A new conservative surgical treatment for trigeminal neuralgia: ?Phenol root-painting?

Abstract

The most widely accepted surgical procedure for the treatment of trigeminal neuralgia is section of the root fibres, either carried out by the posterior approach, advocated by Dandy, or by _Frazier's temporal approach.Section of the fibres, in spite of its disadvantages, has stood the test of time because it has been proved beyond doubt, to be really effective in obtaining relief for patients suffering from tic douloureux. Nevertheless, many other surgical procedures have been described, each attempting to achieve the perfect method.Division of the fibres gives permanent relief in most eases. But this certainty in achieving relief is off set by the possibility of complications such as keratitis with loss of vision, lesions of the motor root, painful paraesthesiae and anaesthesia dolorosa. The frequency of these complications, above M1 the risk of keratitis, is diminished with partial section of the fibres, leaving the inner part of the root spared. However, the number of relapses is increased with partial section. Recurrent pain may then be due either to leaving too many fibres intact in the blind attempt to preserve the first division, or less probably to spread of the neuralgia to the remaining fibres.The complications mentioned above, although serious are only occasional, but we particularly want to emphasize the complete sensory loss which is inevitab!e and emmet be regarded as a complication. We think that this consequence is often underestimated by neurosurgeons, but in our experience patients do not tolerate a total lack of sensation in the face well, and some of them, especially those with introspective personalities, say that they would not have agreed to the operation if they had realized that they would have this sensory loss for the rest of their lives.We will here present a comparative and critical study of the technique of "phenol root-painting" and other conservative procedures aimed at stopping the pain without producing mechanical interruption of the fibres, and thereby preserving sensation in the face.