Partial sensory rhizotomy in therapy-refractory and recurrent trigeminal neuralgia - a single center experience

Partial sensory rhizotomy (PSR) is an "ultima ratio" procedure for patients with therapy-refractory trigeminal neuralgia (TN). The treatment can be offered to patients without a neurovascular conflict or to patients who did not benefit either from previous microvascular decompression (MVD) or from other interventional procedures. This study presents our experience with PSR.

Our prospectively maintained database was searched for patients who underwent PSR. We conducted a retrospective analysis of all patients with PSR. Clinical data, MR imaging, surgical videos, and OR notes were evaluated and a telephone interview for the last follow-up was done.

Our search revealed 48 patients treated with PSR between 2004 and 2023. The average age was 59.4 years. Mean history of symptoms was 7.81 years (1-30 years). All types of previous treatments were included. Fifteen patients suffered from multiple sclerosis. A total pain relief was observed in 42 patients immediately after PSR, two patients had a partial pain improvement, and four patients observed no difference. An expected, variable hypesthesia occurred in 37 patients. The most common procedure was a PSR of the lower third. The mean follow-up was 38 months (3-183 months), five patients were lost to follow-up. 28 patients still had complete, 13 partial pain relief. Ten patients still needed medications but were satisfied with a lower dose and generally improved or were even pain-free. Thirteen patients who had benefited from the PSR initially, reported recurrent TN. Five of them received a second PSR after 5-55 months with complete pain relief.

Early after surgery patient satisfaction regarding pain relief/improvement was 92.7% (44 of 48 patients). During follow-up we observed complete or partial pain relief in 31 of 43 patients (72.1%) without pain medication, another 23.3% were satisfied with on-going medication. However, the degree of sensitive deficits is not predictable. Because of our convincing results, patients should be informed about PSR as a therapeutic option for therapy-refractory or recurrent TN. It may be considered either instead of, or as an alternative to, percutaneous procedures or radiosurgery.