Management of trigeminal neuralgia in sclerosteosis
A 28-year-old woman started her symptoms at the age of 1. Initially she presented an episode of right facial palsy that evolved with spontaneous remission after 3 months. After 1 year, she had new-onset facial palsy that affected her left facial side, with complete resolution after 3 months. Over the next years, she experienced recurrent facial palsies and suffered from several headaches. A generous bilateral bifrontotemporal decompressive craniectomy was then performed to treat the symptoms of raised ICP that improved after the surgical procedure [].\nAt the age of 21, the patient was diagnosed with sclerosteosis and TN in the right V2 and V3 distributions. The patient was primarily treated with carbamazepine and gabapentin until presented with an adverse reaction, before being considered for surgery. She underwent a PBC for treatment of the right facial pain in 2007. After surgery, the patient had an immediate and complete resolution of her V2 and V3 pain but experienced right facial numbness in these trigeminal distributions. After 3 years, the pain recurred with the same intensity and a new PBC was performed. She was again placed on medical therapy with carbamazepine and the pain improved in the immediate postoperative period.\nAfter 2 years, in 2012 the pain recurred with the same initial characteristics and another PBC was performed []. Postoperatively, the patient was free of pain and the distribution of facial numbness was unchanged. The patient was able to stop taking any pain medication within 3 weeks after surgery. Six months after surgery, she continued to be free of facial pain. It is important to note, similar do case 1, the increasing difficulty of the foramen ovale puncture over the years due to its stenosis.