• Alfio Spina, Pietro Mortini, Federica Alemanno, Elise Houdayer, and Sandro Iannaccone.
• Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy. Electronic address: spina.alfio@hsr.it.
• World Neurosurg. 2017 Jul 1; 103: 220-230.

ObjectivesTrigeminal neuralgia (TN) is the most common cranial neuralgia in adults, with a slight prevalence in women. Antiepileptic drugs represent the mainstay of the medical treatment, whereas microvascular decompression is the best option in case of neurovascular conflict. Although these treatments showed a good rate of efficacy, they can be contraindicated in some patients and >50% of patients undergoing these treatments will present recurrence of pain in the following months. In this majority of patients, pain becomes chronic and can severely affect their quality of life and cause cognitive disturbances, such as anxiety and depression.MethodsThe purpose of this study was to review the efficacy and safety of current treatment modalities for TN, as well as to propose a multimodal approach for those patients presenting with a chronic form of TN.ResultsCurrent treatment modalities have been reviewed. Actual pain evaluation systems and the neuropsychologic features of TN have been analyzed in order to propose an alternative treatment algorithm.DiscussionChronic pain can also lead to the misperception of patients' own selves leading to enhanced pain perception and altering therapeutic outcomes. Thus, there is the need to define a personalized multimodal approach of treatment, taking into account other available TN therapies and the neuropsychologic aspect of chronic pain.Copyright © 2017 Elsevier Inc. All rights reserved.

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