Bilateral trigeminal neuralgia: a therapeutic dilemma

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.