Modern Concepts and Evidence Base in Trigeminal Neuralgia

The understanding of trigeminal neuralgia has undergone a remarkable refinement in recent years. Central to this evolution is the reclassification of TN subtypes based on etiology: Classical trigeminal neuralgia—now firmly defined as neuralgia due to vascular compression of the trigeminal nerve—has been distinguished from secondary forms caused by other pathology, and from idiopathic forms likely rooted in genetic or intrinsic factors. This clear etiological framework, grounded in robust clinical, imaging, and pathophysiological evidence, is transforming patient care through more precise diagnosis and targeted treatment strategies.

Building on this foundation, in this special issue, we welcome reviews and original research addressing two synergistic domains:1） Clinical innovations— including microvascular decompression, radiofrequency thermocoagulation, and radiosurgery— implemented with rigorous diagnostic criteria; and 2) Mechanistic explorations— studies exploring the fundamental mechanisms of trigeminal neuralgia, such as spanning demyelination dynamics, ion channelopathies, and neuroimmune cross-talk— that elucidate fundamental pain pathways and treatment resistance.

Through this special issue, we aim to consolidate the modern evidence base, bridging mechanistic insights with therapeutic advances. Contributions addressing diagnostic challenges in atypical presentations or predictors of treatment response are particularly encouraged. Whether reinforcing or challenging current paradigms, these contributions aim to advance both our scientific understanding and our clinical practice in this evolving field.