title: [Treatment of trigeminal neuralgia: an update and future prospects of percutaneous techniques].
abstract: BACKGROUND
  Trigeminal neuralgia is one of the most severe facial pain syndromes. The annual incidence varies between 4-13% and has a significant effect on patients' quality of life. When the pain cannot be controlled by pharmacological treatment, several different surgical options can be considered. The choice of technique will be based on observational studies and its application depends on the experience of each centre.
  
  
  OBJECTIVE
  To assess the effectiveness and level of evidence of pharmacological and surgical treatment in trigeminal neuralgia, and to analyse the current role of percutaneous techniques in the treatment of this pathology.
  
  
  METHODS
  The initial treatment of trigeminal neuralgia is pharmacological and carbamazepine is the only drug with a sufficiently high level of evidence. The percutaneous surgical techniques are effective and easy to apply, but the tendency for relapses to appear means there is a preference for vascular microdecompression. Yet, there are no reports of comparative studies that determine the superiority of a technique with a good level of evidence. The three most commonly used percutaneous techniques, balloon compression, glycerol rhizotomy and thermocoagulation by radiofrequency, were reviewed. This last technique is the one that has undergone the greatest development in recent years, with the emergence of neurophysiological techniques that make it possible to optimise results.
  
  
  CONCLUSIONS
  The selection of a surgical technique for use in trigeminal neuralgia does not have much backing from randomised clinical trials. The new procedures in the application of radiofrequency can improve the treatment prospects of this pathology.
authors.affiliation: Hospital Universitari Joan XXIII de Tarragona, Tarragona, Espana.
authors.forename: Agustín
authors.initials: A
authors.lastname: Bescós
authors.forename: Vicenç
authors.initials: V
authors.lastname: Pascual
authors.forename: Marcos
authors.initials: M
authors.lastname: Escosa-Bage
authors.forename: Xavier
authors.initials: X
authors.lastname: Malaga
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D017115:Catheter Ablation; D004564:Electrocoagulation; D018755:GABA Agonists / Q000627:therapeutic use; D005990:Glycerol / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008959:Models, Neurological; D011183:Postoperative Complications; D016634:Radiosurgery; D019051:Rhizotomy; D012668:Trigeminal Ganglion / Q000601:surgery; D014277:Trigeminal Neuralgia / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*
chemical_list: D000927:Anticonvulsants; D018755:GABA Agonists; D005990:Glycerol