<p>Value of Partial Sensory Rhizotomy in the Microsurgical Treatment of Trigeminal Neuralgia Through Retrosigmoid Approach</p>

Abstract

Purpose: Microvascular decompression (MVD) is the most effective surgical procedure for the treatment of refractory primary trigeminal neuralgia (TN), but due to the presence of nonneurovascular compression (NVC), the application of MVD is limited. In some cases, partial sensory rhizotomy (PSR) is required. The purpose of this study was to compare the outcome of MVD and MVD+PSR in the treatment of primary TN and to evaluate the application value of PSR in the treatment of TN. Patients and Methods: We retrospectively analyzed the postoperative outcomes of patients who received MVD or MVD+PSR for the first time from the same surgeon in the neurosurgery department of China-Japan Friendship Hospital from March 2009 to December 2017. A total of 105 patients were included in the data analysis, including 40 in the MVD group and 65 in the MVD+PSR group. Results: The MVD group had an effectiveness rate of 60% and a recurrence rate of 31.4% after an average follow-up of 49.4 months. The MVD+PSR group had an average effectiveness rate of 69.2% and a recurrence rate of 28.6% after an average follow-up of 71.4 months. There was no statistically significant intergroup difference in long-term effectiveness (p=0.333) or recurrence rates (p=0.819). The incidence of facial numbness was significantly higher in the MVD+PSR group than in the MVD group (83.1% vs 7.5%; p<0.001). However, facial numbness had no significant effect on the patients' daily life. Conclusion: MVD+PSR and MVD have the same effectiveness in the treatment of primary TN. MVD+PSR is associated with a higher incidence of facial numbness than MVD, but the difference does not affect the patients' daily life. PSR should have a place in the treatment of TN by posterior fossa microsurgery.

Very early re-do microvascular decompression for patients with trigeminal neuralgia

“…Although some investigators have proposed partial sensory rhizotomy as alternative treatment with satisfactory pain control, more than 80% of patients experienced facial numbness. 17,18 Also about 90% of patients suffered from facial numbness after MVD combined with internal neurolysis. [19][20][21] Complications could also impact the life quality of the patients.…”

Clinical Effect of Partial Sensory Root Rhizotomy on Recurrence of Multiple Sclerosing Trigeminal Neuralgia After Percutaneous Balloon Compression

“…The follow-up effect was good. Yin Liu [19] believe that in the postmenstrual fossa MVD surgery, there is no obvious vascular compression, the decompression effect is not satisfactory, and the patient's age is more than 60 years old. It is appropriate to adopt PSR surgery, and its effective rate is the same as that of MVD.…”

Trigeminal Neuralgia: Current Approaches and Emerging Interventions

“…For these patients, posterior fossa exploration with internal neurolysis of the trigeminal nerve by separating nerve fascicles via microsurgical techniques may provide pain relief. 263,[270][271][272] Pain-free outcomes for partial sensory rhizotomy are similar to slightly worse than those for MVD patients, although patients undergoing partial sensory rhizotomy are more likely to experience postoperative sensory complaints, presumably due to direct internal neurolysis of the nerve. 258,273,274 Intraoperative glycerin rhizotomy has also been described for patients without vascular compression.…”