Introduction
Trigeminal neuralgia (TN) is a debilitating condition characterized by unilateral stabbing facial pain along the divisions of cranial nerve V. The lifetime prevalence of TN is estimated to be 0.7 per 1,000 people and usually presents between the fourth and seventh decades(1, 2). First line management involves medical therapy, although 10-25% of patients fail to respond to standard medication regimens and some patients may become resistant to medical treatment over time(3, 4). For patients with medically refractory TN, there are a number of proven invasive treatments which they may pursue. Approximately 8,000 patients undergo surgical treatment for TN in the U.S. annually with a total cost of over $100 million(5). MVD is the most common surgical procedure performed for TN in the U.S., however, the use of Gamma Knife surgery has been increasing worldwide(6, 7). Unfortunately, …show more content…
Microvascular decompression (MVD) is a common approach to medically refractory TN, and is the only nondestructive procedure for TN in widespread use(8, 9). Approximately 80% of MVD patients experience immediate pain relief, with 75% and 64% maintaining relief after 1 year and 10 years, respectively(9). However, age, degree of pain, medical co-morbidies, previous procedures, or patient preferences may preclude the use of MVD(10). Destructive techniques such as stereotactic radiosurgery (SRS) are considered less invasive and aim to lesion the nerve in order to achieve pain control. SRS avoids the operative risk of MVD and patients are usually discharged the same day. However, the pain recurrence rate is greater than 35% at 5 years, and the results appear less durable than MVD(11-13). Other modalities of radiosurgery, such as linear accelerator-based radiosurgery, have been shown to be effective and safe in observational studies, but limited prospective data exists for the treatment of TN(14,
Trigeminal neuralgia (TN) is a debilitating condition characterized by unilateral stabbing facial pain along the divisions of cranial nerve V. The lifetime prevalence of TN is estimated to be 0.7 per 1,000 people and usually presents between the fourth and seventh decades(1, 2). First line management involves medical therapy, although 10-25% of patients fail to respond to standard medication regimens and some patients may become resistant to medical treatment over time(3, 4). For patients with medically refractory TN, there are a number of proven invasive treatments which they may pursue. Approximately 8,000 patients undergo surgical treatment for TN in the U.S. annually with a total cost of over $100 million(5). MVD is the most common surgical procedure performed for TN in the U.S., however, the use of Gamma Knife surgery has been increasing worldwide(6, 7). Unfortunately, …show more content…
Microvascular decompression (MVD) is a common approach to medically refractory TN, and is the only nondestructive procedure for TN in widespread use(8, 9). Approximately 80% of MVD patients experience immediate pain relief, with 75% and 64% maintaining relief after 1 year and 10 years, respectively(9). However, age, degree of pain, medical co-morbidies, previous procedures, or patient preferences may preclude the use of MVD(10). Destructive techniques such as stereotactic radiosurgery (SRS) are considered less invasive and aim to lesion the nerve in order to achieve pain control. SRS avoids the operative risk of MVD and patients are usually discharged the same day. However, the pain recurrence rate is greater than 35% at 5 years, and the results appear less durable than MVD(11-13). Other modalities of radiosurgery, such as linear accelerator-based radiosurgery, have been shown to be effective and safe in observational studies, but limited prospective data exists for the treatment of TN(14,