Surgical Treatment for Trigeminal Neuralgia

Abstract

Various treatments for trigeminal neuralgia (TN) are known to yield initial satisfactory results; however, the surgical treatment has excellent long-term outcomes and a low recurrence rate. Surgical treatment addresses the challenge of vascular compression, which accounts for 85% of the causes of TN. As for surgical treatment for TN, microvascular decompression (MVD) has become the surgical treatment of choice after Peter J. Jannetta reported the results of MVD surgery in 1996. Since then, many studies have reported a success rate of over 90% for the initial surgical treatment. Most MVDs aim to separate (decompress) the culprit vessel from the trigeminal nerve. To increase the success rate of surgery, accurate indications for MVD and management of the offender vessels without complications are critical. In addition, if there is no vascular compression, partial sensory rhizotomy or internal neurolysis can be performed to improve surgical outcomes.

Morbid Obesity and Diabetes Increase the Risk of Reoperation following Microvascular Decompression: A National Surgical Quality Improvement Program Analysis of 1,303 Patients

“…7 MVD has been reported with an initial success rate of 80 to 95%, and 70% of patients are pain-free and off medications at 10 years' postsurgery. [8][9][10] Radiosurgery is also a wellestablished and safe alternative for primary or refractory treatment of TN demonstrating high response rates for treatment. 11 Unlike other invasive interventions, however, patients treated with radiosurgery often have persistent or recurrent pain requiring additional procedures.…”

“…12 Postoperative complications following MVD are generally low, reported as less than 10% and can include cranial nerve palsy, cerebrospinal fluid (CSF) leak, infection, stroke, and in rare cases, hemorrhage, or death. 8,9,[13][14][15] Risk factors associated with increased likelihood of postoperative complications include high body mass index (BMI), American Society of Anesthesiologists (ASA) class II to III, hypertension, tobacco use, chronic obstructive pulmonary disease (COPD), diabetes, and increased procedure duration. 13,[16][17][18] Surprisingly, reoperation rates have been reported as high as 11% and most commonly occur due to wound infection, wound dehiscence, CSF leak, or refractory/recurrent pain.…”

Mental Nerve Neurectomy: A Comparison of Titanium Screw Versus Gutta-Percha Oburation of the Mental Foramen

“…Mainly they include chemical rhizotomy (glycerol rhizotomy), radiofrequency ablation, and endoscopic rhizotomy. Surgical management involves neurectomy [ 13 ] or neurovascular decompression [ 14 ] from the peripheral branches up to the pons from where the trigeminal nerve originates (Jannetta Procedure) [ 15 ].…”

Deep Learning Super-Resolution Technique Based on Magnetic Resonance Imaging for Application of Image-Guided Diagnosis and Surgery of Trigeminal Neuralgia

“…If the response to medication is poor or adverse drug reactions occur, surgical options such as microvascular decompression (MVD) or gamma knife radiosurgery (GKRS) may be considered [ 2 , 3 , 4 , 5 , 6 ]. The choice of treatment methodology for TN involves a comprehensive consideration of the severity of pain, vascular anatomy, and patient age, with the primary goal of both approaches being to accurately distinguish the cause of TN and minimize damage to normal tissues [ 4 , 5 , 6 ]. MVD is primarily considered; however, if pain persists or significant postoperative complications occur, GKRS may be an option [ 4 , 5 ].…”