Ahead of Print: A Review of Percutaneous Treatments for Trigeminal Neuralgia

Screen Shot 2013-10-09 at 2.37.06 PMBackground: Common treatments for trigeminal neuralgia (TN) include percutaneous techniques, microvascular decompression (MVD), and gamma knife radiosurgery (GK). While MVD is considered the gold standard for treatment, percutaneous techniques remain an effective option for select patients.

Objective: To review the historical development, advantages, and limitations of the most common percutaneous procedures for TN: balloon compression (BC), glycerol rhizotomy (GR), and radiofrequency thermocoagulation (RF).

Methods: Prior publications reporting clinical outcomes after BC, GR, and RF were reviewed and included. Operative technique was based on the experience of the primary surgeon and senior author.

Results: All three percutaneous techniques (BC, GR, and RF) provide effective pain relief but differ in method and specificity of nerve injury. BC selectively injures larger pain fibers while sparing small fibers and does not require an awake, cooperative patient. Pain control rates up to 91% at 6 months and 66% at 3 years have been reported. RF allows for somatotopic nerve mapping, selective division lesioning, and provides pain relief in up to 97% of patients initially and 58% at 5 years. Multiple treatments improve outcomes but carry significant morbidity risk. GR offers similar pain-free outcomes of 90% at 6 months and 54% at 3 years but with higher complication rates (25% vs. 16%) compared to BC. Advantages to percutaneous techniques include shorter procedure duration, minimal anesthesia risk, and in the case of GR and RF, immediate patient feedback.

Conclusion: Percutaneous treatments for TN remain safe, simple, and effective for achieving good pain control while minimizing procedural risk.

From: A Review of Percutaneous Treatments for Trigeminal Neuralgia by Barbaro et al.

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