Disease Overview: It is a disease characterized by chronic, paroxysmal facial pain with lightning-like attacks, severe pain, and often trigger points on the face. The incidence is about 182/100,000, and the age of 50-60 years is the high incidence age. It is more common in women (male to female ratio is about 1:2), the incidence is higher on the right side than on the left side (about 2:1), and it is more common in the elderly, accounting for about 75% of cases over 50 years of age. It is believed that vascular compression of the trigeminal sensory root (Trigeminalsensoryroot, TSR) into the pontine zone (Trigeminalrootentryzone, REZ) is the main cause. In addition, multiple sclerosis, benign and malignant tumors in the REZ, arteriovenous malformations, posterior cranial sulcus malformations, focal cerebral infarction, and osteomyelitis of the jaws due to odontogenic infection can also cause trigeminal neuralgia, all of which are relatively rare. Diagnostic points: The diagnosis of trigeminal nerve mainly relies on typical clinical manifestations, which should generally have the following characteristics: episodic headache with paroxysmal, burning, slashing, tearing or pinprick-like pain, intermittent as usual, with trigger points, and pain strictly distributed in the trigeminal nerve distribution area, mostly unilateral, more common on the right side, commonly in the maxillary and mandibular branches. Positive neurological signs are not obvious, and there may be slight painful lateral hyperalgesia. CT and MRI examination can exclude secondary trigeminal neuralgia. 3D-TOF-MRA examination, which can reconstruct the relationship between the trigeminal nerve and the peripheral artery, provides relevant information for surgery (Figure). Differential diagnosis: l Toothache is mostly due to inflammation, characterized by persistent distension, dull pain, throbbing pain, confined to the gums and not radiating to other parts. l Oral examination reveals redness and swelling of the gums, percussion pain, etc. The pain disappears after treatment of the affected teeth. Migraine is a unilateral headache caused by the imbalance of vasodilation and contraction. It is common in young and middle-aged women and often has a history of headache or family history. There are often triggering factors such as fatigue, menstruation, and emotional stress. The pain may extend beyond the trigeminal nerve distribution area, and the pain is dull and long-lasting, and may be accompanied by nausea and vomiting. The symptoms can be relieved by the application of antihistamines. The nature of the pain is the same as that of trigeminal neuralgia, and the incidence is about 1% of that of trigeminal neuralgia. The pain is paroxysmal and can be triggered by eating, talking or swallowing. Spraying the pharynx with 4% cocaine and 1% dicaine can relieve the pain and facilitate the diagnosis of glossopharyngeal neuralgia. Trigeminal neuritis can be caused by influenza, maxillary sinusitis, frontal sinusitis, mandibular osteomyelitis, typhoid fever, malaria, diabetes, gout, alcoholism, lead poisoning, food poisoning, etc. The pain is persistent and is aggravated by pressure on the nerve branches. Hyperalgesia or hypersensitivity in the trigeminal nerve distribution area may be accompanied by motor branch dysfunction. Treatment principles: Drug therapy: primary trigeminal neuralgia is preferred to be treated with carbamazepine (or Dexedrine, oxcarbazepine). Start with a small dose, such as 200 mg per day, and gradually increase the dose to a maximum of 1000-1600 mg per day. However, very few patients exceed a total of 900 mg per day. High doses have been associated with adverse effects such as dizziness, drowsiness, nystagmus, liver damage, bone marrow suppression, and hyponatremia. Other drugs such as phenytoin sodium, clonazepam, baclofen, and wild papaya are also effective. Surgical treatment: microvascular decompression surgery Indications for surgery: 1, after a period of regular drug treatment, the drug efficacy is not obvious or the efficacy is significantly reduced. 2.Patients who are allergic to drugs or who cannot tolerate serious side effects. 3.Patients whose pain seriously affects their work, life and rest. 4. Patients whose trigeminal neuralgia symptoms are not controlled or recur after other surgeries. 5.Exclude secondary trigeminal neuralgia, such as tumor, vascular malformation, aneurysm, arachnoiditis, etc. in the pontocerebellar angle area, trigeminal nerve root or hemimelia. 6. The patient is in good general condition and can tolerate the surgery. Surgical efficacy: the clinical efficiency is 90-98% in the near future, and the long-term efficacy decreases, about 85%. The recurrence rate is 5-10%. The main complications are intracranial hemorrhage, cerebrospinal fluid leakage, transient facial numbness, etc., but the incidence is very low. Other surgical treatment methods: 1. Sensory root amputation, suitable for trigeminal nerve branch 2,3 pain and ineffective or recurrence after microvascular decompression, with an efficiency of 85%. Postoperatively, it is associated with facial numbness and peripheral facial palsy. 2. Percutaneous selective radiofrequency thermocoagulation of the semilunar ganglion is suitable for those who are older than 65 years old, have poor general condition, or have already undergone microvascular decompression, and have recurrence or ineffectiveness after surgery. The recent efficiency rate is 95% and the recurrence rate is 20%. About 3% of the patients have sensory abnormalities; about 6% of the patients have decreased corneal sensation; 2% of the patients have neurogenic keratitis. 3, radiosurgery, the indications are the same as “percutaneous selective meningeal ganglion radiofrequency thermal coagulation”, the recent efficiency is 80-90%, about 10% ineffective. Postoperative often have different degrees of facial numbness.