Cryoneurotomy in the management of intractable trigeminal neuralgia

In this paper we describe the effects of peripheral cryoneurotomy on a consecutive series of patients with intractable trigeminal neuralgia (TN) who had been treated by a single surgeon over a ten-year period. The results of 55 patients who underwent a total of 102 cryoneurotomies were documented. The age at first cryofreeze was 64 (30-92) years with 24 males and 31 females. Thirty-five had primary TN and 20 secondary TN. The first cryofreeze resulted in 28.2 (5-144) pain free months. Twenty-nine had a second freeze which lasted 34 (2-100) pain-free months and 13 had a third cryofreeze which lasted 26 (1-108) pain free months. Two patients had further freezes. Thirty-four of the primary TN patients had prolonged freedom from pain with one dying perioperatively. The 20 patients with secondary TN had shorter period of pain relief (p<0.05) and one committed suicide. The procedure of peripheral cryoneurotomy is recommended for older, unwell patients with primary TN that is refractory to medical or neurosurgical treatments. It is less effective for dysaesthesia secondary to traumatic nerve injuries.