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Journal of Neurosciences in Rural Practice
Medknow Publications
Publication Date
  • Commentary
  • Medicine


Trigeminal neuralgia is a devastatingly painful condition that severely reduces patients’ quality of life, and is most often managed by medical management using anti-convulsants, usually carbamazepine.[1] However, these cases can become refractory to medical treatment and need further neurosurgical intervention. In such a situation, one dilemma that often arises in under-developed and developing countries is an access to neurosurgical care and the mode of surgical interventions available. Neurosurgical treatments can be categorized as reversible or non-reversible. Some reversible neurosurgical interventions include the injection of local anesthetic agents,[2] alcohol[3] and botulinum toxin,[4] all of which can be done on an outpatient basis and even in rural practice by a trained medical practitioner or oral and maxillofacial surgeon. However, these procedures do not provide long lasting pain relief, and in the case of botulinum toxin injection, it can be very expensive. A recent issue of this journal highlighted an emerging role of transcutaneous electric nerve stimulation, which showed very promising results.[5] However, until more evidences are available, more invasive and irreversible neurosurgical treatment appears to be the best alternative for managing refractory trigeminal neuralgia. Invasive neurosurgical treatment includes microvascular decompression (which is non-ablative) and various ablative procedures that are performed at various sites, namely peripherally, at the Gasserion ganglion or within the posterior cranial fossa. Peripheral neurectomy is a not a new neurosurgical procedure, having been practiced since late 19th century,[6] but documentations on its success and long term outcome is still lacking until today.[7] Therefore, with increased sophistication in neurosurgical procedures and the ability to scan and review the Merkel's cave and Gasserion ganglion using new and highly accurate imaging modalities, the currently accepted norm to surgically manage trigeminal neuralgia has shifted

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