Abstract
The patient was a 73-year-old female with a chief complaint of right oral pain during eating. The pain could not be closely evaluated because of difficulty in communication due to her past medical history of subarachnoid hemorrhage. The cause could not be identified by computed tomography or magnetic resonance imaging, but neuralgia of the third branch of the right trigeminal nerve was suspected based on the course. Oral drugs and a nerve block were administered, but evaluation of the effect of each treatment was difficult. Because the pain was intractable, craniotomy was performed on a trial basis. Two arteries contacted the trigeminal nerve, for which microvascular decompression was applied, and it was markedly effective. Reflecting on this case, we should evaluate pain by formalizing physical expressions, such as facial expressions, for patients with communication difficulty. Even though no cause may be observed on imaging, it is suggested to perform a craniotomy on a trial basis for patients with intractable trigeminal neuralgia.
