Névralgie faciale essentielle. Névralgie du Trijumeau. « Tic douloureux de Trousseau »

Trigeminal neuralgia (TN) is characterized by episodes of intense stabbing, electric-shocklike of unilateral facial pain. Physical examination findings are typically normal. MRI and/or MRA can be performed to exclude an uncommon mass lesion or aberrant vessel compressing the nerve roots. The primary treatment of “Tic douloureux” is first pharmacologic. The mainstays of the pharmacologic management are the anticonvulsants medications, the most effective one being, since 1962, Carbamazepine (Tegretol®). In 2009 it remains the best available drug for trigeminal neuralgia. Numerous others anticonvulsants can be prescribed (Gabapentin, Oxcarbazepine, Clonazepam, Pregabaline…) they can be better tolerated than carbamazepine and phenytoin, but in France all these drugs are “Off label use”. When the pharmacological treatment fails (30-50 %), a choice between a minimally invasive technique and a surgical approach should be made. By far, one of the most common procedures to treat pain, especially in elderly patients, is the use of radiofrequency lesioning (RF). The main advantages of RF seem to be its effectiveness and high pain relief rate (> 90%). Percutaneous balloon compression of the Gasserian ganglion and percutaneous glycerol rhizotomy have a high recurrence rate and these procedures are nowadays less and less indicated. Gamma-knife surgery is the least invasive procedure, it affects a delayed injury upon the trigeminal nerve and reduces trigeminal neuralgia pain within a few weeks in most patients. Microvascular decompression surgery alleviates neurovascular compression upon the trigeminal nerve root, long-term studies have shown that the 5-year success is about 80 %.