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A Review of Percutaneous Treatments for Trigeminal Neuralgia

Cheng, Jason S. MD*; Lim, Daniel A. MD, PhD*,‡,§; Chang, Edward F. MD*; Barbaro, Nicholas M. MD

doi: 10.1227/NEU.00000000000001687
Operative Technique: Editor's Choice

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.

ABBREVIATIONS: BC, balloon compression

GR, glycerol rhizotomy

MS, multiple sclerosis

MVD, microvascular decompression

RF, radiofrequency thermocoagulation

TN, trigeminal neuralgia

*Department of Neurological Surgery,

Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, and

§Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, California;

Department of Neurological Surgery, Indiana University School of Medicine, and Goodman Campbell Brain and Spine, Indianapolis, Indiana

Correspondence: Jason S. Cheng, MD, University of California, San Francisco, Department of Neurological Surgery, 505 Parnassus Ave, M779, San Francisco, CA 94143. E-mail:

Received February 25, 2013

Accepted September 06, 2013

Copyright © by the Congress of Neurological Surgeons