In order to illustrate the inherent problems of managing bilateral trigemin
al neuralgia a retrospective study of the 16 cases of bilateral trigeminal
neuralgia, out of just over 300 cases of trigeminal neuralgia, treated over
a 14-year period, has been performed. All the patients, presented with a t
ypical history of trigeminal neuralgia and underwent surgical exploration.
Pain relief was initially achieved in all cases; however, only four remaine
d cured, three have become pain free after additional rhizotomy, a further
one after peripheral cryotherapy and four with medical treatment. Four pati
ents have had bilateral operations for trigeminal neuralgia, but in two cas
es the pain was relieved on one side only. Bilateral trigeminal neuralgia p
resents special problems of management with respect to underlying neuropath
ology (e.g. multiple sclerosis), the need for the limitation of the use of
ablative techniques in order to minimise the disability of bilateral sensor
y and motor dysfunction, and the relatively poor response to microvascular
decompression. These factors emphasize the multifactorial nature of the cau
se of trigeminal neuralgia. Magnetic resonance tomographic angiography is n
ow available and is important in determining the range of therapeutic optio
ns for this group of patients.