J Korean Neurosurg Soc.  2007 Jun;41(6):359-366.

Surgical Management Options for Trigeminal Neuralgia

Affiliations
  • 1Departments of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, USA. lunsfordld@upmc.edu

Abstract

Trigeminal neuralgia is a condition associated with severe episodic lancinating facial pain subject to remissions and relapses. Trigeminal neuralgia is often associated with blood vessel cross compression of the root entry zone or more rarely with demyelinating diseases and occasionally with direct compression by neoplasms of the posterior fossa. If initial medical management fails to control pain or is associated with unacceptable side effects, a variety of surgical procedures offer the hope for long-lasting pain relief or even cure. For patients who are healthy without significant medical co-morbidities, direct microsurgical vascular decompression (MVD) offers treatment that is often definitive. Other surgical options are effective for elderly patients not suitable for MVD. Percutaneous retrogasserian glycerol rhizotomy is a minimally invasive technique that is based on anatomic definition of the trigeminal cistern followed by injection of anhydrous glycerol to produce a weak neurolytic effect on the post-ganglionic fibers. Other percutaneous management strategies include radiofrequency rhizotomy and balloon compression. More recently, stereotactic radiosurgery has been used as a truly minimally invasive strategy. It also is anatomically based using high resolution MRI to define the retrogasserian target. Radiosurgery provides effective symptomatic relief in the vast majority of patients, especially those who have never had prior surgical procedures. For younger patients, we recommend microvascular decompression. For patients with severe exacerbations of their pain and who need rapid response to treatment, we suggest glycerol rhizotomy. For other patients, gamma knife radiosurgery represents an effective management strategy with excellent preservation of existing facial sensation.

Keyword

Microvascular decompression; Trigeminal neuralgia; Gamma knife radiosurgery; Glycerol rhizotomy

MeSH Terms

Aged
Blood Vessels
Decompression
Demyelinating Diseases
Facial Pain
Glycerol
Hope
Humans
Magnetic Resonance Imaging
Microvascular Decompression Surgery
Radiosurgery
Recurrence
Rhizotomy
Sensation
Trigeminal Neuralgia*
Glycerol
Full Text Links
  • JKNS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr