The choice of therapy in medically intractable trigeminal neuralgia

Trigeminal neuralgia stands out as one of the few severe neuropathic pain states for which successful treatment options are available. Up to one-half of patients become refractory to medical therapy over time. At this point, the question of which intervention is appropriate becomes an important issue. A personal series of 150 patients treated between 1988 and 1995 is reviewed. Patients under 65 years and in good general health underwent surgery for microvascular decompression of the trigeminal root; in the remaining 120 patients glycerol was injected percutaneously into the trigeminal cistern. The results in these two patient groups is presented and the rationale of choosing an operative versus a percutaneous procedure is discussed in light of the outcome in this series and in the literature.