Trigeminal neuralgia is a transient, recurrent, severe pain that occurs in the distribution area of the trigeminal nerve. It is divided into two categories: primary and secondary. The former is of unknown etiology; the latter is caused by inflammation, trauma, tumor, vascular disease, etc. It often starts after the age of 40 and is more common in women. As the advertisements for the treatment of trigeminal neuralgia are everywhere, patients know little about the formal treatment of trigeminal neuralgia, which causes patients to be deceived and suffer from pain from time to time. So, what are the treatment methods for trigeminal neuralgia? Drug treatment 1, carbamazepine: effective for pain relief in 70% of patients, but about 1/3 of patients cannot tolerate its side effects such as drowsiness, vertigo and digestive discomfort. Start with 2 times a day, later it can be 3 times a day. 0.2-0.6g daily, divided into 2-3 doses, with an extreme daily dose of 1.2g. 2. Phenytoin sodium: less effective than carbamazepine. Surgical treatment 1. Trigeminal nerve and semilunar ganglion closure surgery is performed by injecting drugs that act directly on the trigeminal nerve to denature it and cause conduction block, which can relieve pain. The commonly used closure drugs are anhydrous alcohol and glycerin. Peripheral branch closure is simple to perform, but the effect is not long lasting, usually lasting 3-8 months, rarely more than 1 year. The operation of meniscal closure is relatively complex, can cause neurokeratitis and other complications, the total efficiency of 72-99%, early recurrence rate of 20%, 5-10 years recurrence rate of 50%. 2, meniscal ganglion percutaneous radiofrequency thermal coagulation therapy is a safe, simple, patient-friendly treatment method, the efficacy of up to 90%. The rationale is that the nociceptive fibers within the trigeminal nerve can be selectively destroyed, while preserving the tactile fibers. It is performed by inserting a radiofrequency needle electrode into the semilunar ganglion under X-ray or CT guidance, energizing it and gradually heating it to 65-75 degrees to destroy the target site for 60 seconds. This method is suitable for patients who cannot or refuse open surgery due to their advanced age.3. Microvascular decompression MVD surgery is currently the preferred surgical treatment for primary trigeminal neuralgia. The indications for surgery include: those who are confirmed to have vascular compression of trigeminal nerve by imaging examination; those who are willing to accept surgery due to poor effect of other treatments; the vessel that compresses trigeminal nerve and produces pain is called the “responsible vessel”. (1) Superior cerebellar artery (75%), the superior cerebellar artery can form a vascular loop that extends caudally and is in contact with the trigeminal nerve at the brainstem, mainly compressing the nerve root above or above the medial side. (2) The anterior inferior cerebellar artery (10%), which generally compresses the trigeminal nerve from below, may also form a clamping compression on the trigeminal nerve together with the superior cerebellar artery. (3) Basilar artery, with age and hemodynamic effects, the basilar artery may bend to both sides and compress the trigeminal nerve root, generally more bent to the side of the thinner vertebral artery. (4) Other rare responsible vessels include posterior inferior cerebellar artery, variant vessels (such as permanent trigeminal artery), transverse cerebral pontine vein, lateral veins and basilar plexus. The responsible vessel can be one or multiple, and can be either an artery or a vein. Microvascular decompression is performed by making a 4 cm longitudinal incision behind the affected ear and within the hairline under general anesthesia, making a cranial opening of approximately 2 cm in diameter, entering the pontocerebellar horn region under a microscope, exploring the trigeminal nerve pathway, “loosening” all possible compressive vessels and arachnoid cords, and isolating these vessels with Once the responsible vessels are isolated, the source of irritation disappears and the hyperexcitability of the trigeminal nucleus disappears and returns to normal. In the vast majority of patients, the pain disappears immediately after surgery and normal facial sensation and function are preserved without affecting the quality of life.