What is the role of percutaneous procedures in the treatment of trigeminal neuralgia (TN)?

Updated: Jul 11, 2019
  • Author: Manish K Singh, MD; Chief Editor: Robert A Egan, MD  more...
  • Print

Percutaneous procedures usually can be performed on an outpatient basis under local or brief general anesthesia at acceptable or minimal risk of morbidity. For these reasons, they commonly are performed in debilitated persons or those older than 65 years.

Zakrzweska and Thomas described 3 types of procedures: percutaneous radiofrequency trigeminal gangliolysis (PRTG), percutaneous retrogasserian glycerol rhizotomy (PRGR), and percutaneous balloon microcompression (PBM). [56] Patients are left with minor, local, residual facial numbness after PRTG; may occasionally lose sensation after PRGR; and rarely do so after PBM. In each procedure, the surgeon introduces a trocar or needle lateral to the corner of the mouth and, under fluoroscopic guidance, into the ipsilateral foramen ovale. The ganglion is lysed at this location.

Percutaneous procedures and surgery yield the best results when applied early in the course of trigeminal neuralgia. Even if medical treatment comes first, trials, when they are adequately completed and the agent is deemed ineffective, should be followed promptly by the next trial in order not to delay and decrease the efficacy of more invasive treatments.

Percutaneous radiofrequency rhizotomy and percutaneous microcompression with balloon inflation are relatively inexpensive and accessible techniques, and they are less invasive than surgery, with a lower (long-term) efficacy-to-recurrence ratio. A comparison of the two techniques found them both effective with a median duration of pain relief of 21 months after PRGR and 20 months after PBC. [57] The result is highly dependent on the surgeon's skill. General anesthesia is required.

Also see Trigeminal Neuralgia Surgery.

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!