Systematic Review of Ablative Neurosurgical Techniques in the Management of Trigeminal Neuralgia

This paper is a review of the literature to discover the outcomes and complications of ablative treatments for trigeminal neuralgia. The four included procedures are:

1. Radiofrequency Thermocoagulation

2. Glycerol Rhizolysis

3. Balloon compression

4. Stereotactic Radiosurgery (gamma knife).

Pain Relief:

Radiofrequency provides the highest rates of sustained complete pain relief followed by radiosurgery. While effective, the benefits of glycerol decrease rapidly after 24 months and at 36 months is the least beneficial of the three techniques. Balloon compression has results similar to radiofrequency but there was not enough data to reach a conclusion.

Complications:

Sensory Loss: all patients treated with glycerol and radiofrequency have sensory loss if the procedure is done correctly. However, more than 30% of the radiofrequency patients and 50% of the radiosurgery patients have permanent sensory loss.

Complication rate (excluding sensory):

Radiofrequency: 29.2%

Glycerol: 24.8%

Balloon Compression: 16.1%

Radiosurgery: 12.1%

Stereotactic radiosurgery for primary trigeminal neuralgia

Pain outcome:

Typically takes one month to achieve the maximal level of pain relief.

Complete relief three months: 75%

Complete relief three years: of those who initially responded, 50% remained pain free

Complications:

Sensory disturbance is dose related and is 13% or less

Prognosis:

Most effective in those with typical rather than atypical TN who had no prior ablative procedures.

Stereotactic radiosurgery is the least invasive surgical treatment for TN.

Reviewed by Wm. Pat Marshall, M.D.

TNA Patient and member of the TNA Board of Directors

Updated 2-7-05