Medically refractory trigeminal neuralgia treatment

see Trends in surgical treatment for trigeminal neuralgia

see Cost effectiveness in surgical treatment for trigeminal neuralgia.

Microvascular decompression

see Microvascular decompression for trigeminal neuralgia

Percutaneous procedures

see Percutaneous trigeminal rhizotomy.

Gamma Knife radiosurgery

see Gamma Knife radiosurgery for trigeminal neuralgia.


Microvascular decompression should be performed more prudently in elderly patients (>80 years old), and the indications for PR should be relatively relaxed. MVD + PR could improve the curative effect in patients with trigeminal neuralgia >80 years. Gamma knife treatment of trigeminal neuralgia had high safety, less complications, and positive curative effect, especially suitable for patients >80 years 1).


MVD results in superior rates of short- and long-term pain relief, facial numbness and dysesthesia control, and less recurrence amongst those in whom pain freedom was achieved, at the cost of greater postoperative complications when compared to SRS. Although no significant difference was found in terms of the need for retreatment surgery, there was a trend towards less procedures favoring MVD. First treatment by either technique represents the overall trends reported 2).

References

1) Yu R, Wang C, Qu C, Jiang J, Meng Q, Wang J, Wei S. Study on the Therapeutic Effects of Trigeminal Neuralgia With Microvascular Decompression and Stereotactic Gamma Knife Surgery in the Elderly. J Craniofac Surg. 2018 Nov 30. doi: 10.1097/SCS.0000000000004999. [Epub ahead of print] PubMed PMID: 30507874. 2) Lu VM, Duvall JB, Phan K, Jonker BP. First treatment and retreatment of medically refractive trigeminal neuralgia by stereotactic radiosurgery versus microvascular decompression: a systematic review and Meta-analysis. Br J Neurosurg. 2018 May 10:1-10. doi: 10.1080/02688697.2018.1472213. [Epub ahead of print] PubMed PMID: 29745268.

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