Treatment of trigeminal neuralgia: Surgical

Abstract

Abstract When patients with trigeminal neuralgia can no longer achieve adequate pain relief and quality of life becomes poor, surgical procedures need to be considered. There is a lack of high-quality evidence to support surgical treatments so all the recommendations are based on low-grade evidence of prospective or retrospective series. Microvascular decompression, a neurosurgical operation, is the procedure of choice in patients with primary trigeminal neuralgia who have evidence of neurovascular compression of the trigeminal nerve on magnetic resonance imaging. Long-term pain relief of 10 years can be achieved with minimal long-term complications. All the other procedures, including stereotactic radiosurgery, balloon compression, glycerol rhizolysis, and radiofrequency thermocoagulation, are destructive and are suitable for patients who are poor candidates for microvascular decompression including those with significant medical comorbidities. They will result in varying sensory loss and pain relief on average for 4 years. Patients should be made aware of the range of options open to them and the pros and cons of each procedure.