Efficacy of Neurectomy of Peripheral Branches of the Trigeminal Nerve in Trigeminal Neuralgia: A Critical Review of the Literature.

Abstract

Of the many chronic painful conditions, trigeminal neuralgia (TN) affecting the orofacial region needs the particular attention of physicians and surgeons, especially those specialising in the maxillofacial region. Treatment protocols for the management of classic TN include pharmacology and surgical intervention. Oral and maxillofacial surgeons have traditionally employed the peripheral neurectomy in the surgical management of TN. This review aims to evaluate the efficacy of peripheral neurectomy in the management of TN with regard to (a) the relief of symptoms in comparison with standard neurosurgical procedures and (b) the duration of pain relief and complications observed compared to standard neurosurgical procedures. The review of the literature was done according to PRISMA guidelines and included randomised controlled trials, reviews and prospective clinical studies involving surgical procedures for the management of TN. The primary outcomes evaluated were (a) initial relief of pain, (b) duration of relief of pain, (c) complications observed with ablative procedures and (d) recurrence of symptoms. A total of 43 studies fulfilled the inclusion criteria. In a total of 7913 patients from the 43 studies, central procedures were found to have best results for both quality and duration of pain relief. Percutaneous and peripheral procedures were associated with increased recurrence rates. The consolidated rates of complication for peripheral, percutaneous and central procedures were 39.46, 65.42 and 10.41%, respectively. The use of peripheral neurectomy alone in the management of classic TN was observed in 10 studies. Peripheral neurectomy in TN is associated with lesser quality of pain relief in comparison with central neurosurgical procedures. It also provides only short- to medium-term pain relief. Most studies with the use of peripheral neurectomy involved only a small group of patients with short follow-up periods. Oral and maxillofacial surgeons must not consider the peripheral neurectomy as the first surgical option in the management of classic TN. Long-term results can be achieved better with appropriate central neurosurgical procedures and pharmacotherapy.