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The incidence of trigeminal neuralgia is about 5/10. Generally elderly people are affected by the so called "essential" form, although an early onset is not infrequent in secondary forms. The etiopathogenesis as well as the efficacy of different surgical treatments are still unclear because of the lack of animal sperimental models and of randomized controlled clinical studies. Nevertheless the hypothesis of a vascular conflict as the main etiologic factor is generally accepted. According both to our experience and to the literature data, microvascular decompression in the cerebello-pontine-angle appears to be the best clinical option presenting the most advantageous cost-benefit balance. The use of percutaneous lesive techniques, even if effective, should be limited in consideration of the risk of developing neuropathic disturbances, sometimes more difficult to treat than the original pain.

The use of local anaesthesia has been advocated by most pediatric surgeons in order to cut down hospitalization costs as well as to avoid general anaesthesia. In 1992, 26 patients aged 4 to 14 years (avg. 8 years) underwent small surgical procedures with local anesthesia, obtained by the application of EMLA cream 60 to 120 minutes prior to the procedure. EMLA cream is aneutectic mixture of lidocaine and prilocaine with a meeting point at a lesser temperature than the two compounds separately. In this way, concentration of anaesthetics increases up to 80% in the emulsion droplets. This preparation enables small operations to be performed under local anesthesia even in small children who can be safely treated as outpatients. Disadvantages due to the long time necessary for optimal action can be overcome by application of the cream at home by the parents themselves.

Forty surgically proved gliomas have been studied by MR: 21 were low-grade gliomas and 19 were anaplastic astrocytomas and glioblastomas. The examination involved the use of T1-weighted (IR and/or SE, TR 500 ms, TE 50 ms) and T2-weighted scans (SE, TR 1000 ms, TE 50 with multiple echos). All patients underwent CT and surgical removal or stereotactic biopsy whose findings were retrospectively compared with those of MR. MR findings were similar in low-grade and anaplastic astrocytomas, but quite different from imaging of glioblastomas. Tumoral cyst and areas of necrosis were recognized on MR studies and confirmed by surgical findings. Differentiation between tumor and oedema was difficult. The MR images did not allow a more specific diagnosis of nature or of malignancy than available with CT up to now, but offer major advantages, such as a superior depiction of tumor extent and anatomic relationships.