Skip to main content
SpringerLink
Log in

Trigeminal Neuralgia: Surgical Perspective

  • Chapter
Principles and Practice of Stereotactic Radiosurgery

Abstract

Trigeminal neuralgia, characterized by intermittent sharp, lancinating pain in the distribution of one or more branches of the trigeminal nerve, is the most common facial pain syndrome in the United States, with approximately 15,000 cases diagnosed each year [1]. Although a minority of cases are caused by spaceoccupying posterior fossa lesions such as tumors or vascular malformations, it is now well accepted that in most cases, the disorder results from vascular compression of the trigeminal nerve root [2]–[5]. The majority of patients respond, at least initially, to medical management, with surgery reserved for patients who do not respond to medications. Surgical options range from percutaneous, destructive procedures (glycerol or radiofrequency rhizotomy, balloon compression) to the invasive but nondestructive microvascular decompression. This chapter will review each of these surgical methods of treatment and compare and contrast them with stereotactic radiosurgery in the broader context of clinical decision-making.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 229.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Pollock BE, Ecker RD. A prospective cost-effectiveness study of trigeminal neuralgia surgery. Clin J Pain 2005; 21:317–322.

    Article  PubMed  Google Scholar 

  2. Jannetta PJ. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 1967; 26:159–162.

    Article  PubMed  Google Scholar 

  3. Jannetta PJ. Observations on the etiology of trigeminal neuralgia, hemifacial spasm, acoustic nerve dysfunction and glossopharyngeal neuralgia. Definitive microsurgical treatment and results in 117 patients. Neurochirurgia (Stuttg) 1977; 20:145–154.

    CAS  Google Scholar 

  4. Jannetta PJ. Microsurgery of cranial nerve cross-compression. Clin Neurosurg 1979; 26:607–615.

    CAS  PubMed  Google Scholar 

  5. Jannetta PJ. Neurovascular compression in cranial nerve and systemic disease. Ann Surg 1980; 192:518–525.

    Article  CAS  PubMed  Google Scholar 

  6. Håkanson S. Trigeminal neuralgia treated by the injection of glycerol into the trigeminal cistern. Neurosurgery 1981; 9:638–646.

    PubMed  Google Scholar 

  7. Young RF. Percutaneous trigeminal glycerol rhizotomy. In: Rengachary SS, Wilkins RH, eds. Neurosurgical Operative Atlas, Volume 1. Chicago: American Association of Neurological Surgeons, 1991:117–123.

    Google Scholar 

  8. Lunsford LD, Bennett MH. Percutaneous retrogasserian glycerol rhizotomy for tic douloureux: part 1; technique and results in 112 patients. Neurosurgery 1984; 14:424–430.

    Article  CAS  PubMed  Google Scholar 

  9. Fujimaki T, Fukushima T, Miyazaki S. Percutaneous retrogasserian glycerol injection in the management of trigeminal neuralgia: long-term follow-up results. J Neurosurg 1990; 73:212–216.

    Article  CAS  PubMed  Google Scholar 

  10. North RB, Kidd DH, Piantadosi S, et al. Percutaneous retrogasserian glycerol rhizotomy: predictors of success and failure in treatment of trigeminal neuralgia. J Neurosurg 1990; 72:851–856.

    Article  CAS  PubMed  Google Scholar 

  11. Slettebø H, Hirschberg H, Lindegaard K-F. Long-term results after percutaneous retrogasserian glycerol rhizotomy in patients with trigeminal neuralgia. Acta Neurochir (Wien) 1993; 122:231–235.

    Article  Google Scholar 

  12. Burchiel KJ. Percutaneous retrogasserian glycerol rhizolysis in the management of trigeminal neuralgia. J Neurosurg 1988; 69:361–366.

    Article  CAS  PubMed  Google Scholar 

  13. Fick J, Tew JM Jr. Percutaneous radiofrequency rhizolysis for trigeminal neuralgia. In: Rengachary SS, Wilkins RH, eds. Neurosurgical Operative Atlas, Volume 1. Chicago: American Association of Neurological Surgeons, 1991:379–390.

    Google Scholar 

  14. Sweet WH, Wepsic JG. Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers. Part I: trigeminal neuralgia. J Neurosurg 1974; 40:143–156.

    Article  CAS  PubMed  Google Scholar 

  15. Broggi G, Franzini A, Lasio G, et al. Long-term results of percutaneous retrogasserian thermorhizotomy for “essential” trigeminal neuralgia: considerations in 1000 consecutive patients. Neurosurgery 1990; 26:783–787.

