Systematic Review of Ablative Neurosurgical Techniques for the Treatment of Trigeminal Neuralgia

Abstract

Radiofrequency thermocoagulation offers the highest rates of complete pain relief, although further data on balloon microcompression are required. It is essential that uniform outcome measures and actuarial methods be universally adopted for the reporting of surgical results. Randomized controlled trials are required to reliably evaluate new surgical techniques.

A prospective study of 39 patients with trigeminal neuralgia treated with percutaneous balloon compression

“…However the exact cause of TN remains unclear. When TN occurs in a young patient or when it is bilateral, the presence of demyelinating conditions such as multiple sclerosis should be investigated 5,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] . The goal of PBC is to injure the myelinated fibers that mediate the "trigger" for the lancinating pain of trigeminal neuralgia.…”

“…About 33 (84.5%) of the patients had mild to moderate postoperative hemifacial numbness (hypoesthesia) that gradually diminished with time and was well tolerated. This transient hypoesthesia usually can be considered as a side effect of PBC 10,23 . However, four patients had permanent hypoesthesia and, in these cases, hypoesthesia is considered to be a complication.…”

Percutaneous Balloon Compression for Trigeminal Neuralgias and Autonomic Cephalalgia

“…8 Since then, it has been used as one of the alternative therapeutic approaches combining high rate of efficacy (with 93-99% initial pain relief), easy performance, and generally low morbidity. 4,9 Corneal anesthesia and anesthesia dolorosa, which occurs with considerable frequency in other ablative techniques such as radiofrequency rhizotomy, 1,3,4 are rare with BC treatment. 4 Some authors consider that BC is the method of choice for patients with ophthalmic division involvement, whereas others recommend its use as the first line treatment in patients who are reluctant to have a major surgical operation such as microvascular decompression.…”

“…4,9 Corneal anesthesia and anesthesia dolorosa, which occurs with considerable frequency in other ablative techniques such as radiofrequency rhizotomy, 1,3,4 are rare with BC treatment. 4 Some authors consider that BC is the method of choice for patients with ophthalmic division involvement, whereas others recommend its use as the first line treatment in patients who are reluctant to have a major surgical operation such as microvascular decompression. 10 In line with the literature, our results suggest that BC is effective with lower incidence of complications.…”

“…These procedures range from open surgical procedures (vascular decompression of the trigeminal root in the brainstem) to percutaneous procedures (radiofrequency trigeminal rhizotomy, glycerol rhizolysis, balloon compression [BC], and stereotactic radiosurgery), which are more routinely used today. 3,4 Unlike TN, pain in TAC is often resistant to medical treatment (including anti-inflammatory drugs, lamotrigine, and corticosteroids). Surgical interventions for TAC have been described in only few reports in the literature 5,6 and no consensus about surgical options in these patients exists.…”