Neurosurgical Treatment for Trigeminal Neuralgia
Surgical procedure is warranted in trigeminal neuralgia (TGN) when pharmacologic therapy fails with insufficient pain relief or unacceptable side effects. Surgical management may broadly be divided into (a) procedures on the trigeminal nerve or gasserian ganglion by external or percutaneous approach, usually performed by pain physicians; (b) procedures carried out on the nerve root entry zone by open and invasive surgery (e.g., microvascular decompression) performed by neurosurgeons; and (c) non-invasive gamma knife (GK) radiosurgery performed by radiation oncologists and neurosurgeons. Microvascular decompression (MVD), although more invasive, has an overall superior success rate. Percutaneous techniques may be more agreeable to elderly patients who are at high surgical risk. The percutaneous procedures and GK surgery are discussed in separate chapters. This chapter elaborates open surgical procedures which may be divided into ablative/destructive procedures (e.g., peripheral neurectomy), or non-ablative procedures where the nerve function remains preserved (Table 1).
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