Which specialist consultations are beneficial to patients with trigeminal neuralgia (TN)?

Updated: Oct 23, 2019
  • Author: Mityanand Ramnarine, MD, FACEP; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Answer

Patients with a typical history and normal physical examination may be referred to their primary care physician for further care. Neurologic or neurosurgical consultations may be helpful, particularly if atypical features are present.

  • Referral to a neurologist may be helpful if the diagnosis is in doubt.

  • Referral to a neurosurgeon may be indicated for patients whose conditions prove refractory to medical treatment. Percutaneous radiofrequency ablation of a portion of the trigeminal ganglion is commonly performed, as are anesthetic blocks of the trigeminal ganglion. Gamma knife radiosurgery is used at some centers. [11] Less commonly performed is decompression of the region of trigeminal root entry of impinging vascular structures. An MRI of a patient who has undergone gamma knife surgery is shown below.

    MRI with high resolution on the pons demonstrating MRI with high resolution on the pons demonstrating the trigeminal nerve root. In this case, the patient with trigeminal neuralgia has undergone gamma-knife therapy, and the left-sided treated nerve (arrow) is enhanced by gadolinium.
  • Comprehensive pain center follow-up care may be helpful.


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