The Surgical Treatment of Trigeminal Neuralgia

Abstract

Trigeminal Neuralgia is a clinical presentation of different diseases, defined in the last edition of the International Classification of Headache Disorders (ICHD-3) as "Classical Trigeminal Neuralgia" and "Painful Trigeminal Neuropathy". In both groups typical and atypical clinical findings are present. They must be taking into consideration for defining a correct clinical diagnosis. In addition MRI findings and other objective signs allow to disclose the Etiology of the Trigeminal Neuralgia. Looking at the Literature reports and at our own experience, techniques, results, and indications of microvascular decompression, radiofrequency thermocoagulation, glycerol rhizolysis, balloon microcompression, and sterotactic radiosurgery of the trigeminal root are reported and discussed.

Trigeminal neuralgia recurrence: a comparison of microvascular decompression and percutaneous balloon compression: a five years follow-up study

“…When medical treatment fails, surgical options such as percutaneous procedures, stereotactic radiosurgery and microvascular decompression (MD) should be considered. Percutaneous techniques include percutaneous rhizotomy by radiofrequency, which consists on a thermal injury of the trigeminal ganglion; balloon compression, characterized by a mechanical lesion of the ganglion; and percutaneous rhizotomy with glycerol, which provokes demyelination and axonal fragmentation of pain fibers through a chemical lesion 6,7,8,9 . Gamma knife surgery, a destructive procedure as well, consists on a focused beam of radiation that is aimed at the trigeminal root in the posterior fossa 10 .…”

Impact of combining pulsed and thermal radiofrequency on long-term therapy of idiopathic trigeminal neuralgia: A prospective study

“…Despite numerous available approaches, the results are not completely satisfying. Pain treatment in patients with idiopathic TN is a challenge in clinical practice [2,4,6].…”

“…Interventional therapy for TN is either destructive with trigeminal nerve sensory function destroyed intentionally or non-destructive with decompression of the trigeminal nerve and preservation of its regular function [4]. The most common procedures in treating TN pain are the use of radiofrequency (RF).…”