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Updated: Mar 12, 2026
Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain
Published on: May 10, 2017
A Clinical Analysis of Secondary Surgery in Trigeminal Neuralgia Patients Who Failed Prior Treatment
Il Ho Kang1, Bong Jin Park1, Chang Kyu Park1
1Department of Neurosurgery, Kyung Hee University College of Medicine, Seoul, Korea.
Objective:
Although many treatment modalities have been introduced for trigeminal neuralgia (TN), the long-term clinical results remain unsatisfactory. It has been particularly challenging to determine an appropriate treatment strategy for patients who have responded poorly to initial therapies. We analyzed the surgical outcomes in TN patients who failed prior treatments.
Methods:
We performed a retrospective analysis of 37 patients with recurrent or persistent TN symptoms who underwent surgery at our hospital between January 2010 and December 2014. Patients with follow-up data of at least one year were included. The prior treatment modalities of the 37 patients included microvascular decompression (MVD), gamma knife radiosurgery (GKRS), and percutaneous procedures such as radiofrequency rhizotomy (RFR), balloon compression, and glycerol rhizotomy (GR). The mean follow-up period was 69.9 months (range : 16-173). The mean interval between the prior treatment and second surgery was 26 months (range : 7-123). We evaluated the surgical outcomes using the Barrow Neurological Institute (BNI) pain intensity scale.
Results:
Among the 37 recurrent or persistent TN patients, 22 underwent MVD with partial sensory rhizotomy (PSR), 8 received MVD alone, and 7 had PSR alone. Monitoring of the surgical treatment outcomes via the BNI pain intensity scale revealed 8 (21.6%) patients with a score of I, 13 (35.1%) scoring II, 13 (35.1%) scoring III, and 3 (8.2%) scoring IV at the end of the follow-up period. Overall, 91.8% of patients had good surgical outcomes. With regard to postoperative complications, 1 patient had transient cerebrospinal fluid rhinorrhea (2.7%), another had a subdural hematoma (2.7%), and facial sensory changes were noted in 8 (21.1%) patients after surgery.
Conclusion:
Surgical interventions, such as MVD and PSR, are safe and very effective treatment modalities in TN patients who failed initial or prior treatments. We presume that the combination of MVD with PSR enabled us to obtain good short- and long-term surgical outcomes. Therefore, aggressive surgical treatment should be considered in patients with recurrent TN despite failure of various treatment modalities.
Insights
For trigeminal neuralgia (TN) patients with treatment failure, repeat surgery combining microvascular decompression (MVD) and partial sensory rhizotomy (PSR) offers effective long-term pain relief. This aggressive surgical approach is safe and highly successful for recurrent TN.
Area of Science:
- Neurosurgery
- Neurology
- Pain Management
Background:
- Trigeminal neuralgia (TN) treatments often yield unsatisfactory long-term results.
- Identifying effective strategies for patients with poor initial treatment response is challenging.
Purpose of the Study:
- To analyze surgical outcomes in TN patients who previously failed other treatments.
- To evaluate the efficacy and safety of repeat surgical interventions for recurrent or persistent TN.
Main Methods:
- Retrospective analysis of 37 TN patients undergoing surgery between 2010-2014.
- Inclusion criteria: recurrent/persistent TN, minimum one-year follow-up.
- Prior treatments included MVD, GKRS, RFR, balloon compression, and glycerol rhizotomy.
Main Results:
- 91.8% of patients achieved good surgical outcomes (BNI pain scale I-III).
- Procedures included MVD with PSR (22), MVD alone (8), and PSR alone (7).
- Postoperative complications were low, including transient CSF rhinorrhea (2.7%) and subdural hematoma (2.7%). Facial sensory changes occurred in 21.1%.
Conclusions:
- Surgical interventions like MVD and PSR are safe and effective for TN patients with treatment failure.
- Combining MVD with PSR may lead to favorable short- and long-term outcomes.
- Aggressive surgical treatment should be considered for recurrent TN unresponsive to various therapies.
