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Review
. 2024 Dec 12;25(1):10.
doi: 10.1007/s11910-024-01387-2.

Pathophysiology and Management of Refractory Trigeminal Neuralgia

Jennifer I Stern  1 , Rushna Ali  2 , Chia-Chun Chiang  1 , Carrie E Robertson  3
Affiliations
Review

Pathophysiology and Management of Refractory Trigeminal Neuralgia

Jennifer I Stern et al. Curr Neurol Neurosci Rep. .

Abstract

Purpose of review: Discuss the current understanding of the pathophysiology and management of refractory trigeminal neuralgia (TN). This includes a discussion on why TN can recur after microvascular decompression and a discussion on "outside of the box" options when both first- and second-line management strategies have been exhausted.

Recent findings: This review discusses second- and third-line oral medication options, botulinum toxin A, repeat microvascular decompression, repeat ablative procedures, internal neurolysis, trigeminal branch blockade, and neuromodulation using TMS or peripheral stimulation. Additional management for chronic neuropathic facial pain such as deep brain stimulation, motor cortex stimulation, and focused ultrasound thalamotomy are also discussed, though evidence in trigeminal neuralgia is limited. Treatment of recurrent TN despite multiple surgeries can be challenging, and multiple minimally invasive and more invasive management options have been reported in small studies and case reports. Further studies are needed to determine an optimal stepwise approach.

Keywords: Facial pain; Microvascular decompression; Refractory; Trigeminal ganglion; Trigeminal neuralgia; Trigeminal neuropathy.

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Conflict of interest statement

Declarations. Human and Animal Rights and Informed Consent : This article does not contain any studies with human or animal subjects performed by any of the authors. Competing Interests: The authors declare no competing interests. Statements and Declarations: Dr. Stern is a shareholder in Emmyon, Inc., which has no relevance to any portion of the manuscript. Dr. Chiang has served as a consultant for Satsuma pharmaceuticals and eNeura. She has received research support from the American Heart Association, with funds paid to her institution. Dr Ali has no disclosures. Dr. Robertson has served on an advisory board for Satsuma and Linpharma pharmaceuticals. She has received research support from Pfizer, Lundbeck, and Teva, with funds paid to her institution.

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