The surgical treatment of trigeminal neuralgia.

Trigeminal Neuralgia is a clinical presentation of different diseases, defined in the last edition of the International Classification of Headache Disorders (ICHD-3) as “Classical Trigeminal Neuralgia” and “Painful Trigeminal Neuropathy”. In both groups typical and atypical clinical findings are present. They must be taking into consideration for defining a correct clinical diagnosis. In addition MRI findings and other objective signs allow to disclose the Etiology of the Trigeminal Neuralgia. The surgical treatment offers many options: open surgery in posterior fossa, neuroablative procedures on the trigeminal nerve, neuromodulation techniques on the trigeminal pathways. Open surgery and neuroablative procedures are the treatments chosen in Classical Trigeminal Neuralgia and in Painful Trigeminal Neuropathy showing pure or prevalent typical clinical findings. Instead in Painful Trigeminal Neuropathy with pure or prevalent atypical clinical findings the neuromodulation techniques are the treatments to be chosen. Looking at the Literature reports and at our own experience, techniques, results, and indications of microvascular decompression, radiofrequency thermocoagulation, glycerol rhizolysis, balloon microcompression, and sterotactic radiosurgery of the trigeminal root are reported and discussed.