    Article  CAS  PubMed  Google Scholar 

  16. Yoon KB, Wiles JR, Miles JB, et al. Long-term outcome of percutaneous thermocoagulation for trigeminal neuralgia. Anaesthesia 1999; 54:803–808.

    Article  CAS  PubMed  Google Scholar 

  17. Taha JM, Tew JM, Buncher CR. A prospective 15-year follow up of 154 consecutive patients with trigeminal neuralgia treated by percutaneous stereotactic radiofrequency thermal rhizotomy. J Neurosurg 1995; 83:989–993.

    Article  CAS  PubMed  Google Scholar 

  18. Ischia S, Luzzani A, Polati E, et al. Percutaneous controlled thermocoagulation in the treatment of trigeminal neuralgia. Clin J Pain 1990; 9:96–104.

    Article  Google Scholar 

  19. Mullan S, Lichtor T. Percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia. J Neurosurg 1983; 59:1007–1012.

    Article  CAS  PubMed  Google Scholar 

  20. Brown JA, Gouda JJ. Percutaneous balloon compression for the treatment of trigeminal neuralgia. In: Rengachary SS, Wilkins RH, eds. Neurosurgical Operative Atlas, Volume 7. Chicago: American Association of Neurological Surgeons, 1998:107–116.

    Google Scholar 

  21. Skirving DJ, Dan NG. A 20-year review of percutaneous balloon compression of the trigeminal ganglion. J Neurosurg 2001; 94:913–917.

    Article  CAS  PubMed  Google Scholar 

  22. Brown JA, McDaniel MD, Weaver MT. Percutaneous trigeminal nerve compression for treatment of trigeminal neuralgia: results in 50 patients. Neurosurgery 1993; 32:570–573.

    Article  CAS  PubMed  Google Scholar 

  23. Brown JA, Pilitsis JG. Percutaneous balloon compression for the treatment of trigeminal neuralgia: results in 56 patients based on balloon compression pressure monitoring. Neurosurg Focus 2005; 18:E10.

    Article  PubMed  Google Scholar 

  24. McLaughlin MR, Jannetta PJ, Clyde BL, et al. Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg 1999; 90:1–8.

    Article  CAS  PubMed  Google Scholar 

  25. Jannetta PJ, McLaughlin MR, Casey KF. Technique of microvascular decompression: technical note. Neurosurg Focus 2005; 18:E5.

    PubMed  Google Scholar 

  26. Apfelbaum RI. Surgery for tic douloureux. Clin Neurosurg 1983; 31:351–68.

    CAS  PubMed  Google Scholar 

  27. Klun B. Microvascular decompression and partial sensory rhizotomy in the treatment of trigeminal neuralgia: personal experience with 220 patients. Neurosurgery 1992; 30:49–52.

    Article  CAS  PubMed  Google Scholar 

  28. Burchiel KJ, Clarke H, Haglund M, et al. Long-term efficacy of microvascular decompression in trigeminal neuralgia. J Neurosurg 1988; 69:35–38.

    Article  CAS  PubMed  Google Scholar 

  29. Kolluri S, Heros RC. Microvascular decompression for trigeminal neuralgia: a five-year follow-up study. Surg Neurol 1984; 22:235–240.

    Article  CAS  PubMed  Google Scholar 

  30. Olson S, Atkinson L, Weidmann M. Microvascular decompression for trigeminal neuralgia: recurrences and complications. J Clin Neurosci 2005; 12:787–789.

    Article  PubMed  Google Scholar 

  31. Bederson JB, Wilson CB. Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. J Neurosurg 1989; 71:359–367.

    Article  CAS  PubMed  Google Scholar 

  32. Barker FG, Jannetta PJ, Bissonette DJ, et al. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 1996; 334:1077–1083.

    Article  PubMed  Google Scholar 

  33. Theodosopoulos PV, Marco E, Applebury C, et al. Predictive model for pain recurrence after posterior fossa surgery for trigeminal neuralgia. Arch Neurol 2002; 59:1297–1302.

    Article  PubMed  Google Scholar 

  34. Kondo A. Microvascular decompression surgery for trigeminal neuralgia. Stereotact Funct Neurosurg 2001; 77:187–189.

    Article  CAS  PubMed  Google Scholar 

  35. Kalkanis SN, Eskandar EN, Carter BS, et al. Microvascular decompression surgery in the United States, 1996 to 2000: mortality rates, morbidity rates, and the effects of hospital and surgeon volumes. Neurosurgery 2003; 52:1251–1262.

