A multidisciplinary trigeminal neuralgia clinic offers an opportunity for shared decision-making with patients deciding on their personal care pathway which is valued by patients. Not all patients opt for surgery, and some continue to attend a multidisciplinary follow-up program. Providing a full range of services including psychological support improves outcomes 1).
Carbamazepine and oxcarbazepine continue to be first choice for Trigeminal neuralgia medical treatment, but have been supplemented by additional options such as pregabalin, lamotrigine, and Onabotulinum toxin A. In patients insufficiently responding to medical treatment, there are neurosurgical treatment options giving very good results. The best long-term results have been described for microvascular decompression, but percutaneous and radiosurgical treatments also are good options, especially in patients with an increased surgical risk profile, in secondary trigeminal neuralgia, and in case of recurrence after microvascular decompression 2).
Blockade of the Gasserian ganglion or its branches is an effective analgesic procedure for trigeminal neuralgia, traditionally performed using fluoroscopy or CT imaging. Ultrasonography allows point of care and real-time visualization of needle placement within the surrounding anatomical structures.