Microsurgical operations in the treatment of trigeminal neuralgia

Three neurosurgical procedures to aid patients suffering from intractable, medically resistant tic douloureux are described: (1) the Sweet-Nugent transcutaneous radiofrequency neurolysis of the gasserian ganglion, (2) the Gardner-Rand suboccipital arterial decompression or rhizotomy of the trigeminal root, and (3) the Rand subtemporal transtentorial retrogasserian arterial decompression or rhizotomy of the trigeminal root. Each procedure has its indications, and the neurosurgeon should adjust his approach to the circumstances of the individual case. The clinical results with follow-up evaluations over a 10-year period for each of these operations are approximately the same. Ninety percent or more of patients suffering from intractable tic douloureux were completely relieved. Anesthesia dolorosa was not observed in more than 300 patients treated by these three operations, even though on rare occasions total anesthesia occurred following radiofrequency neurolysis. There was no operative mortality in the radiofrequency neurolysis series, and the operative morbidity and mortality rates were less than 4% for both the suboccipital and subtemporal craniotomy procedures.