Long-term results of 405 refractory trigeminal neuralgia surgeries in 256 patients

Background and Objectives: The initial response of trigeminal neuralgia to medication is about 69%. However drug therapy is ineffective in 25% of patients and about 8% become drug-intolerant. These patients proceed to surgical interventions, which require constant appraisal to determine their efficacy and acceptability. The purpose of this study was to evaluate the long-term outcome of surgical interventions for trigeminal neuralgia to offer a guide to patients and surgeons when choosing the right procedure for the appropriate patient and to investigate the effects of patients' and surgeons' preferences on the outcome. Patients and Methods: The study design was consecutive case review. Participants were 256 consecutive patients with refractory trigeminal neuralgia, who underwent 405 surgical procedures to control trigeminal neuralgia. The main outcome measures were: the response rate, time to pain recurrence and surgical complications. 172 were fit for microvascular decompression (MVD), glycerol injection (GI) or radiofrequency thermocoagulation (RF) and were offered the choice between the three procedures; 95 went for MVD and 77 underwent either GI or RF. The choice between GI and RF was a surgical decision. Results: The 3-year success rate was 54.8% in patients who underwent GI and 70.7% in patients who underwent percutaneous RF. In contrast 85.6% of patients who underwent MVD remained pain-free at 3 years. The complication rate following these surgical interventions was relatively low with no deaths. Conclusions: Surgical intervention for the treatment of refractory trigeminal neuralgia is effective and safe and should be considered in patients after failed medical therapy. Whilst MVD offered the best long-term outcome in this series, percutaneous GI or RF offered a safe and reliable alternative for those who chose to undergo these procedures. © Georg Thieme Verlag KG Stuttgart