Trigeminal rhizotomies in the treatment of trigemium neuralgia

Abstract

Background: Rhizotomy is a procedure that seeks to interrupt, the pain function of sensitive nerves. Trigeminal Neuralgia (TN) is a disease that can benefit from a trigeminal rhizotomy. Currently, percutaneous trigeminal radiofrequency rhizotomy and balloon microcompression techniques are widely used. Objective: To expose therapeutic experience of TN by trigeminal rhizotomy therapy. Methods: Retrospective study of TN patients undergoing trigeminal rhizotomy in a reference service in endovascular neurosurgery in Blumenau, Santa Catarina, from 2009 to 2019. The variables analyzed were gender, age, symptoms, comorbidities and procedural characteristics. Results: 39 patients were analyzed, 24 were women (61.5%) aged between 33 and 84 years and a mean of 62.8 years old. Regarding the symptoms presented, the most prevalent was headache (69.2%), followed by paresthesia (10.2%), tinnitus (7.7%) and dizziness (5.1%). For comorbidities, 25.6% had systemic arterial hypertension and 15.4% had dyslipidemia. The trigeminal branches most involved in rhizotomies were V2-V3 (56.4%), followed by V2 (28.2%), V1 (7.7%), V1-V2 (5.1%) and V3 (2.5%). The left side was more affected (56.4%). The percutaneous approach was performed in all patients, in 92.3% the balloon technique was performed and in 7.7% radiofrequency was used. In 79,5% of the cases, it was possible to accomplish the treatment with only one session. Conclusion: The approach of TN through rhizotomy proved to be a technique with low morbidity, reaffirming the good results of therapy. The monitoring of cases is essential to allow a better assessment of the long-term effectivenes of the treatment.