The Surgical Treatment of Trigeminal Neuralgia

Sergio Zeme

doi:10.4172/2167-0846.s4-006

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. The surgical treatment offers many options: open surgery in posterior fossa, neuroablative procedures on the trigeminal nerve, neuromodulation techniques on the trigeminal pathways. Open surgery and neuroablative procedures are the treatments chosen in Classical Trigeminal Neuralgia and in Painful Trigeminal Neuropathy showing pure or prevalent typical clinical findings. Instead in Painful Trigeminal Neuropathy with pure or prevalent atypical clinical findings the neuromodulation techniques are the treatments to be chosen. 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

Highlights

Trigeminal neuralgia is a painful condition of the face usually having a clear-cut clinical presentation: evoked paroxysmal pain in one or more unilateral trigeminal branches
Corneal sensory impairment has been found in 1-20%, and it caused a keratytis in 0.6-3% of cases
The surgical treatment is often curative in most of the patients affected by invalidating Trigeminal Neuralgia (TN), not controlled by a well-tolerated pharmacological treatment

Summary

Introduction

Trigeminal neuralgia is a painful condition of the face usually having a clear-cut clinical presentation: evoked paroxysmal pain in one or more unilateral trigeminal branches. CTN is further divided in CTN purely paroxysmal and CTN with concomitant persistent facial pain This denomination encompasses the cases classified before as primary, essential, and idiopathic trigeminal neuralgia. Open surgical trigeminal rhizotomy and tractotomy are nowadays rarely performed; Neuromodulation procedures, such direct electrostimulation of the peripheral trigeminal branches, the gasserian ganglion, the motor cortex or the spinal cord [9,10], transcranial magnetic or electric stimulation of the motor cortex [11], intrathecal drugs delivery [12], and pulsed radiofrequency of peripheral trigeminal branches or gasserian ganglion [13] For this reasons the ICHD committee introduced the definition of “CTN purely paroxysmal” and “CTN with concomitant persistent facial pain” in the substitution of the previous denomination of trigeminal neuralgia type 1 and type 2 [6].

Results

Conclusions