Trigeminal neuralgia. Non-invasive techniques versus microvascular decompression. It is really available any further improvement?

Carlo Alberto Pagni, L. Fariselli, S. Zeme

Research output: Contribution to journalArticle

Abstract

Analysis of the results of the various methods for treatment of typical trigeminal neuralgia (TN) based on the literature and personal experience. The personal experience includes 847 cases: total thyzotomy in the posterior fossa 17 cases; rhyzotomy in the posterior fossa sparing the intermediate fibers 16 cases; microvascular decompression (MVD) 141 cases; controlled thermorhizotomy (PTR) 54 cases; Fogarty Balloon compression (FBC) 223 cases; glycerol ganglyolis (PGG) 12 cases; miscellaneous 48 case; medical treatment only 310 cases; cyberknife radiosurgery (CKR) 46 cases. The follow-up in this series is 1-32 years. MVD of the Vth cranial nerve in posterior fossa gives the best results in term of long-term pain relief without collateral effects in drug-resistant TN. Percutaneous techniques (PTR, PGG, FBC) are indicated in patients either without neurovascular conflict or with excessive surgical risk. Stereotactic radiosurgery (SRS) and CKR might be considered an improvement of percutaneous and surgical techniques, but contrary to the expectations, the rate of complete pain relief at long term is lower. SRS and CKR are less effective than MVD which, in spite of the risks it entails, remains the choice treatment for typical trigeminal neuralgia.

Original languageEnglish
Pages (from-to)27-33
Number of pages7
JournalActa Neurochirurgica, Supplement
Issue number101
DOIs
Publication statusPublished - 2008

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Microvascular Decompression Surgery
Trigeminal Neuralgia
Radiosurgery
Prostaglandins G
Pain
Cranial Nerves
Glycerol
Therapeutics
Pharmaceutical Preparations

Keywords

  • cyberknife radiosurgery
  • microvascular decompression in posterior fossa rhizotomy
  • percutaneous techniques
  • stereotactic radiosurgery
  • Typical trigeminal neuralgia

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

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title = "Trigeminal neuralgia. Non-invasive techniques versus microvascular decompression. It is really available any further improvement?",
abstract = "Analysis of the results of the various methods for treatment of typical trigeminal neuralgia (TN) based on the literature and personal experience. The personal experience includes 847 cases: total thyzotomy in the posterior fossa 17 cases; rhyzotomy in the posterior fossa sparing the intermediate fibers 16 cases; microvascular decompression (MVD) 141 cases; controlled thermorhizotomy (PTR) 54 cases; Fogarty Balloon compression (FBC) 223 cases; glycerol ganglyolis (PGG) 12 cases; miscellaneous 48 case; medical treatment only 310 cases; cyberknife radiosurgery (CKR) 46 cases. The follow-up in this series is 1-32 years. MVD of the Vth cranial nerve in posterior fossa gives the best results in term of long-term pain relief without collateral effects in drug-resistant TN. Percutaneous techniques (PTR, PGG, FBC) are indicated in patients either without neurovascular conflict or with excessive surgical risk. Stereotactic radiosurgery (SRS) and CKR might be considered an improvement of percutaneous and surgical techniques, but contrary to the expectations, the rate of complete pain relief at long term is lower. SRS and CKR are less effective than MVD which, in spite of the risks it entails, remains the choice treatment for typical trigeminal neuralgia.",
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