Surgeries for Trigeminal Neuralgia

Trigeminal Neuralgia attacks may not last long, but they tend to keep coming back – and they’re incredibly painful!  The pain in the face usually doesn’t last longer than a couple of minutes, but there can be several attacks in succession, totally incapacitating the patient.  Check out this issue of HeadWay for more on the symptoms of Trigeminal Neuralgia.

For patients who don’t respond to medications, surgery is an option.  A recent study from the Netherlands (Erasmus University Medical Center, Rotterdam) showed about 1% of patients trying surgery every year, often with good results.

Three types of surgery were studied:  percutaneous radiofrequency thermocoagulation (PRT), partial sensory rhizotomy (PSR), and microvascular decompression (MVD).

So what worked best for the 672 patients in the study?

Well, the most effective overall was microvascular decompression (MVD).  Risk of having to repeat the procedure was low.  But it’s not that simple.  MVD is also the only surgery that requires and opening of the skull.  PSR and MVD are both performed by neurosurgeons, though the risk of complications was lower with MVD than with PSR.

Percutaneous radiofrequency thermocoagulation (PRT), however, was the most popular – probably because it is the least invasive.  More patients with PRT had to have repeat procedures – but many patients feel it’s worth the risk because it’s a less invasive procedure, usually performed by an anesthesiologist.

In the end, patients may opt to try PRT first.  If PRT continues to fail, MVD may be the next thing to try, because of its higher rate of success.

Remember that different surgeries may be better for you depending on your medical history and on what type of trigeminal neuralgia you have.

Of course, this is after medications have been tried.  Sadly, a previous study of Dutch patients suggested that about 1/3 are not getting recommended treatments, but treatments that seem to be more likely to fail (such as the use of paracetamol/acetaminophen or NSAIDs, which are generally not recommended for facial pain.

You can find the abstract for this 2011 published study here: A nationwide study of three invasive treatments for trigeminal neuralgia.