Trigeminal neuralgia is a common clinical condition, mostly seen in middle-aged and elderly people, especially in people with atherosclerotic hypertension and diabetes mellitus. It is very difficult to cure and the pain is very severe and affects daily life. Due to the lack of adequate medical knowledge and medical information, most patients often seek medical treatment blindly, which makes it difficult to get timely and correct treatment, and not only delays the disease, but also causes loss of confidence in disease treatment due to repeated ineffective treatment, in fact, most patients are still suffering from pain. In order to let the majority of patients understand the knowledge about trigeminal neuralgia and get rid of the pain as soon as possible. The main manifestations of trigeminal neuralgia The trigeminal nerve, as its name implies, includes three branches, namely the ophthalmic nerve, the maxillary nerve and the mandibular nerve. Pain can occur in one or more branches. Ophthalmic neuralgia is distributed in the frontal and parietal regions; maxillary neuralgia is distributed in the cheek region below the fissure of the eye and above the corner of the mouth; mandibular neuralgia is distributed in the cheek region below the corner of the mouth. The most characteristic feature of trigeminal neuralgia is the pain in the face, which comes and goes without aura, like lightning, and the pain is severe and unbearable, like cutting, burning, needling or electric shock, and there are often particularly sensitive areas in the upper lip, corners of the mouth, nose, palate or buccal mucosa (medically called “trigger points or board points”). In order to prevent painful attacks, patients are often afraid to talk, eat, brush their teeth and wash their faces, which seriously affects their daily life. Trigeminal neuralgia can be caused by many reasons, and can be divided into primary trigeminal neuralgia and secondary trigeminal neuralgia according to the different causes. Secondary trigeminal neuralgia refers to trigeminal neuralgia caused by organic diseases. Common causes include trigeminal radiculitis, skull base arachnoiditis, skull base malformation, skull base tumor (cholesteatoma, meningioma, trigeminal neuroma), etc. Primary trigeminal neuralgia refers to trigeminal neuralgia of unknown etiology, which is also the most common type in clinical practice. However, it was later found that most of this trigeminal neuralgia is caused by compression of intracranial blood vessels, and the pain can be relieved by decompression of blood vessels, so some people also classify trigeminal neuralgia caused by blood vessel compression as secondary trigeminal neuralgia. In conclusion, according to the current examination methods, the cause of most trigeminal neuralgia can be clarified, which makes the radical treatment of trigeminal neuralgia possible. Diagnosis of trigeminal neuralgia The effective treatment of any disease depends on the correct diagnosis. Similarly, before choosing a treatment method, it must be clear whether this facial pain is really trigeminal neuralgia and what the cause of the pain is. Otherwise, it is easy to seek medical treatment in a hurry and eventually not get satisfactory results. The diagnosis of trigeminal neuralgia is mainly based on the typical clinical manifestations: a short, sharp, lightning-like and severe pain in the face, not daring to press with the hand during the pain attack, or even not daring to wash the face, shine the teeth, speak or eat in order to prevent the pain from attacking. Based on these characteristics, it is easy to distinguish migraine, cervical spine headache, tension headache, headache caused by oral and five sensory diseases. For example, migraine is a throbbing headache that occurs in the head and face, with a predominantly distending pain, a long duration of each attack, ranging from minutes, hours or days, and often accompanied by nausea and vomiting in severe cases. All odontogenic pains have clear dental disease, the pain episodes are clearly related to the activity of the teeth, and an oral examination can make a clear diagnosis. Paranasal sinusitis, for example, can also cause facial pain, although this pain is often persistent and patients have a history of paranasal sinusitis, and the pain mostly does not interfere with face washing, tooth shining, speech, or eating. Before treatment, the cause of trigeminal neuralgia also needs to be clarified. Currently, it is mainly based on MRI. Conventional MRI can clarify the presence or absence of cholesteatoma, meningioma, trigeminal neuroma, auditory neuroma, etc., but cannot show vascular compression, while 3D TOF MRI can clearly show the presence or absence of vascular compression, and can even suggest the origin of blood vessels. Therefore, detailed MRI is required before treatment. Trigeminal neuralgia treatment choice The evaluation of a treatment method is mainly based on the following points: (1) the cure rate of the disease, after treatment, the patient is completely back to normal and does not need to receive any further treatment measures, the higher the cure rate, the better; (2) the recurrence rate of the disease, that is, the probability of the disease reoccurring within a certain period of time, the lower the recurrence rate, the better; (3) the incidence of complications, that is, the probability of complications due to receiving treatment, the better; (4) the incidence of complications, the better. The lower the recurrence rate, the better; (3) the incidence of complications, that