Abstract
Surgical procedure is warranted in trigeminal neuralgia (TGN) when pharmacologic therapy fails with insufficient pain relief or unacceptable side effects. Surgical management may broadly be divided into (a) procedures on the trigeminal nerve or gasserian ganglion by external or percutaneous approach, usually performed by pain physicians; (b) procedures carried out on the nerve root entry zone by open and invasive surgery (e.g., microvascular decompression) performed by neurosurgeons; and (c) non-invasive gamma knife (GK) radiosurgery performed by radiation oncologists and neurosurgeons. Microvascular decompression (MVD), although more invasive, has an overall superior success rate. Percutaneous techniques may be more agreeable to elderly patients who are at high surgical risk. The percutaneous procedures and GK surgery are discussed in separate chapters. This chapter elaborates open surgical procedures which may be divided into ablative/destructive procedures (e.g., peripheral neurectomy), or non-ablative procedures where the nerve function remains preserved (Table 1).
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References
Dandy WE. Concerning the cause of trigeminal neuralgia. Am J Surg. 1934;24:447–55.
Sjöqvist O. Studies on pain conduction in the trigeminal nerve: a contribution to the surgical treatment of facial pain. Acta Psychiatr Neurol Scand Suppl. 1938;17:1–139.
Kanpolat Y, Kahilogullari G, Ugur HC, Elhan AH. Computed tomography-guided percutaneous trigeminal tractotomy-nucleotomy. Neurosurgery. 2008;63(1 Suppl 1):ONS147–55.
Raslan AM. Percutaneous computed tomography-guided radiofrequency ablation of upper spinal cord pain pathways for cancer-related pain. Neurosurgery. 2008;62(3 Suppl 1):226–34.
Ali FM, Prasant M, Pai D, Aher VA, Kar S, Safiya T. Peripheral neurectomies: a treatment option for trigeminal neuralgia in rural practice. J Neurosci Rural Pract. 2012;3:152–7.
Haliasos N, Prezerakos G, Kuruvath S, Garvan N, Bavetta S. Peripheral neurectomy as a second line treatment option for trigeminal neuralgia: 27 years’ experience of a “Sidelined” procedure. Neurosurgery. 2010;67:551.
Meaney JF, Eldridge PR, Dunn LT, Nixon TE, Whitehouse GH, Miles JB. Demonstration of neurovascular compression in trigeminal neuralgia with magnetic resonance imaging. Comparison with surgical findings in 52 consecutive operative cases. J Neurosurg. 1995;83:799–805.
Jannetta PJ. Microsurgical approach to the trigeminal nerve for tic douloureux. Prog Neurosurg. 1976;7:180–200.
Sarsam Z, Garcia-Finana M, Nurmikko TJ, Varma TR, Eldrige P. The long-term outcome of microvascular decompression for trigeminal neuralgia. Br J Neurosurg. 2010;24:18–25.
Tatli M, Satici O, Kanpolat Y, Sindou M. Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes. Acta Neurochir. 2008;150:243–55.
Pollock BE. Comparison of posterior fossa exploration and stereotactic radiosurgery in patients with previously nonsurgically treated idiopathic trigeminal neuralgia. Neurosurg Focus. 2005;18:1–4.
Brisman R. Microvascular decompression vs. gamma knife radiosurgery for typical trigeminal neuralgia: preliminary findings. Stereotact Funct Neurosurg. 2007;85:94–8.
Linskey ME, Ratanatharathorn V, Peñagaricano J. A prospective cohort study of microvascular decompression and gamma knife surgery in patients with trigeminal neuralgia. J Neurosurg. 2008;109(Suppl):160–72.
Pollock BE, Schoeberl KA. Prospective comparison of posterior fossa exploration and stereotactic radiosurgery dorsal root entry zone target as primary surgery for patients with idiopathic trigeminal neuralgia. Neurosurgery. 2010;67:633–8.
Wang DD, Raygor KP, Cage TA, Ward MM, Wesycotts SS, Barbaro NM, Chang EF. Prospective comparison of long-term pain relief rates after first-time microvascular decompression and stereotactic radiosurgery for trigeminal neuralgia. J Neurosurg. 2018;128:68–77.
Sivakanthan S, Van Gompel JJ, Alikhani P, van Loveren H, Chen R, Agazzi S. Surgical management of trigeminal neuralgia: use and cost-effectiveness from an analysis of the Medicare Claims Database. Neurosurgery. 2014;75:220–6.
Sekula RF, Frederickson AM, Jannetta PJ, Quigley MR, Aziz KM, Arnone GD. Microvascular decompression for elderly patients with trigeminal neuralgia: a prospective study and systematic review with meta-analysis. J Neurosurg. 2011;114:172–9.
Miller JP, Magill ST, Acar F, Burchiel KJ. Predictors of long-term success after microvascular decompression for trigeminal neuralgia. J Neurosurg. 2009;110:620–6.
Gao J, Fu Y, Guo SK, Li B, Xu ZX. Efficacy and prognostic value of partial sensory rhizotomy and microvascular decompression for primary trigeminal neuralgia: a comparative study. Med Sci Monit. 2017;23:2284–91.
Jellish WS, Benedict W, Owen K, Anderson D, Fluder E, Shea JF. Perioperative and long-term operative outcomes after surgery for trigeminal neuralgia: microvascular decompression vs percutaneous balloon ablation. Head Face Med. 2008;4:1.
Lemos L, Alegria C, Oliveira J, Machado A, Oliveira P, Almeida A. Pharmacological versus microvascular decompression approaches for the treatment of trigeminal neuralgia: clinical outcomes and direct costs. J Pain Res. 2011;4:233–44.
Ko AL, Ozpinar A, Lee A, Raslan AM, McCartney S, Burchiel KJ. Long-term efficacy and safety of internal neurolysis for trigeminal neuralgia without neurovascular compression. J Neurosurg. 2015;122:1048–57.
Yadav YR, Parihar V, Agarwal M, Sherekar S, Bhatele P. Endoscopic vascular decompression of the trigeminal nerve. Minim Invasive Neurosurg. 2011;54:110–4.
Bohman LE, Pierce J, Stephen JH, Sandhu S, Lee JY. Fully endoscopic microvascular decompression for trigeminal neuralgia: technique review and early outcomes. Neurosurg Focus. 2014;37:E18.
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Borkar, S.A., Agrawal, M., Sinha, S. (2019). Neurosurgical Treatment for Trigeminal Neuralgia. In: Rath, G. (eds) Handbook of Trigeminal Neuralgia. Springer, Singapore. https://doi.org/10.1007/978-981-13-2333-1_21
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