    Article  PubMed  Google Scholar 

  36. Leksell L. Stereotaxic radiosurgery in trigeminal neuralgia. Acta Chir Scand 1971; 137:311–314.

    CAS  PubMed  Google Scholar 

  37. Kondziolka D, Lunsford LD, Flickinger JC, et al. Stereotactic radiosurgery for trigeminal neuralgia: a multi-institutional study using the gamma unit. J Neurosurg 1996; 84:940–945.

    Article  CAS  PubMed  Google Scholar 

  38. Kondziolka D, Lunsford LD, Flickinger JC. Stereotactic radiosurgery for the treatment of trigeminal neuralgia. Clin J Pain 2002; 18:42–47.

    Article  PubMed  Google Scholar 

  39. Rogers CL, Shetter AG, Fiedler JA, et al. Gamma Knife radiosurgery for trigeminal neuralgia: the initial experience of the Barrow Neurological Institute. Int J Radiat Oncol Biol Phys 2000; 47:1013–1019.

    CAS  PubMed  Google Scholar 

  40. Shetter AG, Rogers CL, Ponce F, et al. Gamma Knife radiosurgery for recurrent trigeminal neuralgia. J Neurosurg 2002; 97(Suppl 5):536–538.

    PubMed  Google Scholar 

  41. Pollock BE, Phuong LK, Gorman DA, et al. Stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 2002; 97:347–353.

    Article  PubMed  Google Scholar 

  42. UrgošÍk D, Vymazal J, Vladyka V, et al. Gamma Knife treatment of trigeminal neuralgia: clinical and electrophysiological study. Stereotact Funct Neurosurg 1998; 70(Suppl 1):200–209.

    PubMed  Google Scholar 

  43. Young RF, Vermuelen S, Posewitz A. Gamma Knife radiosurgery for the treatment of trigeminal neuralgia. Stereotact Funct Neurosurg 1998; 70(Suppl 1):192–199.

    Article  PubMed  Google Scholar 

  44. McNatt SA, Yu C, Giannotta SL, et al. Gamma Knife radio — surgery for trigeminal neuralgia. Neurosurgery 2005; 56:1295–1303.

    Article  PubMed  Google Scholar 

  45. Sheehan J, Pan H-C, Stroila M, et al. Gamma Knife surgery for trigeminal neuralgia: outcomes and prognostic factors. J Neurosurg 2005; 102:434–441.

    Article  PubMed  Google Scholar 

  46. Tawk RG, Duffy-Fronckowiak M, Scott BE, et al. Stereotactic Gamma Knife surgery for trigeminal neuralgia: detailed analysis of treatment response. J Neurosurg 2005; 102:442–449.

    Article  PubMed  Google Scholar 

  47. Drzymala RE, Malyapa RS, Dowling JL, et al. Gamma Knife radiosurgery for trigeminal neuralgia: the Washington University initial experience. Stereotact Funct Neurosurg 2005; 83:148–152.

    Article  PubMed  Google Scholar 

  48. Chen JCT, Girvigian M, Greathouse H, et al. Treatment of trigeminal neuralgia with linear accelerator radiosurgery: initial results. J Neurosurg 2004; 101(Suppl 3):346–350.

    PubMed  Google Scholar 

  49. Richards GM, Bradley KA, Tomé WA, et al. Linear accelerator radiosurgery for trigeminal neuralgia. Neurosurgery 2005; 57:1193–1200.

    Article  PubMed  Google Scholar 

  50. Kubicek GJ, Hall WA, Orner JB, et al. Long-term follow-up of trigeminal neuralgia treatment using a linear accelerator. Stereotact Funct Neurosurg 2004; 82:244–249.

    Article  PubMed  Google Scholar 

  51. Lim M, Villavicencio AT, Burneikiene S, et al. CyberKnife radiosurgery for idiopathic trigeminal neuralgia. Neurosurg Focus 2005; 18:E9.

    Article  PubMed  Google Scholar 

  52. Ma L, Kwok Y, Chin LS, et al. Comparative analyses of linac and Gamma Knife radiosurgery for trigeminal neuralgia treatments. Phys Med Biol 2005; 50:5217–5227.

