Interventional Treatment Options for Trigeminal Neuralgia

Abstract

Trigeminal neuralgia is characterized by sudden and severe shock-like episodes of transient unilateral pain in the trigeminal nerve distribution. Most cases are idiopathic and are known to respond favorably to anticonvulsants. For patients who fail at least three drug trials or experience intolerable side effects, surgery may be warranted. First, a diagnostic block at the trigeminal nerve or Gasserian ganglion to confirm clinical diagnosis is performed. Surgical intervention can be either ablative or nonablative, each with its respective indications, contraindications, and risk-benefit profile. Most common are the percutaneous rhizotomies: conventional and pulsed radiofrequency ablation (RFA), chemical glycerol injections, and mechanical balloon compression. Stereotactic or gamma knife radiosurgery (GKRS) is the least invasive with only a moderate duration of pain relief, whereas microvascular decompression (VMD) is the most invasive, but associated with greatest long-term benefit. RFA has consistently shown favorable results and is the only modality with evidence of pain relief in ≥50% of patients treated 20 years postoperatively. Auxiliary interventional options such as peripheral neurectomy, botulinum toxin type-A (BTX-A) injections, and cryotherapy are available for those with contraindications to rhizotomies, radiosurgery, or neurosurgery. Ultimately, physicians must tailor their management of trigeminal neuralgia to the needs of the patient.

Unknown Etiology for Ataxia and Vertigo After Trigeminal Nerve Block: A Case Report

“…Patients with trigeminal neuralgic pain refractory to medical therapy are considered for interventional therapy. 5,6 The options include nerve blocks of trigeminal nerve branches, interventions to the trigeminal ganglion or root by stereotactic radiosurgery, or gamma knife radiosurgery or surgery for microvascular decompression. 6 We performed maxillary and mandibular nerve blocks via a coronoid approach.…”

“…5,6 The options include nerve blocks of trigeminal nerve branches, interventions to the trigeminal ganglion or root by stereotactic radiosurgery, or gamma knife radiosurgery or surgery for microvascular decompression. 6 We performed maxillary and mandibular nerve blocks via a coronoid approach. Complications of this procedure include hematoma formation, temporary increase in pain, facial muscle weakness and asymmetry, dysesthesia, meningitis, inadvertent intracranial injection, and local anesthesia toxicity.…”

Recurrence Rate of Trigeminal Neuralgia With the Use of Percutaneous Stereotactic Continuous Radiofrequency Ablation at 80°C for 90 Seconds: A Single-Center Study

“…There have been multiple treatment modalities described in the texts including medical and surgical options to treat TN [2,3]. Since the individual course of the disease varies, most of the physicians adopt a step-bystep approach tailored to the individual needs of the patients starting preferentially from a medical therapeutic trial of anti-epileptic drugs, typically carbamazepine [4].…”

“…Other anticonvulsants that are prescribed include but are not limited to oxcarbazepine, gabapentin, and phenytoin [4]. Various surgical interventions are used to treat the condition, such as radiofrequency rhizotomies, balloon gangliolysis, stereotactic radiosurgery, and microvascular decompression to name a few [2,3].…”

Cone Beam CT With Flat Panel Detector and Biplane Fluoroscopy-Guided Percutaneous Trigeminal Nerve Rhizotomy Using Three-Dimensional Needle Trajectory Planning

“…However, this is a technically challenging procedure and there are critical structures within millimeters of the foramen ovale such as the carotid artery, other cranial nerves, as well as the brain. Complications may include facial hematoma, carotid cavernous fistula, cranial nerve palsy, stroke, and intracranial bleeding [ 3 , 4 ]. New technologies have evolved that offer improved precision, efficiency, and safety in performing PTR such as CT, CT-fluoroscopy, and cone beam CT (CBCT).…”