The present article gives an update of relevant aspects in the diagnosis and therapy of trigeminal neuralgia from the neurological, neuroradiological and neurosurgical point of view. The diagnosis of trigeminal neuralgia is clinical, but high-quality imaging is mandatory to identify secondary causes and a neurovascular contact. New methods such as DTI (diffusion tensor imaging) allow a more differentiated assessment of the consequences of a vascular contact on the trigeminal nerve. Carbamazepine and oxcarbazepine continue to be first choice for the medical treatment, but have been supplemented by additional options such as pregabaline, lamotrigine, and onabotulinumtoxin 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.

中文翻译：

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三叉神经痛

本文从神经学、神经放射学和神经外科的角度对三叉神经痛诊断和治疗的相关方面进行了更新。三叉神经痛的诊断是临床的，但必须进行高质量的影像学检查以确定继发性原因和神经血管接触。DTI（弥散张量成像）等新方法允许对血管接触对三叉神经的后果进行更加差异化的评估。卡马西平和奥卡西平仍然是药物治疗的首选，但辅以普瑞巴林、拉莫三嗪和肉毒杆菌毒素 A 等其他选择。对于药物治疗反应不足的患者，有神经外科治疗选择，效果非常好。