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

  • Conference paper
Reconstructive Neurosurgery

Part of the book series: Acta Neurochirurgica Supplementum ((NEUROCHIRURGICA,volume 101))

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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Authors and Affiliations

  1. Muratori 30, 20135, Milano, Italy

    Carlo Alberto Pagni

  2. Neurosurgical Department Fondazione, Istituto Carlo Besta, Milano, Italy

    L. Fariselli

  3. Neurosurgical Clinic, University of Torino, Torino, Italy

    S. Zeme

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  1. Carlo Alberto Pagni
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  2. L. Fariselli
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  3. S. Zeme
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Editors and Affiliations

  1. Department of Neurosurgery, Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, R.O.C.

    Wen-Ta Chiu

  2. Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan, R.O.C.

    Yung-Hsiao Chiang

  3. Department of Neurosurgery, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan, R.O.C.

    Ming-Chien Kao  & Ching-Chang Hung  & 

  4. Center for Neuropsychiatry, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C.

    Shinn-Zong Lin

  5. Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan, R.O.C.

    Han-Jung Chen

  6. Department of Rehabilitation Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan, R.O.C.

    Simon F. T. Tang

  7. National Institute on Drug Abuse, National Institute of Health, Baltimore, USA

    Barry J. Hoffer

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Pagni, C.A., Fariselli, L., Zeme, S. (2008). Trigeminal neuralgia. Non-invasive techniques versus microvascular decompression. It is really available any further improvement?. In: Chiu, WT., et al. Reconstructive Neurosurgery. Acta Neurochirurgica Supplementum, vol 101. Springer, Vienna. https://doi.org/10.1007/978-3-211-78205-7_5

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  • DOI: https://doi.org/10.1007/978-3-211-78205-7_5

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