1. A 16-year-old female presents to the office with recurrent episodes of right facial pain, primarily located around the right eye and the right cheek. The pain feels like an electric shock, is of severe intensity, and lasts for only a few seconds at a time. It can be aggravated by activities such as chewing, brushing her teeth, or even talking. Over the last few days, she has noticed that, apart from the recurrent paroxysms of pain, she experiences a mild baseline pain on the right side of her face. Based on this information, what is the likely diagnosis?
2. You have a 15-year-old patient who suffers from recurrent paroxysms of shooting pain in the trigeminal nerve distribution, raising concern for trigeminal neuralgia. The patient reports that symptoms began immediately after a mild head-to-head injury with another child at school. There was no loss of consciousness following the incident. You are concerned about idiopathic trigeminal neuralgia. What is the next best step in evaluation and management? (Multiple options may be correct.)
MRI/MRA identifies a vascular ring noted from the superior cerebellar artery around the right trigeminal nerve. However, there is no direct or indirect radiological evidence of neurovascular compression, such as morphological changes in the nerve or signs of nerve root atrophy or enhancement. What is the next step in management?
If the patient does not respond to medical management, what is the safest surgical technique?
