older patients it has always taken into account the risk of surgery when the surgical technique for assessing those refractories. Although many technical centers being continuously choice microvascular decompression, sometimes we resorted to ablative techniques for the higher incidence of complications. Although some recent publications reframe the elderly may not actually have a higher risk of complications own intervention, the incidence of pulmonary thromboembolism, stroke or death are higher.
Again individualized treatment and valuing the whole person, understanding the risk factors, life, treatment that has proven continues to be the basis of a correct clinical practice.
Dr. Jesus Porta Etessam. March, 2016