The variety of treatment options for trigeminal neuralgia (TN) reported in the literature reflects clinicians' dissatisfaction with the results of treatment of this severe disease. The search for new methods of treatment is going in two directions: by improving drug therapy through the introduction of new drugs and their combinations and through the development of new surgical techniques affecting the trigeminal nerve (TN) system. Each of the therapeutic methods of treatment is mainly aimed at only one of the links in the pathogenetic chain of trigeminal neuralgia development: either at increasing the threshold of excitability of sensitized neurons of the brain stem and cortex, or at switching off the trigger zone. The main link, where the pathological focus of demyelination (the site of neurovascular conflict) is formed, remains outside the sphere of influence of existing therapeutic methods. The need to improve therapeutic methods is also due to the fact that, in addition to primary TN patients, patients who have no conflict detected during microvascular decompression (MVD), in whom pain relapse occurred after successful MVD, in those cases when root compression by a vessel is detected, but for technical reasons it is impossible to perform safe repositioning of the vessel, when there are medical contraindications to general anesthesia, etc., need treatment.

Trigeminal neuralgia, treatment, paroxysm, corticosteroid, microvascular decompression, neurovascular conflict, brainstem, cortex.

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