    Article  CAS  PubMed  Google Scholar 

  53. Lopez BC, Hamlyn PJ, Zakrzewska JM. Stereotactic radiosurgery for primary trigeminal neuralgia: state of the evidence and recommendations for future reports. J Neurol Neurosurg Psychiatry 2004; 75:1019–1024.

    Article  CAS  PubMed  Google Scholar 

  54. Tronnier VM, Rasche D, Hamer J, et al. Treatment of idiopathic trigeminal neuralgia: comparison of long-term outcome after radiofrequency rhizotomy and microvascular decompression. Neurosurgery 2001; 48:1261–1268.

    Article  CAS  PubMed  Google Scholar 

  55. Barker FG II, Jannetta PJ, Bissonette DJ, et al. Trigeminal numbness and tic relief after microvascular decompression for typical trigeminal neuralgia. Neurosurgery 1997; 40:39–45.

    Article  PubMed  Google Scholar 

  56. Pollock BE. Comparison of posterior fossa exploration and stereotactic radiosurgery in patients with previously nonsurgically treated idiopathic trigeminal neuralgia. Neurosurg Focus 2005; 18:E6.

    Article  PubMed  Google Scholar 

  57. Erbay SH, Bhadelia RA, Riesenburger R, et al. Association between neurovascular contact on MRI and response to Gamma Knife radiosurgery in trigeminal neuralgia. Neuroradiology 2006; 48:26–30.

    Article  PubMed  Google Scholar 

  58. Henson CF, Goldman HW, Rosenwasser RH, et al. Glycerol rhizotomy versus Gamma Knife radiosurgery for the treatment of trigeminal neuralgia: an analysis of patients treated at one institution. Int J Radiat Oncol Biol Phys 2005; 63:82–90.

    PubMed  Google Scholar 

  59. Elias WJ, Burchiel KJ. Trigeminal neuralgia and other neuropathic pain syndromes of the head and face. Curr Pain Headache Rep 2002; 6:115–124.

    Article  PubMed  Google Scholar 

  60. Elias WJ, Burchiel KJ. Microvascular decompression. Clin J Pain 2002; 18:35–41.

    Article  PubMed  Google Scholar 

  61. Liu JK, Apfelbaum RI. Treatment of trigeminal neuralgia. Neurosurg Clin N Am 2004; 15:319–334.

    Article  PubMed  Google Scholar 

  62. Lopez BC, Hamlyn PJ, Zakrzewska JM. Systematic review of ablative neurosurgical techniques for the treatment of trigeminal neuralgia. Neurosurgery 2004; 54:973–983.

    Article  PubMed  Google Scholar 

  63. Ashkan K, Marsh H. Microvascular decompression for trigeminal neuralgia in the elderly: a review of the safety and efficacy. Neurosurgery 2004; 55:840–850.

    Article  PubMed  Google Scholar 

  64. Zakrzewska JM, Lopez BC, Kim SE, et al. Patient reports of satisfaction after microvascular decompression and partial sensory rhizotomy for trigeminal neuralgia. Neurosurgery 2005; 56:1304–1312.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA

    David B. Cohen MD (Functional Neurosurgery Fellow)

  2. Department of Neurosurgery, Drexel University School of Medicine, USA

    Michael Y. Oh MD (Assistant Professor and Co-Director) & Peter J. Jannetta MD (Professor and Vice-Chairman)

  3. Stereotactic and Functional Neurosurgery, Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA

    Michael Y. Oh MD (Assistant Professor and Co-Director)

  4. Department of Neurosurgery, Jannetta Center for Cranial Nerve Disorders, Allegheny General Hospital, Pittsburgh, PA, USA

    Peter J. Jannetta MD (Professor and Vice-Chairman)

Authors
  1. David B. Cohen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Y. Oh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter J. Jannetta MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Boston University School of Medicine, Boston, MA, USA

    Lawrence S. Chin MD (Professor and Chairman) (Professor and Chairman)

  2. Department of Radiation Oncology, University of Maryland Medical School, Baltimore, MD, USA

    William F. Regine MD (Professor and Chairman) (Professor and Chairman)

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Cohen, D.B., Oh, M.Y., Jannetta, P.J. (2008). Trigeminal Neuralgia: Surgical Perspective. In: Chin, L.S., Regine, W.F. (eds) Principles and Practice of Stereotactic Radiosurgery. Springer, New York, NY. https://doi.org/10.1007/978-0-387-71070-9_53

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-71070-9_53

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-71069-3

  • Online ISBN: 978-0-387-71070-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation