1. What are the characteristics of trigeminal neuralgia pain? Trigeminal neuralgia is characterized by pain that is episodic in nature and very intense in intensity. The patient feels a kind of pain like a knife cut or electric shock. The pain comes on very suddenly, often lasting a few minutes, and then suddenly subsides. Sometimes the pain comes on suddenly while the patient is being seen, and the patient lies on the floor and rolls around in pain. This pain can be relieved for a period of time, after a period of pain. Some periods of relief can last for tens of days, and then a cycle of attacks begins again. This pain is so painful that some patients can’t stand it and seek suicide. 2.What are the treatments for trigeminal neuralgia? There are many treatment methods for trigeminal neuralgia, mainly divided into three categories, which are recognized as effective methods at home and abroad. The first method is drug treatment, which mainly allows patients to take oral drugs, drugs including carbamazepine, gabapentin, oxcarbazepine, etc. This drug is effective for many patients. Patients may prefer to take oral carbamazepine for pain relief. The second method is minimally invasive interventional treatment, also known as trigeminal nerve hemimelia disruption. Chemical destruction can be used, or radiofrequency thermocoagulation, which involves placing a very fine radiofrequency needle into the trigeminal meningeal ganglion, the tip of which can be heated to 70 to 80 degrees, causing a slight denaturation of the proteins within the meningeal ganglion so that pain signals cannot be transmitted. The third method is neurosurgery, also called microvascular decompression. It involves opening the back of the head to relieve the compression of blood vessels on the trigeminal nerve. These three methods can be used separately for patients with different pain levels. 3, some patients take a very large dose of carbamazepine treatment is not good, such patients long-term medication will appear what side effects? Carbamazepine is still relatively safe if taken in small doses, but there are many side effects if taken in large doses and for a long time. For example, a large amount of prolonged use can cause damage to liver and kidney function, and we have also encountered serious patients who even led to kidney failure and a kidney transplant. Another side effect of carbamazepine is that it can cause intractable insomnia, which is not easy to treat once it is formed. Another more serious side effect is exfoliative dermatitis. The patient’s skin may peel, ulcerate, and become painful, and the patient’s internal mucous membranes may also be prone to peeling, which may lead to gastrointestinal bleeding in severe cases. In addition, long-term use can lead to damage to the hematopoietic system, and in severe cases, aplastic anemia can occur. Patients who take high doses of the drug for a long time should go to the hospital regularly to check liver and kidney function and blood count, preferably once a month. Once abnormal changes in these functions are detected, the drug should be discontinued in a timely manner. During the medication period, if the sleep is not good, you should also pay attention to the occurrence of drug-related insomnia. 4.Does the attack of trigeminal neuralgia have anything to do with psychological factors such as good or bad mood? Most of the patients we met are not in a good mood, because most of the patients with long-term severe pain are accompanied by anxiety and depression, and many of them are in a very low mood. Many patients are depressed and have no interest in things around them, and some have even lost confidence in life. We have recently conducted some studies on the psychological changes of trigeminal neuralgia patients, and it has been confirmed that many patients with trigeminal neuralgia had very high depression and anxiety indices before treatment, and after treatment, the pain was relieved and the patients’ anxiety and depression indices were reduced. The patient’s mood has also been significantly improved. 5.How big is the risk of the procedure of minimally invasive interventional treatment? Minimally invasive treatment is divided into two categories, one is blind minimally invasive treatment, which has no imaging equipment to guide the positioning, but only the doctor repeatedly punctures the face into the skull based on experience. Since the foramen ovale at the base of the skull is very small, only two or three millimeters, the doctor has to repeatedly try to puncture it many times and for a long time, and sometimes it is not even easy to succeed. During the trial puncture process, the surrounding tissues are damaged. This is the reason why blind treatment is more risky. The CT interventions used now are very precise due to the positioning and puncture under CT guidance. We are now able to place a single puncture in 50% of our patients, and the depth of the puncture needle inside the foramen ovale within the skull can be precisely controlled to within one millimeter. This makes the risk very small. 6.Do I need to take carbamazepine again after the surgery? In some patients, the nerve destruction effect will only appear after a few days after the surgery, during which the pain may be aggravated due to the edema of the nerve. There are also patients who do not have pain after surgery, but they cannot stop taking carbamazepine suddenly because they have been using it for a long time. If the drug is suddenly stopped, the patient will experience severe withdrawal symptoms, including irritability, panic, dizziness, and severe nausea and vomiting. For a large number of long-term drug patients in the postoperative period to gradually reduce the amount, and strive to stop the drug within a few days. 7.What are the problems to pay attention to after radiofrequency thermal coagulation? The first problem that needs attention after radiofrequency thermocoagulation is that the patient should be strictly bedridden for a certain period of time, because in the process of puncturing the semilunar nerve pool, there is cerebrospinal fluid outflow, plus the heating of the radiofrequency needle, the needle hole is not easy to close, and prematurely getting out of bed will cause rapid changes in cerebrospinal fluid pressure and excessive cerebrospinal fluid outflow, resulting in hypocranial pressure headache. Another issue that needs attention is the routine use of antibiotics after surgery to avoid intracranial infection. Because although the surgical trauma is small, it invades the skull after all, and if infection occurs bacteria will enter the ventricles with the cerebrospinal fluid, with very serious consequences.