Trigeminal neuralgia is a recurrent severe pain in the area of distribution of the trigeminal nerve in the face. It is the most common of all neurological pain disorders and occurs mostly in middle-aged and elderly people, more in women than in men, and more on the right side than on the left side. Clinical manifestations of trigeminal neuralgia: The main manifestation is the sudden occurrence of a brief paroxysmal lightning-like severe pain on one side of the face without any cause. The pain is like electric shock, knife cut, burning or needle prick. Some episodes of pain may be accompanied by lacrimation and runny eyes. The pain usually lasts for a few seconds to 1 or 2 minutes and then stops abruptly and the patient returns to his or her pre-pain state. Most of the attacks are mild at first, with fewer episodes and longer intervals, but as the disease progresses, the attacks become more frequent and the pain becomes more intense. The pain may start in one or several branches of the trigeminal nerve, or it may spread to other branches. The pain is mostly distributed along the nerve’s course. The pain of branch 1 is located in the superficial or deep part of the eye, upper lid and forehead; the pain of branch 2 is mainly in the cheek, upper lip, palate, upper teeth and upper gums. The painful sites of branch 3 are in the lower jaw, lower lip, lower teeth, lower gingiva, and anterior 2/3 of the tongue. A small number of patients have bilateral trigeminal neuralgia (2% to 5%). 40% to 50% of patients have one or more particularly sensitive areas called “trigger points”. Trigger points mostly occur in the upper and lower lip, beard, upper and lower gums, nose, nasolabial folds, cheeks, eyebrows and other places. This area is extremely hypersensitive to touch and movement, and a touch instantly triggers an intense pain attack that starts at this point and immediately spreads to other areas. The pain can be caused by facial movements such as eating, talking, yawning, chewing, swallowing, washing, shaving, etc. Even movements of other parts of the body that pull on the face can cause painful episodes. The pain can be periodic, with each pain attack lasting from a few seconds to 1 or 2 minutes before stopping abruptly. Each episode can last from a few weeks to a few months, after which the symptoms can gradually decrease, disappear or be relieved for a few days to a few years. After the remission period, the pain returns. Most patients have more frequent episodes of pain, and the pain level increases. The affected half of the face may be spasmodically distorted, and sometimes sympathetic syndrome occurs after the termination of the attack, which is manifested by whitening of the affected face, followed by flushing, conjunctival congestion, and accompanied by lacrimation, runny nose, and salivation. Etiology of trigeminal neuralgia: Modern medicine believes that most of the cases are due to pathological disturbance of trigeminal nerve conduction caused by some kind of compression, mostly due to normal vascular cross-compression of trigeminal nerve root, occasionally due to compression by aneurysm or tumor. Diagnosis and examination of trigeminal neuralgia: The diagnosis is mainly based on symptoms and signs, but cranial CT and MRI examination are needed to exclude other intracranial lesions. Treatment of trigeminal neuralgia: The main treatment methods are: medication; acupuncture; trigeminal nerve peripheral branch closure; trigeminal nerve hemianopia block; radiofrequency thermal coagulation therapy; gamma knife treatment; trigeminal nerve root microvascular decompression and so on. At present, the most fundamental and effective treatment is trigeminal nerve microvascular decompression. The procedure is to open the cranium behind the ear, expose the trigeminal nerve, find the compressed blood vessel in the brain stem area, and pad it with gelatin sponge, muscle sheet or Teflon cotton sheet to achieve the purpose of decompression. The mortality rate of microvascular decompression is extremely low. Some patients may experience transient nausea, vomiting, facial sensory disturbance, or even hearing loss and vertigo after the procedure. Only a very small number of patients may have permanent sequelae such as hearing loss, deafness, facial palsy, facial sensory disturbances, and brainstem infarction.