Problems of tic douloureux (trigeminal neuralgia) management.

A review of experience with the management of tic douloureux (trigeminal neuralgia) at Groote Schuur Hospital from 1948 to 1972 shows that thermocoagulation, fractional section of the Gasserian ganglion and phenol injection were the methods most frequently used. After 1972, carbamazepine was found to be an effective treatment but follow-up was difficult. The alternative surgical treatments of posterior fossa exploration of the trigeminal nerve for release of vascular compression and radiofrequency coagulation of the Gasserian ganglion are discussed. Since 1979 radiofrequency coagulation of the Gasserian ganglion has been employed when carbamazepine has failed. The technique and results are described.