A review of percutaneous treatments for trigeminal neuralgia

Jason S. Cheng, Daniel A. Lim, Edward F. Chang, Nicholas Barbaro

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

BACKGROUND: Common treatments for trigeminal neuralgia include percutaneous techniques, microvascular decompression, and Gamma Knife radiosurgery. Although microvascular decompression 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 trigeminal neuralgia: balloon compression (BC), glycerol rhizotomy (GR), and radiofrequency thermocoagulation (RF). METHODS: 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 3 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 somatotopic nerve mapping and 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 with BC. Advantages of percutaneous techniques include shorter procedure duration, minimal anesthesia risk, and in the case of GR and RF, immediate patient feedback. CONCLUSION: Percutaneous treatments for trigeminal neuralgia remain safe, simple, and effective for achieving good pain control while minimizing procedural risk.

Original languageEnglish (US)
Pages (from-to)25-33
Number of pages9
JournalNeurosurgery
Volume10
Issue number1
DOIs
StatePublished - 2014

Fingerprint

Rhizotomy
Trigeminal Neuralgia
Electrocoagulation
Glycerol
Pain
Microvascular Decompression Surgery
Therapeutics
Radiosurgery
Publications
Anesthesia
Morbidity
Wounds and Injuries

Keywords

  • Balloon compression
  • Glycerol rhizotomy
  • Percutaneous
  • Radiofrequency thermocoagulation
  • Trigeminal neuralgia

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Cheng, J. S., Lim, D. A., Chang, E. F., & Barbaro, N. (2014). A review of percutaneous treatments for trigeminal neuralgia. Neurosurgery, 10(1), 25-33. https://doi.org/10.1227/NEU.00000000000001687

A review of percutaneous treatments for trigeminal neuralgia. / Cheng, Jason S.; Lim, Daniel A.; Chang, Edward F.; Barbaro, Nicholas.

In: Neurosurgery, Vol. 10, No. 1, 2014, p. 25-33.

Research output: Contribution to journalArticle

Cheng, JS, Lim, DA, Chang, EF & Barbaro, N 2014, 'A review of percutaneous treatments for trigeminal neuralgia', Neurosurgery, vol. 10, no. 1, pp. 25-33. https://doi.org/10.1227/NEU.00000000000001687
Cheng, Jason S. ; Lim, Daniel A. ; Chang, Edward F. ; Barbaro, Nicholas. / A review of percutaneous treatments for trigeminal neuralgia. In: Neurosurgery. 2014 ; Vol. 10, No. 1. pp. 25-33.
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