Bilateral Trigeminal Neuralgia: A Multi-Therapeutic Approach to Pain Management

Understanding Bilateral Trigeminal Neuralgia: Trigeminal neuralgia (TN) is characterized by intense facial pain, often triggered by routine activities like eating or speaking. When the condition affects both sides of the face, it is classified as bilateral TN, making treatment even more complex.

Study Highlights and Key Findings:

  • A 62-year-old female patient with multiple sclerosis and BTN had been experiencing pain refractory to medical therapy.
  • A tailored, multi-step treatment approach was employed, including:
    • Radiofrequency Thermocoagulation: Immediate pain relief was achieved for the right third trigeminal division.
    • Radiosurgery: Used to target the left hemifacial side, reducing pain over time.
    • Peripheral Alcohol Injection: Applied to the left second trigeminal division after radiosurgery for additional pain management.
  • The patient achieved long-term pain control and was able to discontinue medical therapy.

Clinical Implications: BTN requires a strategic approach to avoid bilateral sensitivity deficits. Neurosurgeons must assess each case individually, considering patient-specific factors such as age, overall health, and comorbidities like multiple sclerosis. The multi-therapeutic approach provides a viable alternative to invasive surgeries.

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