is, the probability of complications arising from the treatment received, of course, the fewer the complications, the better. As far as trigeminal neuralgia is concerned, there are various treatments available in the clinic, and large and small propaganda reports all glorify it as the best treatment plan, so it is really hard to distinguish the truth from the falsehood as a non-medical professional, and it is also hard to choose the suitable treatment for yourself. Here is a brief introduction to some of the main treatment measures that exist in clinical practice. Trigeminal neuralgia treatment measures are usually divided into two categories: 1, etiological treatment: the main purpose of treatment is to remove the real cause of trigeminal neuralgia, so this treatment measure is expected to obtain a cure, but the premise of this treatment is that the cause of trigeminal neuralgia has been clarified, so it is mainly applied to secondary trigeminal neuralgia with clear etiology, such as posterior cranial fossa cholesteatoma, meningioma or trigeminal neuroma 2, symptomatic treatment: that is, mainly for the treatment of the pain symptoms themselves, such as oral analgesic drugs carbamazepine (Deltamethrin), wild papaya, phenytoinamide, depigmentation tablets, Sanli pain, etc., Chinese medicine, herbal medicine, acupuncture, physiotherapy, massage, drug local closure, radiofrequency thermal coagulation therapy, gamma knife radiation therapy, etc. All these treatments may provide temporary relief of pain, but since the cause of the pain is not removed, the patient is unlikely to obtain a cure, and recurrent attacks of pain and repeated treatments are inevitable. For example, when the pain is mild, you can choose symptomatic treatment, when the patient is too old to undergo surgery, and when the patient is generally well and the pain is severe, you can choose etiologic treatment to cure the disease completely. Since more than 90% of trigeminal neuralgia is caused by vascular compression, microvascular decompression is the treatment that can cure the disease while preserving the function of the trigeminal nerve, so the following is the most clinically used treatment technique, microvascular decompression. The principle, efficacy, advantages and risks of microvascular decompression The principle of microvascular decompression: the long-term compression of the trigeminal nerve root by blood vessels can lead to demyelination of the nerve root, resulting in pain. Therefore, this is a treatment method that targets the cause of the disease and is expected to completely cure trigeminal neuralgia. Efficacy of microvascular decompression: the treatment effect of trigeminal neuralgia is divided into four types: immediate complete relief (the pain is completely relieved immediately after the surgery), delayed complete relief (the pain is not immediately relieved after the surgery, but is gradually reduced over a period of time, but eventually can be completely relieved), significant relief (the pain level can be significantly reduced after the surgery, and the amount of oral analgesic drugs is significantly reduced) and ineffective. Overall, the probability of complete pain relief after microvascular decompression is over 90%, the probability of effective is over 95%, and the probability of ineffective is less than 2%, which is the most effective treatment option compared with other treatment measures. The long-term efficacy of microvascular decompression is also good, with a cure rate of over 85% and an effective rate of over 92% at 5 years after surgery, and a cure rate of over 80% and an effective rate of over 90% at 10 years after surgery. Advantages and risks of microvascular decompression surgery: Although many patients are desperate to cure the disease because of severe pain, they are always worried and afraid at the mention of surgery, always thinking that the surgery will open the skull and “they will have to make an incision inside the brain”, and eventually they often dare not receive surgical treatment, especially for patients with relatively mild symptoms. In fact, microvascular decompression surgery for trigeminal neuralgia is a very mature surgical technique that has been in clinical use for more than 60 years, and the surgery is not performed inside the brain, but in the subarachnoid space between the brain tissue and the skull, so the risk of surgery is quite low. Especially in recent years, the application of minimally invasive surgical techniques has not only significantly improved the surgical efficacy, but also greatly reduced the risk of surgery, and microvascular decompression surgery has become the current international preferred solution for the radical treatment of trigeminal neuralgia. Its greatest advantages are treatment for the cause, high rate of complete cure and efficiency of pain, low recurrence rate, few complications, and the hope of preserving the normal function of the trigeminal nerve after surgery. Of course, microvascular decompression is not without any risk, the size of the risk depends on the number and thickness of the compressed vessels and the relationship between the vessels and the nerve roots. The greater the number of compressed vessels, the thicker the vessels, and the heavier the adhesions between the vessels and nerve roots are the main factors that increase the risk of surgery. Therefore, detailed pre-surgical evaluation, early surgical treatment and skillful surgical technique are the keys to improve surgical efficacy and reduce surgical risk.